Laryngoscope, 1990 May, 100(5), 548 - 51 Oral ofloxacin as treatment of malignant external otitis: a study of 17 cases; Levy R et al.; Seventeen patients with malignant external otitis were treated with oral ofloxacin . Their mean age was 69 years . Seven of the patients were diabetic . Pseudomonas aeruginosa, sensitive to ofloxacin (Kirby-Bauer method, inhibition zone greater than or equal to 22 mm), was isolated from the external auditory canal in all patients . Ofloxacin (200 mg b.i.d.) was given to the patients for 12 to 39 days . Two patients also received additional parenteral antibiotic therapy . Subjective and objective improvement occurred in all patients during treatment, and complete resolution was documented in all patients, with one exception . Only one patient suffered recurrence 2 weeks after discontinuation of antimicrobial therapy . The results of our study suggest that oral ofloxacin is an effective treatment for malignant external otitis caused by Pseudomonas aeruginosa. J Pediatr, 1990 May, 116(5), 714 - 9 Pulmonary function and clinical course in patients with cystic fibrosis after pulmonary colonization with Pseudomonas aeruginosa; Kerem E et al.; To evaluate the relationship between Pseudomonas aeruginosa colonization and the development of lung disease, we studied 895 patients who attended our cystic fibrosis clinic between 1975 and 1988 . The prevalence of P . aeruginosa colonization was 82% . Patients who acquired P . aeruginosa in the first year of life had a similar 10-year survival rate (85%) to that in patients who were colonized between the ages of 1 and 7 years (87%), and to that in patients colonized after the age of 7 years (78%) . One year before colonization, mean age, forced expiratory volume in 1 second (FEV1), forced vital capacity, and forced expiratory flow in the mid-expiratory phase were similar to those in a group of patients who remained free of P . aeruginosa . No significant change in pulmonary function variables could be demonstrated 1 year and 2 years after the colonization . The rate and duration of hospitalization did not increase in the years after P . aeruginosa colonization compared with the years before colonization . By the age of 7 years, the mean percentage of predicted FEV1 was lower by 10% in patients who were already colonized by P . aeruginosa compared with those who were not colonized (p less than 0.01) . A similar reduction in FEV1 was observed at all ages from 7 to 35 years, but no precipitate rate of decline in FEV1 could be associated with P . aeruginosa colonization . We conclude that although P . aeruginosa colonization is associated with 10% lower lung function, it does not cause an immediate and rapid reduction, as has been previously reported . The clinical course and the pulmonary deterioration in cystic fibrosis after P . aeruginosa colonization is a gradual and variable process. Infect Immun, 1990 May, 58(5), 1301 - 7 Characterization of Pseudomonas aeruginosa adherence to mouse corneas in organ culture; Singh A et al.; The present study was designed to obtain further information on the nature of the corneal macromolecule(s) to which Pseudomonas aeruginosa adheres and how adherence might be prevented . Scarified adult mouse corneas in organ culture were treated with trypsin or lipase to determine whether the receptor molecule(s) was protein or lipid in nature . Trypsin (20 micrograms/ml) treatment of the cornea for 5 min had no significant effect on bacterial adherence, and longer periods of enzyme exposure resulted in extensive surface cell lysis . In contrast, lipase treatment (50,000 U/ml) for 1 h caused little visible cell lysis and significantly reduced bacterial adherence . To test further the lipid nature of the receptor, a highly purified monosialoganglioside (GM1) preparation (500 micrograms/ml) was used to preincubate (1 h) the cornea prior to bacterial application, and this also inhibited bacterial adherence . Similar corneal treatment with gangliotetraosylceramide (asialo GM1) (500 micrograms/ml) had little effect on ocular bacterial binding . Premixing of the bacterial inoculum with GM1 prior to corneal application had no significant effect on inhibiting bacterial binding, but similarly premixing the bacterial inoculum with asialo GM1 transiently decreased adherence . Lastly, premixing of the bacterial inoculum or preincubation of corneas with fibronectin (500 micrograms/ml for 1 h) both decreased bacterial adherence . These findings provide evidence that the receptor-adhesin interactions of P . aeruginosa at the ocular surface in organ culture are complex, involve a glycolipid moiety, and may be blocked by a ganglioside containing at least one sialosyl residue or by fibronectin, which may bind to membrane-associated gangliosides. Infect Immun, 1990 May, 58(5), 1133 - 40 Secretion of toxin A from Pseudomonas aeruginosa PAO1, PAK, and PA103 by Escherichia coli; Hamood AN et al.; The exotoxin A gene (toxA) from Pseudomonas aeruginosa PAO1 was expressed from the lac promoter in Escherichia coli, and the localization of the toxin A protein was determined . Throughout the growth cycle, the ADP-ribosyltransferase activity of toxin A was gradually reduced in the periplasm of E . coli, with no apparent degradation of the toxin A protein . This suggests the presence of an E . coli periplasmic factor that interferes with the ADP-ribosyltransferase activity in toxin A . Such an inactivating factor was found in the periplasmic extract from control E . coli cells . The processing of toxin A in E . coli was examined by pulse-chase immunoprecipitation experiments . Mature toxin was detected in both the periplasm and cytoplasm, whereas the membranes contained both mature and precursor forms . Toxin A precursor appears to be processed in both the cytoplasm and the periplasm of E . coli . Toxin A proteins from P . aeruginosa PAO1, PA103, and PAK were compared for their secretion in E . coli . Despite the differences in the amino acid sequences of their leader peptides, toxin A proteins from strains PAO1, PA103, and PAK were processed and secreted to the periplasm of E . coli. Kansenshogaku Zasshi, 1990 May, 64(5), 575 - 83 {Adherence of Pseudomonas aeruginosa to mouse tracheal epithelium--the effect of antimicrobial agents}; Yamasaki T; The adherence of bacteria to mucosal surfaces is an important initial event in the pathogenesis of most bacterial infectious diseases . In order to clarify the mechanism of respiratory tract infections caused by Pseudomonas aeruginosa, we paid attention to pili (fimbriae), which is one of the adherence factors for the nonmucoid strains of P . aeruginosa . The adherence of P . aeruginosa was studied using two mutants: piliated and nonpiliated strains and 0.1 N hydrochloric acid-injured mouse tracheal epithelium as a respiratory tract model . The adherence ability was evaluated by means of direct count of adhered bacteria using a scanning electron microscope . The effect of antimicrobial agents was studied on the adherence and the production of pili . Both mutants of P . aeruginosa adhered more significantly to the acid-injured tracheal epithelium than the normal one (p less than 0.01) . The number of the piliated strain adhering to the acid-injured tracheal epithelium was significantly greater than that of the nonpiliated strain (p less than 0.01) . The piliated bacteria treated with heat, formalin, antiserum against pili, N-acetylneuraminic acid and N-acetylglucosamine showed a significant decrease in number of adherence . The piliated bacteria were grown in a media containing 1/4 MICs of seven antimicrobial agents for four hours at 37 degrees C, after that a significant reduction in the number of pili per bacterium was recognized with erythromycin, minocycline and clindamycin (p less than 0.01) . The piliated bacteria treated with erythromycin showed a significant decrease on adherence to the acid-injured tracheal epithelium in parallel with piliation.(ABSTRACT TRUNCATED AT 250 WORDS) J Bacteriol, 1990 May, 172(5), 2601 - 7 Morphogenetic expression of Moraxella bovis fimbriae (pili) in Pseudomonas aeruginosa; Beard MK et al.; Type 4 fimbriae (pili) are found in a wide variety of gram-negative bacteria and are composed of small structural subunits which share significant sequence homology among different species, especially at their amino-terminal ends . Previous studies demonstrating morphogenetic expression of Bacteroides nodosus fimbriae from cloned subunit genes in Pseudomonas aeruginosa suggested that there is a common mechanism for type 4 fimbriae assembly and that the structural subunits are interchangeable (J . S . Mattick et al., J . Bacteriol . 169:33-41, 1987) . Here we have examined the expression of Moraxella bovis fimbrial subunits in P . aeruginosa . M . bovis subunits were assembled into extracellular fimbriae in this host, in some cases as a homopolymer but in others as a mosaic with the indigenous subunit, indicating structural equivalence . This result contrasts with other studies in which recombinant P . aeruginosa expressing different subunits produced fimbriae composed almost exclusively of one subunit or the other (T . C . Elleman and J . E . Peterson, Mol . Microbiol . 1:377-380, 1987) . Both observations can be explained by reversibility of subunit-subunit interactions at the site of assembly, with the forward equilibrium favoring chain extension between compatible subunits. Res Microbiol, 1990 May, 141(4), 483 - 97 Antibacterial activity of phenethyl alcohol and resulting membrane alterations; Corre J et al.; The antibacterial activity of phenethyl alcohol (PEA) towards Gram-negative (Escherichia coli and Pseudomonas aeruginosa) and Gram-positive bacteria (Staphylococcus aureus and Enterococcus faecium) was investigated . This activity was expressed as IC (inhibitory concentration) and BC (bactericidal concentration) . PEA was bactericidal in the concentration range of 90 to 180 mM, these concentrations being 4- to 5-fold higher than the corresponding IC . The mechanism of action of PEA upon the cell membrane of bacteria was also studied . Morphological examination with a transmission electron microscope showed that Gram-negative cell envelopes were permeabilized; for Gram-positive bacteria, the plasmic membrane in S . aureus was solubilized, whereas lesser changes were observed in E . faecium . At lethal concentrations, PEA also induced a rapid and total leakage of K+ ions from the four strains studied . Despite the correlation between alterations in the structural integrity of the cytoplasmic membrane in Gram-negative cells and the loss of cell viability, it cannot be inferred that membrane damage is the only cause of the lethal effect. Cancer Lett, 1990 Apr 20, 50(2), 121 - 7 The cytotoxicity of Pseudomonas exotoxin A, inactivated by modification of the cell-binding domain I, is restored when conjugated to an erythroid cell-specific targeting agent; Bourdenet S et al.; To be capable of selective killing of tumor cells, the non-selective Pseudomonas aeruginosa exotoxin A must have its cell-binding domain inactivated or removed and then be chemically linked to, or genetically fused with, a specific targeting agent . In the present study, epsilon-NH2 groups of lysine residues of the cell-binding domain of exotoxin A were extensively propionylated with N-succinimidyl-3-propionate (NSP) . The NSP-treated exotoxin retained its cytocidal ADP-ribosyltransferase activity, but it could no longer bind to, and inhibit the proliferation of, Friend murine erythroleukemia cells . Cytotoxicity (i.e., the ability to inhibit proliferation) for the Friend erythroid cells was restored completely to the NSP-inactivated exotoxin by conjugating it to ADIF, an autocrine factor secreted by chicken erythroleukemia cells which selectively inhibits the differentiation of erythroid cells such as Friend erythroleukemia cells without inhibiting their proliferation. Biochim Biophys Acta, 1990 Apr 19, 1038(2), 231 - 9 Activation of human Hageman factor by Pseudomonas aeruginosa elastase in the presence or absence of negatively charged substance in vitro; Yamamoto T et al.; Human Hageman factor, a plasma proteinase zymogen, was activated in vitro under a near physiological condition (pH 7.8, ionic strength I = 0.14, 37 degrees C) by Pseudomonas aeruginosa elastase, which is a zinc-dependent tissue destructive neutral proteinase . This activation was completely inhibited by a specific inhibitor of the elastase, HONHCOCH(CH2C6H5)CO-Ala-Gly-NH2, at a concentration as low as 10 microM . In this activation Hagemen factor was cleaved, in a limited fashion, liberating two fragments with apparent molecular masses of 40 and 30 kDa, respectively . The appearance of the latter seemed to correspond chronologically to the generation of activated Hageman factor . Kinetic parameters of the enzymatic activation were kcat = 5.8 x 10(-3) s-1, Km = 4.3 x 10(-7) M and kcat/Km = 1.4 x 10(4) M-1 x s-1 . This Km value is close to the plasma concentration of Hageman factor . Another zinc-dependent proteinase, P . aeruginosa alkaline proteinase, showed a negligible Hageman factor activation . In the presence of a negatively charged soluble substance, dextran sulfate (0.3-3 micrograms/ml), the activation rate by the elastase increased several fold, with the kinetic parameters of kcat = 13.9 x 10(-3) s-1, Km = 1.6 x 10(-7) M and kcat/Km = 8.5 x 10(4) M-1 x s-1 . These results suggested a participation of the Hageman factor-dependent system in the inflammatory response to pseudomonal infections, due to the initiation of the system by the bacterial elastase. Mol Cell Biochem, 1990 Apr 18, 94(1), 89 - 95 Identification of the Pseudomonas aeruginosa acid phosphatase as a phosphorylcholine phosphatase activity; Garrido MN et al.; Choline, betaine and N,N-dimethylglycine as the sole carbon and nitrogen source induced a periplasmic acid phosphatase activity in Pseudomonas aeruginosa . This enzyme produced the highest rates of hydrolysis in phosphorylcholine and phosphorylethanolamine among the various phosphoric esters tested . At saturating concentrations of Mg2+, the Km values were 0.2 and 0.7 mM for phosphorylcholine and phosphorylethanolamine respectively . At high concentrations both compounds were inhibitors of the enzyme activity . The Ksi values for phosphorylcholine and phosphorylethanolamine were 1.0 and 3.0 mM respectively . The higher catalytic efficiency was that of phosphorylcholine . Considering these results it is possible to suggest that the Pseudomonas aeruginosa acid phosphatase is a phosphorylcholine phosphatase . The existence of this activity which is induced jointly with phospholipase C by different choline metabolites, in a high phosphate medium, suggests that the attack of Pseudomonas aeruginosa on the cell host may also be produced under conditions of high phosphate concentrations, when the alkaline phosphatase is absent. Presse Med, 1990 Apr 4, 19(13), 607 - 12 {Prospective, randomized, controlled study of imipenem-cilastatin versus cefotaxime-amikacin in the treatment of lower respiratory tract infection and septicemia at intensive care units}; Mouton Y et al.; In a multicentre, prospective, controlled trial 211 patients with suspected septicaemia or pneumonia were allocated at random to either imipenem-cilastatin 500 mg 8-hourly or cefotaxime 1 g 6-hourly combined with amikacin 5 mg/kg 8-hourly . The treatments were administered for at least 5 days . Seventy patients on imipenem and 70 patients on cefotaxime-amikacin were assessable for comparison . There were no statistically significant differences between the two groups in underlying pathology and in the clinical results obtained: septicaemia 20/26 patients of the imipenem group and 20/25 patients of the cefotaxime-amikacin group were cured; pneumonia 38/44 patients of the imipenem group and 34/45 patients of the cefotaxime-amikacin group were cured . There were also no differences in the initial organisms and in the bacteriological cure rate, except for Pseudomonas aeruginosa . At the moment, imipenem administered alone is as effective as the cefotaxime-amikacin combination in the treatment of septicaemia or pneumonia in intensive care patients, with the exception of P . aeruginosa pneumonia in patients under assisted ventilation. Arch Pharm (Weinheim), 1990 Apr, 323(4), 201 - 5 Antimicrobial activity of basic cholane derivatives . Part IX; Bellini AM et al.; Twenty new compounds derived from deoxycholic acid have been synthesized . They contain two basic functions: at C-24 (benzylamino, morpholino, diethanolamino, N,N-diethylethylenediamino, N-methylpiperazino) and at beta-C-3 (amino, methylamino, ethylamino, benzylamino) . The compounds showed interesting antimicrobial activity, as expressed in terms of the low M.I.C . values (0.9-31-micrograms/ml) against five Gram(+) and four Gram(-) strains, two fungi and one yeast . The compounds inhibit the production of a fluorescent pigment in Pseudomonas aeruginosa: this result suggests that the ability to cross the bacterium cell membrane is the first step of activity . A discussion in terms of structure-activity relationship is reported. Crit Care Med, 1990 Apr, 18(4), 378 - 84 Early nosocomial infections in pediatric cardiovascular surgery patients; Pollock EM et al.; All patients undergoing cardiovascular surgery between July 1, 1987 and February 29, 1988 were followed from admission to the pediatric ICU (PICU) daily by an intensivist/anesthetist . Patients were characterized by surgical procedure and PRISM score on ICU admission . Of 310 patients, 40 patients (nosocomially infected patient ratio 12.9) developed 78 infections (nosocomial infection ratio 25.2), of which 28% (n = 22) were wounds, within 2 months of surgery . Early wound infection followed 8% of closed, nonpump cases and 6.7% of open, pump cases . Wound infection was more likely if the sternum was open on the ward (elective or emergency) (27.6% open vs . 5.0% closed, p less than .001) or if the PRISM score was greater than or equal to 10 on PICU admission (10.7% greater than or equal to 10 vs . 2.3% less than 10, p less than .01) . The causative agents in wound infections in closed cases were Staphylococcus aureus (70%) and coagulase negative staphylococci (CONS) (30%) while in open, pump cases the agents were CONS (33%), Pseudomonas aeruginosa (27%), Candida spp . (27%), and S . aureus (20%) . Nonwound infections accounted for 72% of infections (n = 56) . The number of bacteremias and other central and arterial line-related infections approximated wound infection in incidence at 6.8/100 patients . Wound infections are more likely if the sternum has been left open on the ward, if the patient has a high PRISM score on PICU admission, and after specific surgical procedures. Cancer Res, 1990 Apr 1, 50(7), 2099 - 104 Prevention of fatal infections by recombinant human interleukin 1 alpha in normal and anticancer drug-treated mice; Morikage T et al.; The preventive capability of interleukin 1 alpha (IL-1) against bacterial infections was estimated in normal and anticancer drug-treated BALB/c mice in comparison with OK432, granulocyte colony-stimulating factor, interferons alpha and gamma, and interleukin 2 . Pretreatment with IL-1 (days -4 and -2) resulted in a significantly higher survival rate in normal mice inoculated i.p . with Klebsiella pneumoniae, Pseudomonas aeruginosa or Listeria monocytogenes (day 0) . The i.p . and s.c . administrations of IL-1 were equally effective for the induction of antibacterial resistance . Pretreatment with OK432 showed an equal degree of resistance to i.p . infection but was effective only by i.p . administration . Enhanced antibacterial resistance by IL-1 and OK432 was also observed in cyclophosphamide- and aminomethylpyrimidinylmethylchloroethylnitrosourea hydrochloride-pretreated (day -5) normal hosts and in cyclophosphamide-treated tumor-bearing hosts . In the case of granulocyte colony-stimulating factor (i.p . or s.c.) (days -4 to -1), a statistical difference in survival rate between granulocyte colony-stimulating factor and its vehicle-treated groups was observed in cyclophosphamide-pretreated hosts, but not in normal hosts or aminomethylpyrimidinylmethylchloroethylnitrosourea hydrochloride-pretreated hosts . Viable bacteria in the peritoneal cavity and blood at 12 h after i.p . infection of K . pneumoniae correlated well with the survival rate . In IL-1-pretreated hosts, the earlier and increased accumulation of neutrophils into peritoneal cavity after the infection was observed and the number of inflammatory cells in peritoneal cavity correlated well with the survival rate . The enhanced resistance to bacterial infection by IL-1 was suggested to be in part due to the enhanced cellular defense mechanisms . The prophylactic administration of IL-1 would be beneficial for the management of serious infections in cancer patients. Z Hautkr, 1990 Apr, 65(4), 351 - 4, 357 {Skin changes in drug-dependent patients}; Rasokat H; In parenteral drug abuse, cutaneous manifestations are very common . A variety of skin lesions are indicators of a possible drug addiction: obliteration of peripheral veins and hyperpigmentation of the overlying skin, punched-out scars due to subcutaneous injection, persistent edema following thrombophlebitis, and excoriations due to heroin pruritus . Infectious and non-infectious complications may be accompanied by typical skin alterations, such as ecthyma in sepsis caused by Pseudomonas aeruginosa, multiple ulcers due to embolic infarct, or hypersensitivity reactions mediated by an immunological process . A variety of serious complications may develop at the injection sites: abscesses, gangrene, necrosis, or necrotizing fasciitis . These examples show that the dermatologist is in many ways involved in the care for addicted patients . In addition, these patients frequently suffer from sexually transmitted diseases or blood-borne infections; HIV-infection is rapidly spreading in this group . We now face new problems of differential diagnosis, especially since constitutional symptoms of HIV-infection may mimic symptoms of drug abuse and vice versa . Moreover, immunological alterations similar to those in HIV patients may even occur in drug addicts who are not infected with the virus. J Trauma, 1990 Apr, 30(4), 445 - 52 The effect of dietary fatty acids on response to Pseudomonas infection in burned mice; Peck MD et al.; Since fatty acids influence prostaglandin synthesis, and since both fatty acids and prostaglandins modulate immune function, we investigated the hypothesis that manipulation of dietary fats would affect survival after infection in a murine burn model . Mice were fed for 2 to 3 weeks with diets containing different types and amounts of fat . They were then subjected to a 20% flame burn and infected with Pseudomonas aeruginosa . Survival in the group fed 40% of total calories as fish oil had significantly higher mortality than those fed safflower oil . This difference was not noted at lower fat levels . Similar groups of animals were sacrificed the day after injection . Splenic macrophage production of PGE2 was significantly lower in the fish-oil group, but production of LTB4 and TXB2 were not affected . In vitro tests of T- and B-cell function were not different amongst groups . We conclude that manipulation of dietary fats can alter outcome in this murine model of infection after thermal injury. J Bacteriol, 1990 Apr, 172(4), 2020 - 8 Possible insertion sequences in a mosaic genome organization upstream of the exotoxin A gene in Pseudomonas aeruginosa; Pritchard AE et al.; Nucleotide sequence and Southern hybridization data revealed a mosaic genome organization in a region that extends several thousand base pairs upstream of the exotoxin A (toxA) gene in Pseudomonas aeruginosa . An interstrain comparison of DNA in this region showed a pattern of alternating segments of homologous and nonhomologous sequences . Two nonhomologous elements, approximately 1 kilobase pair upstream of the gene in strains PA103 and Ps388, were characterized in more detail . The sequence elements, denoted IS-PA-1 and IS-PA-2 for the different strains, are about 1,000 and 785 base pairs long, respectively, and have 5-base-pair direct repeats at their boundaries, consistent with their being DNA insertion sequences . The distribution of these elements in 34 different strains was determined . IS-PA-1 was found in a single copy upstream of toxA in half of the strains and was found in two copies in four of the strains . Some strains contained neither element, and one strain carried both . The genome of another strain, WR5, which lacks toxA, was shown to contain a 350-base-pair region that was highly homologous to DNA sequences located just upstream of toxA in other strains . The WR5 genome lacked several kilobase pairs of DNA that was found both upstream and downstream of this homologous region in the other strains. Appl Environ Microbiol, 1990 Apr, 56(4), 1046 - 52 Marking the rhizopseudomonas strain 7NSK2 with a Mu d(lac) element for ecological studies; Hofte M et al.; The mini Mu element Mu dII1681, which contains the lac operon genes and a kanamycin resistance gene, was inserted in the chromosome of plant growth-beneficial Pseudomonas aeruginosa 7NSK2 to construct a marked strain (MPB1) . In MPB1, beta-galactosidase is permanently expressed under the culture conditions used . The MPB1 strain could be recovered with an efficiency of about 100% from a sandy loam soil on 5-bromo-4-chloro-3-indolyl-beta-D-galactopyranoside medium containing sebacic acid and kanamycin . The limit of detection is about 10 CFU/g of soil . A detailed comparison was made between the wild-type strain 7NSK2 and the Mu dII1681-containing MPB1 strain . The results showed that no genes essential for growth, siderophore production, survival in sterile and nonsterile conditions, plant growth stimulation, or root colonization had been damaged in the MPB1 strain, which means that MPB1 can reliably be used for ecological studies in soil . MPB1 survived well at 4 or 28 degrees C but died off relatively rapidly in air-dried soil or at subzero temperatures . In these conditions, however, the MPB1 strain did not completely disappear from the soil but survived at a very low level of about 100 CFU/g of soil for more than 3 months . This observation stresses the need for very sensitive counting methods for ecological studies and for the evaluation of released microorganisms . Maize was inoculated with MPB1 via seed inoculation or soil inoculation . Upon seed inoculation, only the upper root parts were effectively colonized, while soil inoculation resulted in a complete colonization of the root system. Mikrobiyol Bul, 1990 Apr, 24(2), 120 - 5 {The in vitro activity of ciprofloxacin against clinically-isolated strains of Pseudomonas aeruginosa and comparison with some other antibiotics}; Sener B et al.; In this study the susceptibility to ciprofloxacin of 100 Pseudomonas aeruginosa strains isolated from various clinical specimens was investigated by disk diffusion test and macrodilution method, and was compared with other various antibiotics . Both of the methods showed that 98 of the strains were susceptible to ciprofloxacin . MIC50 of ciprofloxacin was found to be 0.12, and MIC90 0.50 mcgr/ml for these strains . Pseudomonas aeruginosa strains were found to be highly susceptible to ciprofloxacin in in-vitro conditions. Zhonghua Nei Ke Za Zhi, 1990 Apr, 29(4), 217 - 20, 253 {Experimental study and case control study of nosocomial infection caused by Pseudomonas aeruginosa}; Zheng YN et al.; 144 strains of Pseudomonas aeruginosa (Ps.a) were serotyped and phage-typed . Antibiotic sensitivity test and case control study of nosocomial infection caused by Ps.a were also done for these strains . Three epidemic strains were collected from the ICU in a neurosurgical ward . The etiology of a cross infection among tracheotomy patients was two epidemic strains isolated from the hands of a nurse and an attendant . Hospitalization days longer than 56 days, tracheotomy and indwelling catheterization were 3 risk factors for Ps.a infection shown by logistic analysis . The sensitivity rate of Ps.a to antibiotics was highest with ceftazidine, followed by amikacin and piperacillin . The most common resistant antibiogram was Gentamycin and tobramycin Resistance to gentamicin increased obviously. Microb Pathog, 1990 Apr, 8(4), 243 - 57 Cloning and expression of the Pseudomonas aeruginosa exoenzyme S toxin gene; Sokol PA et al.; The gene for exoenzyme S, an ADP-ribosyl transferase, was cloned from Pseudomonas aeruginosa strain DG1 using an oligonucleotide probe based on the partial N-terminal amino acid sequence to screen a library of DG1 SstI fragments inserted into pKT230 in Escherichia coli DH1 . A positive clone, designated pPD3, hybridized with the oligonucleotide probe and contained a 15 kb SstI insert . In E . coli minicells pPD3 expressed a single protein of Mr 68,000 . This protein was localized primarily in the periplasm in E . coli . A 3.6 kb HindIII-BamHI fragment was subcloned into the vector pT7-4 which contains the promoter from bacteriophage T7 to construct pT7-4HB . In E . coli strains expressing the T7 RNA polymerase on a second plasmid, the Mr 68,000 protein was expressed and shown to react with antibodies to exoenzyme S . No enzymatic activity was detected in cell sonicates or culture supernatants of E . coli (pPD3) . Cell sonicates of E . coli (pT7-4HB) however were cytotoxic to HeLa cells and this cytotoxicity was neutralizable with anti-exoenzyme S antiserm . Thus, exoenzyme S expressed in E . coli is toxic but not enzymatically active . When plasmids carrying the exoenzyme S gene were introduced into P . aeruginosa, there was a significant increase in ADP-ribosyl transferase activity, indicating that the plasmid encoded protein is enzymatically active in P . aeruginosa. Jpn J Antibiot, 1990 Apr, 43(4), 754 - 6 {A specific protein inhibiting membrane permeation of chloramphenicol in Pseudomonas aeruginosa}; O'Hara K et al.; A specific protein (MW 18,000) was found using chloramphenicol (CP) base-affinity chromatography of periplasmic-space proteins obtained from an impermeability-type CP-resistant Pseudomonas aeruginosa harboring plasmid kR102 . Membrane reconstitution experiments using a liposome system appeared to indicate that the permeability of CP was inhibited by the specific protein. Jpn J Antibiot, 1990 Apr, 43(4), 706 - 18 {Studies on aztreonam in the perinatal period}; Cho N et al.; Pharmacokinetic, bacteriological and clinical studies on aztreonam (AZT) in the perinatal period were carried out with the following summary of the results . Antibacterial effects of AZT on bacterial growth of Escherichia coli (MIC 12.5 micrograms/ml) and Pseudomonas aeruginosa (MIC 50 micrograms/ml) in amniotic fluid were determined and it was found that the activity of AZT is enhanced in amniotic fluid . AZT rapidly penetrated into tissues and sera of pregnant women upon intravenous (i.v.) injection and its maternal serum concentrations reached their peak levels shortly after the injection . Placental penetration of AZT to the fetus was good and, after single i.v . injection of 1 g, the concentrations of AZT in the umbilical cord serum and amniotic fluid exceeded MICs against major Gram-negative bacilli . These results indicate that single i.v . injection of AZT 1 g twice a day is effective for the treatment and prophylaxis of perinatal infections . Injection of AZT for the treatment of puerperal infections showed excellent clinical effectiveness with 100% eradication of aerobic Gram-negative rods . No side-effect was observed in any case . All of the results suggested clinical usefulness of AZT in the perinatal period. Jpn J Antibiot, 1990 Apr, 43(4), 677 - 85 {The combined effects of aspoxicillin with aminoglycoside antibiotics on Pseudomonas aeruginosa}; Matsushita T et al.; Combined actions of aspoxicillin (ASPC) with several aminoglycosides (AGs) against various Pseudomonas aeruginosa strains were examined using the checker board method and experimental infection of mice, and the actions were compared with those of piperacillin (PIPC) and mezlocillin (MZPC) . 1 . The combination of ASPC with gentamicin, amikacin (AMK) or tobramycin showed synergistic activities against 81.9-95.5% of the test strains . These frequencies were higher than those of reference penicillins (PCs) . Mean values of FIC index for combinations between ASPC and AGs were smaller than 0.5, thus, the combinations showed the strongest synergism among the PCs tested . 2 . ASPC combined with AGs showed synergistic actions on experimental mouse infections caused by strains of P . aeruginosa . The potency of ASPC was the same as that of PIPC, but MZPC had a weaker activity than ASPC or PIPC . 3 . Schedule of administration of ASPC and AMK was examined using experimental infection in mice caused by P . aeruginosa . When AMK was administered first, a synergism was clearly observed when ASPC was administered within 1 hour of the AMK administration . When ASPC was administered first, a synergism was observed when AMK was administered within 4 hours of the ASPC administration . 4 . Influences of AMK and ASPC or reference PCs on growth of P . aeruginosa 22 were examined at lower concentrations than MIC . AMK showed a bacteriostatic action on the test strain at 1/4 MIC . But no influence was observed at lower concentrations than 1/4 MIC of AMK . ASPC and reference PCs showed slight effects on growth of the test strain at concentrations of 1/32 MIC of PIPC, 1/128 MIC of MZPC and 1/256 MIC of ASPC . The PCs showed bactericidal action against the test strain at these concentrations when combined with 1/4 MIC of AMK. J Chemother, 1990 Apr, 2(2), 82 - 6 Enhanced in-vitro activity of liposome-trapped penicillin-G against Pseudomonas aeruginosa; Kotsifaki H et al.; The growth inhibition of four Pseudomonas aeruginosa strains by liposome-trapped penicillin-G was investigated . There were indications of an association of the efficacy of liposomal penicillin-G with the nature of the 0-antigenic polymeric side chain . Namely, P28-800 and PCF-95 strains, characterized by a rough polysaccharide chain, were the most susceptible, whereas strain P28-0, possessing an intact lipopolysaccharide, resisted the activity of the entrapped drug . Among the rough strains, P642, a beta-lactamase producer, was not affected by the encapsulated drug . The composition of liposomes seems to have a significant impact in arresting the growth of the P . aeruginosa strain. Infusionstherapie, 1990 Apr, 17(2), 104 - 7 Gram-negative bacteria sepsis in the rat and tissue lipolytic activity on LCT and MCT/LCT-based commercial parenteral emulsions; Meraihi Z et al.; The aim of this study was to evaluate the effect of a gram-negative bacteria sepsis on the activity of the enzymes lipoprotein lipase (LPL) and hepatic lipase (HL), involved in the clearance of circulating triacylglycerol-rich fat particles . Fasting rats were intravenously injected with NaCl9 g.l-1, live or heat-killed Pseudomonas aeruginosa bacteria . After 18 h the animals were killed . When compared to controls, the 2 treated groups showed an increase in body temperature, cholesterolemia, triglyceridemia and a decrease in ketonemia, proteinemia, albuminemia and in the in vitro activity of diaphragm, heart and adipose tissue LPL and of HL . The decrease in the enzyme activities occurred independent of the type of emulsion used as in vitro substrate, whether it was based on long-chain triglycerides or on medium- and long-chain triglycerides, but in any case the activity was lower with the first than with the second type of fat emulsion. Microbiologica, 1990 Apr, 13(2), 97 - 100 Adherence of Pseudomonas aeruginosa elastase deficient mutant; Trancassini M et al.; Pseudomonas aeruginosa produces several extracellular substances such as enzymes and toxins which seem to contribute to its pathogenicity . In particular, alkaline protease and elastase production seems to affect bacterial adherence . Aim of this study was to isolate an elastase deficient mutant of P . aeruginosa and to demonstrate a possible correlation between enzyme production and adherence to WEHI cells . Mutant strain showed a significant reduction of elastase and protease alkaline activity, as the decrease of absorbance values demonstrate . Furthermore the adherence to WEHI cells of mutant strain was strongly reduced with respect to the wild strain . Our results prove that proteolytic enzymes play an important role in adherence, probably modifying the cell surfaces and so enhancing adherence. Microbiologica, 1990 Apr, 13(2), 91 - 5 Role of membrane glycosphingolipids as Pseudomonas aeruginosa adhesin receptor in rabbit bladder mucosa; Chiarini F et al.; The adhesiveness of a mucous strain of Pseudomonas aeruginosa to rabbit bladder mucosa was studied after preincubation of the microorganism with several glycolipids with different carbohydrate moieties to investigate their importance in the interaction with bacterial adhesins . Vesical cells were also treated with lectins (limulin and soybean) to confirm the role of saccharides as membrane receptor . The results obtained showed that galactose-containing glycolipids were able, in varying degrees, to reduce bacterial binding . The most active compounds were glycosphingolipids with negatively charged terminal groups . Lectin treatment of bladder mucosal cells confirmed the importance of galactose and sialic acid as mucosal cell membrane receptors for P . aeruginosa. Mol Microbiol, 1990 Apr, 4(4), 677 - 82 A lipopeptide-encoding sequence upstream from the lysA gene of Pseudomonas aeruginosa; Jann A et al.; An open reading frame (ORF) of 141 bp was observed upstream from the Pseudomonas aeruginosa lysA gene . The translation product of this ORF contains a signal peptide with a lipoprotein box, Ile-Ala-Ala-Cys, at the predicted signal peptidase cleavage site . The Escherichia coli phoA gene without its signal sequence was fused in frame to this ORF in a broad host-range plasmid . The resulting construct expressed a hybrid protein exhibiting alkaline phosphatase activity in phoA mutants of both E . coli and P . aeruginosa . This indicates that the ORF encodes a peptide, part of which acts as an export signal . The hybrid peptide was identified by immunoblotting with alkaline phosphatase antiserum . The accumulation of a precursor form was observed when P . aeruginosa cells carrying this gene fusion on a plasmid were treated with globomycin . Moreover, the mature form could be labelled with 2-{3H}-glycerol, indicating that lipidic residues may be linked to the hybrid protein . Taken together, these results strongly suggest that the ORF encodes a lipopeptide . We propose that the gene is called IppL. Mol Microbiol, 1990 Apr, 4(4), 527 - 35 Analysis of the structure-function relationship of Pseudomonas aeruginosa exotoxin A; Wick MJ et al.; Biochemical and genetic techniques have provided considerable insight into the structure-function relationship of one of the ADP-ribosyl transferases produced by Pseudomonas aeruginosa, exotoxin A . Exotoxin A contains a typical prokaryotic signal sequence which, in combination with the first 30 amino-terminal amino acids of the mature protein, is sufficient for exotoxin A secretion from P . aeruginosa . Determination of the nucleotide sequence and crystalline structure of this prokaryotic toxin allowed a molecular model to be constructed . The model reveals three structural domains of exotoxin A . Analysis of the identified domains shows that the amino-terminal domain (domain I) is involved in recognition of eukaryotic target cells . Furthermore, the central domain (domain II) is involved in secretion of exotoxin A into the periplasm of Escherichia coli . Evidence also implicates the role of domain II in translocation of exotoxin A from the eukaryotic vesicle which contains the toxin after it becomes internalized into susceptible eukaryotic cells via receptor-mediated endocytosis . The carboxy-terminal portion of exotoxin A (domain III) encodes the enzymatic activity of the molecule . The structure of this domain includes a cleft which is hypothesized to be the catalytic site of the enzyme . Several residues within domain III have been identified as having a direct role in catalysis, while others are hypothesized to play an important structural role. J Antimicrob Chemother, 1990 Apr, 25(4), 575 - 84 The effect of rifampicin on the in-vitro activity of cefpirome or ceftazidime in combination with aminoglycosides against Pseudomonas aeruginosa; Valdes JM et al.; The in-vitro activity of cefpirome and ceftazidime when combined with aminoglycosides (gentamicin, amikacin, and tobramycin) in the presence and in the absence of rifampicin was evaluated against 32 isolates of Pseudomonas aeruginosa by two methods . Agar dilution susceptibilities demonstrated a marked reduction in synergy (FIC less than or equal to 0.5) when rifampicin was added to the combination . Synergy rates decreased from 59.4-84.4% without to 3.1-9.4% with the addition of rifampicin . In contrast, kill curve tests performed on two P . aeruginosa strains demonstrated synergy at 24 h when rifampicin was added to cefpirome, ceftazidime, gentamicin or a beta-lactam agent plus gentamicin combination . The addition of rifampicin to the combinations of cefpirome or ceftazidime plus gentamicin achieved a 2-log10 lower bacterial count at 24 h than that of the beta-lactam and gentamicin combination alone . When rifampicin was added to the combination cefpirome or ceftazidime plus gentamicin at different times during incubation, a greater bactericidal effect was observed when rifampicin was added at 0 and 1 h of incubation than when added later . No antagonism was observed with rifampicin when used in combination with beta-lactam agents and/or aminoglycosides. J Antimicrob Chemother, 1990 Apr, 25(4), 513 - 23 Resistance of Pseudomonas aeruginosa to cefsulodin: modification of penicillin-binding protein 3 and mapping of its chromosomal gene; Gotoh N et al.; Spontaneous cefsulodin-resistant mutants of Pseudomonas aeruginosa PAO4089 were isolated on agar impregnated with 3 mg/l of cefsulodin . This strain does not produce any chromosomal beta-lactamase . The MICs of cefsulodin for the parent and its mutants were 0.78 and 12.5 mg/l, respectively . Complete cross-resistance between cefsulodin and seven other antipseudomonal beta-lactams was noted in the mutants . The mutant gene, designated as pbpB, was mapped by FP5 plasmid-mediated conjugation and found to be near to cys-59 on the PAO chromosome, the gene order being pur-67, oruI, pbpB and cys-59 . There were no detectable differences between the parent and its mutants in their outer membrane protein profiles . Penicillin-binding protein assay, by the competition method, with cefsulodin or carbenicillin showed a significant reduction in affinity of PBP3 for these beta-lactams . This PBP is the primary target for cefsulodin in P . aeruginosa . The genetic mechanism by which the cefsulodin-resistant clinical isolates of P . aeruginosa have emerged is discussed. Eur J Clin Microbiol Infect Dis, 1990 Apr, 9(4), 257 - 61 Molecular epidemiological study of Pseudomonas aeruginosa isolates from patients with acute leukemia; Kern W et al.; In an attempt to determine the genetic relationship between strains of Pseudomonas aeruginosa isolated from patients with acute leukemia, a recently described restriction fragment from the region upstream of the exotoxin A structural gene was used as a probe in Southern hybridization . The overall rate of cultures positive for Pseudomonas aeruginosa during 169 admissions (119 patients) was 17% . Twelve genotypically distinct strains were found among 18 colonized and/or infected individuals . Three of these strains were recovered from more than one patient, suggesting a certain risk of nosocomial transmission of Pseudomonas aeruginosa and cross-infection . Genotypic comparison showed identical restriction patterns in multiple isolates from single patients, and also in colonizing and subsequently infecting strains . Genotyping distinguished isolates with similar O serotypes and established the identity between isolates with differing susceptibility to agents used for antibacterial prophylaxis. Clin Otolaryngol, 1990 Apr, 15(2), 173 - 5 BIPP--how does it work? Nigam A, Allwood MC. The antibacterial activity of BIPP and its constituents against Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa was measured by growth inhibition tests . BIPP was found to have negligible antibacterial activity . In addition, no release of iodine from BIPP was detected over a 4-week period . It is proposed that much of the evident antibacterial activity of BIPP may be a reflection of the meticulous surgical debridement that accompanies its use . In addition, BIPP makes the impregnated gauze impervious to blood and body fluids ensuring little nutrition for bacteria to thrive in its interstices. J Clin Microbiol, 1990 Apr, 28(4), 747 - 55 Immunoglobulin A and immunoglobulin G antibody responses to alginates from Pseudomonas aeruginosa in patients with cystic fibrosis; Pedersen SS et al.; Patients with cystic fibrosis have a high prevalence of mucoid, alginate-producing Pseudomonas aeruginosa that causes chronic infection of the mucosal surface of the lungs . We developed enzyme-linked immunosorbent assays (ELISAs) for determination in serum of immunoglobulin A (IgA) and IgG antibodies to alginate purified from P . aeruginosa and an ELISA for detection of IgA antibodies to a polyvalent P . aeruginosa standard antigen . Absorption experiments indicated that the assays were antigen and antibody specific and had analytical variations that ranged from 7 to 19% . Serum samples from 207 patients with cystic fibrosis, 100 healthy children, and 94 healthy adults were examined . The patients responded to P . aeruginosa infection with early IgA and IgG antibody responses that were significantly higher than in controls and noncolonized patients . Analysis of paired serum samples showed that infected patients had an increase in specific IgG and IgA antibodies that was significantly higher than in noncolonized patients . The serological data were analyzed for correlation with clinical condition; poor lung function was significantly associated with increased levels of IgA and IgG antibodies to P . aeruginosa alginate and to the standard antigen and with a relative excess of IgA antibodies to the standard antigen compared with IgA antibodies to P . aeruginosa alginate . The assays showed high predictive values if positive, but a negative test did not exclude infection, and the ELISAs should not be used for diagnostic purposes . Mucoid strains were present initially in the sputa of 28 of 54 infected patients with paired serum samples . These patients had a significant increase in anti-alginate antibodies, but it was not different from the increase seen in patients infected only with nonmucoid strains . Therefore, alginate may also be produced in vivo by nonmucoid P . aeruginosa . The study showed that early formation of IgA and IgG antibodies to P . aeruginosa alginate did not prevent development of chronic infection and that P . aeruginosa-specific IgA antibodies correlate with poor lung function. Am Rev Respir Dis, 1990 Apr, 141(4 Pt 1), 914 - 21 Reduction of sputum Pseudomonas aeruginosa density by antibiotics improves lung function in cystic fibrosis more than do bronchodilators and chest physiotherapy alone; Regelmann WE et al.; We evaluated patients with cystic fibrosis (CF) and moderate obstructive lung disease in pulmonary exacerbation in a double-blind placebo-controlled trial to determine the contribution of antibiotic-mediated reduction in sputum bacterial density to clinical improvement . For the first 4 days of study, all patients received bronchodilating aerosols and chest physiotherapy but no antibiotics . During this time, the patients showed significant improvement in mean FVC, FEV1, and maximal midexpiratory flow rate (FEF25-75) . In 12 of 13 trials, the patients showed no significant increases in the density of Pseudomonas aeruginosa during these first 4 days . In these 12 trials, the patients were stratified by their initial FVC and randomized to receive either parenteral tobramycin and ticarcillin (n = 7) or placebo (n = 5), in addition to continued aerosol and chest physiotherapy . In the remaining trial, the patient had a significant rise in the density of P . aeruginosa and was assigned to the antibiotic group . During the next 14 days of therapy, the antibiotic group showed significantly (p less than 0.01) greater reductions in log10 colony-forming units (cfu) of P . aeruginosa per gram of sputum and greater increases in FVC, FEV1, and FEF25-75 than did the placebo group . The degree of decrease in log10 cfu P . aeruginosa/g sputum correlated significantly (p less than 0.001) with the degree of improvement in FVC, FEV1, and FEF25-75.(ABSTRACT TRUNCATED AT 250 WORDS) Proc Natl Acad Sci U S A, 1990 Apr, 87(8), 2887 - 91 AlgR3, a protein resembling eukaryotic histone H1, regulates alginate synthesis in Pseudomonas aeruginosa; Kato J et al.; A regulatory mutation (alg52) in a Pseudomonas aeruginosa alginate-negative mutant (strain 8882) is complemented efficiently by the gene algR2 and somewhat inefficiently by a second gene termed algR3 . algR3 and algR2 are located on a 4.4-kilobase-pair HindIII-BamHI fragment, which has been completely sequenced . algR2 has previously been characterized . Introduction of kanamycin-resistance cassettes and deletion-subcloning experiments involving various open reading frames in the HindIII-BamHI fragment have localized the algR3 gene, which encodes a 340-amino acid polypeptide . This highly basic regulatory protein contains 17% lysine and 36% alanine . The predicted amino acid sequence shows no significant similarity with any bacterial proteins and yet is highly similar to the sea urchin Lytechinus pictus histone H1 subtype of protein . Promoter localization by reverse transcriptase mapping of the algR3 gene shows the presence of Escherichia coli sigma 70 recognition sequences, and coupled transcription/translation experiments in E . coli demonstrate the presence of a 39-kDa polypeptide encoded by the cloned algR3 gene. Infect Immun, 1990 Apr, 58(4), 978 - 82 Induction of interleukin-1 from murine peritoneal macrophages by Pseudomonas aeruginosa exotoxin A; Misfeldt ML et al.; Pseudomonas exotoxin A, an ADP-ribosylating toxin produced by Pseudomonas aeruginosa, has been shown to stimulate the proliferation of murine thymocytes, which requires the participation of accessory cells . This requirement for accessory cells can be replaced by supernatant from adherent peritoneal exudate cells that have been stimulated with exotoxin A . Antibody to exotoxin A inhibits the induction of the thymocyte mitogenic activity from adherent peritoneal macrophages . However, antibody to exotoxin A had no effect on the thymocyte proliferation if the antibody was added to supernatant which contained thymocyte mitogenic activity . The thymocyte mitogenic activity was associated with a protein or protein complex with a molecular mass of greater than 10,000 daltons . D10 bioassays indicated the presence of interleukin-1 (IL-1) in the supernatant . Antibody to IL-1 inhibited the ability of supernatant to induce thymocytes to proliferate . Therefore, these data suggest that Pseudomonas exotoxin A can stimulate the production of IL-1 from adherent peritoneal cells, which induces murine thymocytes to proliferate. Infect Immun, 1990 Apr, 58(4), 1030 - 7 Growth-dependent alterations in production of serotype-specific and common antigen lipopolysaccharides in Pseudomonas aeruginosa PAO1; McGroarty EJ et al.; Pseudomonas aeruginosa PAO1 was grown in various media and at different temperatures, and the heterogeneity of the extracted lipopolysaccharide (LPS) was characterized by polyacrylamide gel electrophoresis . The size distributions of the serotype-specific LPS and the common antigen LPS were analyzed on Western blots (immunoblots) . Cells grown at high, near-growth-limiting temperatures, at low pH, in low concentrations of phosphate, or in high concentrations of NaCl, MgCl2, glycerol, or sucrose produced decreased amounts of the very long chain population of O-antigen LPS molecules . Lower temperatures and lowered glycerol, lowered sucrose, low sulfate, lower salt concentrations, and elevated pH did not significantly affect the level of this LPS population . The size and amount of common antigen LPS was either unaffected or increased slightly when the cells were grown under the above stress conditions . Cells grown under normal, nonstressed conditions were agglutinated only by serotype-specific antibodies . In contrast, cells grown under stress conditions, in which the long-O-polymer LPS was absent, were agglutinated by both serotype-specific and common antigen-specific antibodies . The results indicate that the long O polymers cover and mask the shorter common antigen . However, specific growth conditions limit the production of the long O polymer, allowing the exposure and reactivity of the common antigen on the cell surface. J Hosp Infect, 1990 Apr, 15(3), 255 - 63 A hot water supply as the source of Legionella pneumophila in incubators of a neonatology unit; Verissimo A et al.; The humidification trays of five of seven incubators in a neonatology unit of a hospital were found to be colonized with Legionella pneumophila, serogroup 1 . Bacteriological analysis of the water in the humidification trays showed very large numbers of heterotrophic bacteria, one of which also contained Pseudomonas aeruginosa . Two hot water systems supply the neonatology unit, either of which is used to add water to the humidification trays; one system (A) is maintained at about 60 degrees C, while the other system (B) is maintained at 45 degrees C . The latter was also found to be colonized with L . pneumophila, Sg1 . Monoclonal antibody (Mab) subgrouping of the isolates, indicated that system B was the source of colonization of the humidification trays of the incubators. J Bacteriol, 1990 Apr, 172(4), 1899 - 904 Pseudomonas aeruginosa transposable bacteriophages D3112 and B3 require pili and surface growth for adsorption; Roncero C et al.; Pseudomonas aeruginosa transposable bacteriophages D3112 and B3 were found to require pili for infection . Seventy mutants of P . aeruginosa PAO selected by resistance to D3112 or B3 were also resistant to the phage not used in the selection and suggested that the receptors of these two phages are identical . Of five resistant mutants examined, all were defective in the production of pili and did not adsorb either phage . P . aeruginosa PAK strains altered in pilus expression, such as hyperpiliated or nonpiliated mutants, adsorbed the phage but were not productively infected, implying that an additional host function was required for infection . The cell-associated lipopolysaccharide was not required for D3112 or B3 infection, since mutants deficient in O side-chain and core biosynthesis were still capable of adsorption and productive infection . This is in contrast to Escherichia coli mutator phages Mu and D108, which are dependent on lipopolysaccharide for adsorption . The P . aeruginosa phages adsorbed only to cells grown on solid media or in liquid media supplemented with agents that increase the macroviscosity, such as polyvinylpyrrolidone . Adsorption time course studies of D3112 and B3 using cells grown in solid media revealed similar but not identical adsorption patterns . These studies suggested that expression of the D3112 and B3 cell receptor is induced by growth on solid media. Biotechniques, 1990 Apr, 8(4), 408 - 13 Ultrafiltration to remove endotoxins and other cytokine-inducing materials from tissue culture media and parenteral fluids; Schindler R et al.; The presence of small amounts of endotoxins are often undesirable when investigating cytokines such as interleukin-1 and tumor necrosis factor alpha . Polymyxin B, widely used to block endotoxins, does not block several forms of endotoxins, and at high concentrations, polymyxin B itself stimulates interleukin-1 production . Human peripheral blood mononuclear cells are highly sensitive to endotoxins; they respond with cytokine production to endotoxins at concentrations of 10-50 pg/ml and detect pyrogenic materials nonreactive in the Limulus test . In the present study, ultrafiltration using polysulfone filters was found to remove all interleukin-1- and tumor necrosis factor alpha-inducing substances produced in E . coli cultures . Interleukin-1- and tumor necrosis factor alpha-inducing substances derived from Pseudomonas aeruginosa cultures were also rejected by the filters . Ultrafiltration is therefore a convenient and effective procedure to remove interleukin-1 and tumor necrosis factor alpha-inducing substances from parenteral fluids and solutions that come in contact with blood such as fluids used in hemodialysis . This technique is also applicable for the large-scale production of culture media for mammalian cell expression of recombinant, pyrogen-free proteins intended for use in humans. J Ind Microbiol, 1990 Apr-May, 5(2-3), 65 - 70 Isolation and characterization of acetonitrile utilizing bacteria; Chapatwala KD et al.; Bacteria utilizing high concentrations of acetonitrile as the sole carbon source were isolated and identified as Chromobacterium sp . and Pseudomonas aeruginosa . Maximum growth was attained after 96 h of incubation and P . aeruginosa grew slightly faster than Chromobacterium sp . The strains were able to grow and oxidize acetonitrile at concentrations as high as 600 mM . However, higher concentrations inhibited growth and oxygen uptake . Degradation studies with (14C)acetonitrile indicated 57% of acetonitrile was degraded by Pseudomonas aeruginosa as compared to 43% by Chromobacterium . The isolates utilized different nitrile compounds as carbon substrates. Biochem J, 1990 Mar 15, 266(3), 921 - 3 Nitric oxide is inactivated by the bacterial pigment pyocyanin; Warren JB et al.; Pyocyanin is a phenazine pigment produced by the bacterium Pseudomonas aeruginosa and found in human lung secretions . Micromolar concentrations of pyocyanin inhibited the bioactivity of endothelium-derived relaxing factor (EDRF) generated from bovine pulmonary-artery endothelium in response to bradykinin . This inhibition was reversed by perfusing the EDRF-bioassay system with pyocyanin-free buffer for 15 min, but persisted in the presence of superoxide dismutase (20 units/ml) . When nitric oxide, the major component of EDRF, was passed into an aqueous solution of pyocyanin in the absence of O2, a rapid colour change occurred from blue to pink; m.s . analysis of the products showed that the pyocyanin had been converted into a nitrosylated species. J Biol Chem, 1990 Mar 15, 265(8), 4247 - 53 Inactivation of cytochrome cd1 by hydrazines; Yap-Bondoc F et al.; The dissimilatory nitrite reductase, cytochrome cd1, from Pseudomonas aeruginosa (ATCC 19429) was irreversibly inactivated by methyl- or phenylhydrazine but was only reduced by hydrazine itself . The reaction required oxygen and several turnovers, approximately four, of the cytochrome acting to transfer reducing equivalents from phenylhydrazine to oxygen . The reaction with methyl- or phenylhydrazine altered the visible spectrum of the cytochrome . Bands characteristic of reduced heme c appeared plus new features that were not characteristic of either oxidized or reduced heme d1 . Extraction of the heme from phenylhydrazine-treated cytochrome yielded a covalently modified form of the original heme d1 . Visible, 1H NMR, and mass spectra were obtained on the purified modified heme and on the metal-free esterified derivative . The spectroscopic data indicate that the modification was the regiospecific substitution of the 5 meso-proton by a phenyl group. J Immunol, 1990 Mar 15, 144(6), 2253 - 7 Degradation of IgA proteins by Pseudomonas aeruginosa elastase; Heck LW et al.; Human colostral IgA and myeloma proteins of both IgA1 and IgA2 subclasses were susceptible to cleavage by Pseudomonas aeruginosa elastase . Detailed analysis of the cleavage products of IgA myeloma proteins revealed complete degradation of Fab with no evidence of intact Fab fragments as intermediate cleavage products . In contrast, both IgA1 and IgA2 proteins were resistant to cleavage by alkaline protease from P . aeruginosa . The susceptibility of human IgA proteins to elastase suggests a mechanism by which P . aeruginosa might evade the potentially protective function of IgA by producing this enzyme. J Immunol, 1990 Mar 15, 144(6), 2117 - 22 Purification and characterization of intraparenchymal lung lymphocytes; Abraham E et al.; We analyzed phenotypic and functional characteristics of intraparenchymal pulmonary lymphocytes in mice . As determined by flow cytometry, approximately 30% more T cells than B cells were found . Nearly all T cells bore the alpha beta TCR, most of which stained with either CD4+ or CD8+, although small numbers of double-negative T cells were present; the CD8+/CD4+ ratio was approximately 0.37 . While practically all B cells bore surface IgM, and no IgA+ cells were found, and approximately more than 80% of the plasma cells produced IgA . Approximately half of the LPS-responsive cells produced IgA . Pulmonary B cell clonal precursors specific for the autoantigen, transferrin, were present in higher frequencies than those specific for the bacterial antigens, levan and Pseudomonas aeruginosa polysaccharide type I, or those producing antibodies against OVA . These results demonstrate that a distinct population of lymphocytes is present in the lungs. FEMS Microbiol Lett, 1990 Mar 15, 56(3), 245 - 8 Antigenic epitope in Pseudomonas aeruginosa lipopolysaccharide immunologically cross-reactive with Escherichia coli O26 lipopolysaccharide; Yokota S et al.; The human monoclonal antibody MH-4H7 recognizes the lipopolysaccharide outer core region of some Pseudomonas aeruginosa strains and in of some Pseudomonas aeruginosa strains and in particular strongly binds to strains of Lanyi serotype 04 . In this paper, we report that this monoclonal antibody also reacts with Escherichia coli O26 LPS . However, our results suggest that the previous reported immunological cross reaction between P . aeruginosa 04 and E . coli O26 strains (which was observed by using antisera against heat-stable antigens) is not due to the similarity of the O-polysaccharides. J Assoc Physicians India, 1990 Mar, 38(3), 215 - 7 Study of iatrogenic thrombophlebitis; Velhal GD et al.; This is an analysis of 42 adult patients with 97 episodes of thrombophlebitis following 167 venepunctures . Almost all commonly used fluids had contributed to the development of thrombophlebitis . The observations showed significantly higher chances of development of thrombophlebitis with the quantity of fluids more than 2500 ml . (chi 2 = 15.50, P less than 0.001), autoclaved containers (chi 2 = 5.5, P less than 0.05) use of rubber tubing for infusion set (chi 2 = 4.7, P less than 0.05) and infusion rate more than 20 drops per minute (chi 2 = 15.25 . P less than 0.001) . Average time interval between beginning of IV infusion and development of thrombophlebitis was found to be 18 hours and average extent of thrombophlebitis was 7 cm . The commonest micro-organism isolated from needles was Pseudomonas aeruginosa. Ceylon Med J, 1990 Mar, 35(1), 21 - 3 Glycocalyx positive bacteria isolated from chronic osteomyelitis and septic arthritis; Alam SI et al.; Bacterial cultures isolated from cases of chronic osteomyelitis and septic arthritis were screened for the production of glycocalyx . The presence of glycocalyx was noted in 76.3% of Staphylococcus aureus, 57.14% of Staphylococcus epidermidis, 50% of Pseudomonas aeruginosa, and 75% of Escherichia coli isolates. Nippon Kyobu Geka Gakkai Zasshi, 1990 Mar, 38(3), 499 - 502 {Successful use of an omental pedicled flap for obliterating empyema associated with a large bronchial fistula}; Tsubota N et al.; We transferred the omentum up into the thorax through the diaphragm and succeeded in obliterating the empyema with a large bronchial fistula . A 52 year-old man with 30 years history of empyema was referred because of purulent discharge through the cutaneous fistula starting one year before . Open thoracotomy revealed a round opening 13 mm in diameter to the cavity, which resulted from lobectomy performed 30 years before . After a month of dress changing pseudomonas aeruginosa in the empyema space disappeared . Thereafter radical operation was performed in order to close the fistula . The omental flap supplied by the right gastroepiploic artery was transferred into the empyema space . The flap was sutured to the orifice of the bronchial stump . The residual space was obliterated by the thoracoplasty using the chest wall with ribs and lateral side of the empyema wall . Postoperative course was uneventful and bronchoscopy at two months after the operation revealed that the bronchial mucosa developed and covered over the large bronchial fistula. Arch Pharm (Weinheim), 1990 Mar, 323(3), 141 - 4 Synthesis and antimicrobial evaluation of some arylhydrazones of 4-{(2-methylimidazo{1,2-a}pyridine-3-yl)azo}benzoic acid hydrazide; Cesur Z et al.; A short series of arylhydrazones of 4-{(2-methylimidazo{1,2-a}pyridine-3-yl)azo}benzoic acid hydrazide was synthesized and tested for antimicrobial activity . All of the compounds show antimicrobial activity against Escherichia coli . A few members were also active against Klebsiella pneumoniae, Staphylococcus aureus and Pseudomonas aeruginosa . The interplanar angle (theta) between the aryl ring and the adjacent azomethine group of some representative compounds was measured by electronic absorption spectroscopy . No structure-activity-relationship between interplanar angle or lipophily and activity was found. J Antimicrob Chemother, 1990 Mar, 25(3), 441 - 8 Oral ciprofloxacin in the treatment of peritonitis in patients on continuous ambulatory peritoneal dialysis; Fleming LW et al.; Oral ciprofloxacin in doses of 0.75 to 2 g daily for 8-16 (median 10) days was given as first-line treatment of 33 unselected episodes of CAPD-associated peritonitis in 20 patients . Treatment was well tolerated and effective, curing 25 episodes . Treatment was withdrawn in five episodes, four because of resistant organisms and in the other because of vomiting . Infection relapsed twice in one patient during follow-up and one patient had persistence of the infecting organism (Pseudomonas aeruginosa) despite clinical improvement . Plasma and dialysate ciprofloxacin levels ranged from 1 to 8 mg/l . Assay between days 2 and 4 of treatment indicated the ciprofloxacin steady state concentration . If this proves to be greater than 7 mg/l the dose may be reduced and if less than 2 mg/l the dose should be increased . Overall a single course of oral ciprofloxacin was 76% successful as a first-line treatment for CAPD-associated peritonitis, caused by a wide range of organisms. J Bacteriol, 1990 Mar, 172(3), 1418 - 23 Permeability barrier to hydrophilic solutes in Mycobacterium chelonei; Jarlier V et al.; In order to define the permeability barrier to hydrophilic molecules in mycobacteria, we used as a model a smooth, beta-lactamase-producing strain of Mycobacterium chelonei . The rates of hydrolysis of eight cephalosporins by intact and sonicated cells were measured, and the permeability coefficient (P) was calculated from these rates by the method of Zimmermann and Rosselet (W . Zimmermann and A . Rosselet, Antimicrob . Agents Chemother . 12:368-372, 1977) . P ranged from (0.9 +/- 0.3) x 10(-8) (benzothienylcephalosporin) to (10 +/- 3.3) x 10(-8) cm/s (cephaloridine); i.e., the P values were lower than those reported for Pseudomonas aeruginosa and Escherichia coli by 1 and 3 orders of magnitude, respectively . The permeability barrier was shown to reduce drastically the stream of drug molecules entering the cell, allowing the rather low level of beta-lactamase (0.1 U/mg of protein with penicillin G) to decrease radically the concentration of the drug at the target; this explains the poor in vitro activities of the beta-lactams against M . chelonei . We also estimated P for small, hydrophilic molecules (glucose, glycerol, glycine, leucine), by studying their uptake kinetics . The values found, ranging from 15 x 10(-8) to 490 x 10(-8) cm/s, were consistent again with a very low permeability of M . chelonei cell wall . The permeation of cephalosporins was not very dependent on the hydrophobicity of the molecules or on the temperature, suggesting a hydrophilic pathway of penetration for these molecules. Crit Care Med, 1990 Mar, 18(3), 303 - 8 Increased survival time after delayed histamine and prostaglandin blockade in a porcine model of severe sepsis-induced lung injury; Byrne K et al.; A combination of cimetidine, diphenhydramine, and ibuprofen has been shown to be an effective treatment in a porcine model of septic acute lung injury . The present study was designed to evaluate this therapy in a delayed treatment survival model . Three groups of animals were studied: a control group (C, n = 6) received a sham infusion of 0.9% saline; a septic group (Ps, n = 5) received a continuous infusion of live Pseudomonas aeruginosa organisms; and a treatment group (CID, n = 6) received P . aeruginosa plus cimetidine 150 mg, ibuprofen 12.5 mg/kg, and diphenhydramine 10 mg/kg given at 90 min after P . aeruginosa infusion, and hourly thereafter . Group Ps developed fulminant acute lung injury and hypodynamic septic shock . CID therapy ameliorated temporarily the progressive course of hypoxemia and increased extravascular lung water (EVLW), delayed the onset of cardiovascular deterioration, and improved significantly survival time . It was concluded that CID therapy given at 90 min after the onset of lethal continuous P . aeruginosa infusion improved significantly animal survival time by improving temporarily hypoxemia and increase in EVLW and delaying cardiovascular collapse. J Antimicrob Chemother, 1990 Mar, 25(3), 413 - 22 Cefodizime and cefotaxime in acute exacerbations of chronic bronchitis: a randomized double-blind prospective study in 180 patients; Maesen FP et al.; In a double-blind prospective study, 180 patients admitted to hospital with acute purulent exacerbations of chronic bronchitis were treated for seven days with twice daily 1 g intramuscular injections of either cefodizime or cefotaxime . Sputum cultures performed before, during and immediately after treatment showed complete eradication of the infection in 89/90 given cefodizime and 86/90 receiving cefotaxime . Some symptomatic Pseudomonas aeruginosa superinfections occurred with each agent . During the follow-up week, recurrences or reinfections after apparent clearance occurred in 15 patients given cefodizime and in 21 receiving cefotaxime . Pharmacokinetic studies in blood showed mean Cmax values of 50.8 mg/l for cefodizime and 36.5 mg/l for cefotaxime, corresponding values in the sputum being 1.61 and 0.62 mg/l . Mean AUC values in both blood and sputum were 2 1/2- to 3-fold higher for cefodizime . Some features suggested better performance by cefodizime than by cefotaxime, but the clinical results were not statistically significantly different. Rev Infect Dis, 1990 Mar-Apr, 12(2), 277 - 81 Invasive external otitis caused by Aspergillus; Phillips P et al.; Invasive external otitis occurs almost exclusively in patients with longstanding diabetes . Except for occasional cases, the etiologic agent has been Pseudomonas aeruginosa . We report a case caused by Aspergillus species in a diabetic patient with acute leukemia . Persistent infection was documented by culture and histology after a course of intravenous amphotericin B (total dose, 2 g) . Clinical resolution occurred in association with a 3-month course of oral itraconazole . Four previously reported cases of invasive aspergillus otitis are reviewed. Gene, 1990 Mar 1, 87(1), 37 - 43 The arc operon for anaerobic arginine catabolism in Pseudomonas aeruginosa contains an additional gene, arcD, encoding a membrane protein; Luthi E et al.; The arginine deiminase (ADI) pathway in Pseudomonas aeruginosa serves to generate ATP . The three enzymes involved, ADI, catabolic ornithine carbamoyltransferase and carbamate kinase, are induced by oxygen limitation and encoded by the contiguous arcABC genes . A 1.5-kb region upstream from arcABC was sequenced and found to contain an open reading frame, arcD, coding for a hydrophobic polypeptide of 52 kDa . The content and distribution of hydrophobic amino acids suggest that the arcD gene product may be a transmembrane protein . When arcD was fused to an Escherichia coli promoter, the ArcD protein was synthesized in E . coli maxicells and detected in the membrane fraction . In sodium dodecyl sulfate-polyacrylamide-gel electrophoresis the ArcD protein migrated like a 32-kDa protein; such anomalous electrophoretic mobility is known for other highly hydrophobic proteins . Mutations in arcD rendered the cells unable to utilize extracellular arginine as an energy source . Since anaerobic arginine consumption and ornithine release are coupled in P . aeruginosa, it is proposed that arcD specifies an arginine: ornithine antiporter or a part thereof . Insertions of IS21 or Tn1725 in arcD had a strong polar effect on the expression of the arcAB enzymes, indicating that the arc genes are organized as an arcDABC operon. Nippon Ganka Gakkai Zasshi, 1990 Mar, 94(3), 269 - 76 {Adherence of Pseudomonas aeruginosa to the rabbit corneal epithelium}; Tazawa H; Adherence of bacteria to the corneal epithelium is the first step in the pathogenesis of corneal infection . Keratitis caused by Pseudomonas aeruginosa usually occurs among the contact lens wearers . Adherence of Pseudomonas aeruginosa to rabbit corneal epithelium, damaged by one week of hard contact lens wear, was examined histologically . The cornea was excised for scanning electron microscopy at 5, 15, 30 and 60 minutes after inoculation of Pseudomonas aeruginosa (0.2 ml, 10(8)CFU/ml) . Pseudomonas aeruginosa did not adhere to the intact corneal epithelium, but traumatized cornea provided a site for adherence . In rabbits in which the eyelid was opened by lid retractors, large numbers of organisms were observed adhering to the injured cornea mediated by ocular surface mucin . Thirty minutes after inoculation, the adherent bacteria began to penetrate the epithelial cells and surface mucin by the formation of pockets surrounding the organism. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi, 1990 Mar, 6(1), 42 - 6, 77 {Experimental study of pulmonary infection and its systemic dissemination in the early stage of severe burn}; Rong XZ; A total of 138 rabbits were used for the study of pulmonic infection and systemic dissemination in early stage of severe burns . One group of animals was inflicted with third degree burns on the back covering 20% of total body surface area; coincidently an intratracheal introduction of sero-type IX pseudomonas aeruginosa (IXPA) were performed . Above group of animals were compared with the simple body surface burns, simple intratracheal colonization and amikacin treatment groups . For observation, a series of blood samples, swabs of throat were taken at regular times for bacterial culture and IXPA identification . Endotoxin levels of blood plasma were measured too . Animals were killed at 8, 16, 24, 72 hours post-injury, tissue specimens of lung, liver, spleen and kidney were taken for quantitative bacterial cultures, and lung tissues for histological examination . The results showed that the predominant colonization of IXPA in the throats in burned animals are more difficult to be eliminated than that of in non-burned ones . The susceptibility of drugs to IXPA in burned group is higher than that of in control groups, with more severe tissue damages under microscopic examination . The pathogen of pulmonary infection began to invade into the blood stream at four hours post-injuries, and multiple organs dissemination occurred, in which the livers and kidneys were primarily affected . Coincidently a process of endotoxemia was proved . The systemic use of sensitive antibiotics immediately after burns showed benefit to decrease the rate of bacteremia and dissemination of other organs, as well as the rate of death. Mol Microbiol, 1990 Mar, 4(3), 499 - 503 Multiple promoters control the regulation of the Pseudomonas aeruginosa regA gene; Storey DG et al.; Expression studies utilizing the regA promoters, fused in tandem or separately to promoterless reporter genes, indicated that regA is transcribed from two promoters (P1 and P2) . Both promoters can act independently . Expression from the P1 promoter is not affected by the iron content of the medium . Expression from the P2 promoter is tightly regulated by iron. Mol Microbiol, 1990 Mar, 4(3), 489 - 97 Identification of regB, a gene required for optimal exotoxin A yields in Pseudomonas aeruginosa; Wick MJ et al.; The yield of exotoxin A from Pseudomonas aeruginosa has been shown to be strain-dependent . Exotoxin A production requires the presence of the positive regulatory gene, regA . We cloned the regA genetic locus from the prototypical P . aeruginosa strain PAO1 and examined its ability to influence exotoxin A yields compared to the same region cloned from the hypertoxin-producing strain, PA103 . The P . aeruginosa regA mutant strain, PA103-29, containing the PAO1 regA locus in trans produced approximately five to seven times less extracellular exotoxin A than PA103-29 containing the regA locus cloned from the hypertoxigenic strain, PA103 . Nucleotide sequence analysis of the PAO1 regA locus revealed several differences, the most striking of which was the absence of a second open reading frame that was present in the analogous PA103 DNA . In addition, an amino acid substitution was found at position 144 of RegA (Thr in PAO1 and Ala in PA103) . Recombinant molecules were constructed to test the contribution of each of these changes in nucleotide sequence on extracellular exotoxin A yields . The amino acid substitution in the PAO1 RegA protein was found not to affect overall exotoxin A yields . In contrast, the presence of the second open reading frame immediately downstream of the PA103 regA gene was found to influence extracellular exotoxin A yields . This open reading frame encodes a gene which we call regB . Nucleotide sequence analysis indicates that regB is 228 nucleotides in length and encodes a protein of 7527 Daltons . Our data suggest that regB is required for optimal exotoxin A production and its absence in strain PAO1 partially accounts for the difference in yield of extracellular exotoxin A between P . aeruginosa strains PAO1 and PA103. Ophthalmology, 1990 Mar, 97(3), 296 - 302 Bacterial adherence to extended wear soft contact lenses; Aswad MI et al.; The authors studied the adherence of Pseudomonas aeruginosa and Staphylococcus aureus to extended wear soft contact lenses (EWSCLs) with and without focal deposits using both a radiolabeling technique and electron microscopy . P . aeruginosa showed significant adherence to contact lenses in vitro . In contrast, S . aureus failed to show significant adherence to contact lenses in vitro (i.e., the radioactive uptake was not significantly above background) . The extent of adherence of Pseudomonas was proportional to the number of focal deposits on the lenses . Results of electron microscopic examination showed the bacteria to be adherent primarily to large focal deposits (greater than or equal to 150 microns) . There was no pseudomonal adherence to the small focal deposits (less than or equal to 50 microns) and little adherence to the areas in between the focal deposits . The authors hypothesize that worn lenses, especially those with large focal deposits, serve as a vehicle for the transport of P . aeruginosa to the cornea . This hypothesis could be a partial explanation for the high incidence of keratitis caused by P . aeruginosa in EWSCL patients. Endoscopy, 1990 Mar, 22(2), 72 - 5 Septicemia after endoscopic retrograde cholangiopancreatography; Deviere J et al.; Clinical and bacteriological data from 55 patients who developed septicemia within 3 days after ERCP were collected . Forty-four patients presented with septicemia after therapeutic endoscopy, with incomplete drainage in forty, eight after diagnostic ERCP performed in obstructed bile ducts in another center and not followed by endoscopic therapy, and three with a normal common bile duct after diagnostic ERCP . The incidence of septicemia is significantly higher in cases of malignant obstruction than in benign obstruction (21% vs 3%; p less than 0.01), due mainly to the problems of drainage associated with tumoral infiltration . Forty-eight patients (87%) had incomplete bile duct drainage when they developed septicemia, and among the seven remaining cases, 3 had cholecystitis and 3 abscesses in the biliopancreatic area . Previous diagnostic ERCP without drainage was also clearly associated with septicemia after therapeutic ERCP . The most commonly isolated bacteria from blood and bile cultures were Pseudomonas aeruginosa and Escherichia coli . P . aeruginosa was observed mainly in patients referred from other centers after previous diagnostic ERCP, and was unusual in patients without previous ERCP . It is associated with problems in the disinfection of the scopes . Six deaths were attributed to sepsis, always in patients with incomplete biliary drainage which could not be improved . In most of the cases, septicemia after ERCP is related to incomplete bile duct drainage, and in some cases, to biliopancreatic infected collections . Careful disinfection of the endoscopes and other endoscopic devices is mandatory to avoid an unacceptably high rate of P . aeruginosa infection. Arch Dis Child, 1990 Mar, 65(3), 259 - 63 Serum IgA antibodies against Pseudomonas aeruginosa in cystic fibrosis; Brett MM et al.; Serum IgA antibodies to Pseudomonas aeruginosa cell surface antigens were estimated by ELISA . Titres in patients with and without cystic fibrosis and with no pseudomonal infection were low (less than 105 to less than 261) . Titres in patients with cystic fibrosis who were chronically infected with P aeruginosa were very high (1200-163,000), and patients who grew the organism intermittently had intermediate titres . Longitudinal studies suggested increasing tissue invasion or involvement of the lower respiratory tract, or both, with increasing time of infection and identified patients with a good prognosis after the onset of pseudomonal infection . Detection of an increased serum IgA titre can give an earlier indication than measurement of the serum IgG titre of the presence of P aeruginosa in the respiratory tract in a proportion of patients . IgA measurement seems to be better than IgG measurement at predicting the reappearance of P aeruginosa after apparent eradication of early infection . These results suggest that this assay may be a valuable additional indicator of the presence of P aeruginosa at the beginning of infection, and of the reappearance of the organism after treatment in the early stages of infection. Antimicrob Agents Chemother, 1990 Mar, 34(3), 487 - 8 In vitro activities of combinations of aztreonam, ciprofloxacin, and ceftazidime against clinical isolates of Pseudomonas aeruginosa and Pseudomonas cepacia from patients with cystic fibrosis; Bosso JA et al.; The in vitro activities of two-drug combinations of aztreonam, ciprofloxacin, and ceftazidime were studied in 96 clinical isolates of Pseudomonas aeruginosa and in 20 clinical isolates of Pseudomonas cepacia from cystic fibrosis patients . Some synergy was observed with each combination used against P . aeruginosa, but synergy was rare when the combinations were used against P . cepacia. FEMS Microbiol Lett, 1990 Mar 1, 56(1-2), 83 - 7 An outer membrane protein characteristic of mucoid strains of Pseudomonas aeruginosa; Grabert E et al.; SDS-polyacrylamide gel electrophoresis of outer membrane (OM) proteins of different mucoid strains of P . aeruginosa revealed a protein of about 54 kDa that was absent in nonmucoid strains . This 54 kDa protein was expressed under iron-restricted and iron sufficient growth conditions . Electrophoretic mobility of the 54 kDa protein was modified by the solubilization temperature as well as by the addition of lipopolysaccharide and alginate prior to electrophoresis . Treatment of OMs with octylglucoside/KCl or SDS completely extracted the 54 kDa protein at low temperatures . The possible role of this protein in biosynthesis and/or excretion of bacterial alginate is discussed. J Antibiot (Tokyo), 1990 Mar, 43(3), 314 - 20 Comparison of two carbapenems, SM-7338 and imipenem: affinities for penicillin-binding proteins and morphological changes; Sumita Y et al.; We investigated the binding affinities of SM-7338 for penicillin-binding proteins (PBPs) and the morphological changes induced by it compared with those of imipenem . Both SM-7338 and imipenem had the highest binding affinities for PBP-2 of Escherichia coli, which were in good agreement with the primary morphological response of spherical cell formation . SM-7338 also showed high affinities for PBP-1A, -1Bs, and -3, and imipenem showed high affinities for PBP-1A and -1Bs but not for PBP-3 . At 4-fold MIC, SM-7338 induced a indeterminate form, whereas imipenem did not . This may be due to the higher affinity of SM-7338 for PBP-3 compared to that of imipenem . Against Pseudomonas aeruginosa, SM-7338 had very high affinities for PBP-2 and -3, and imipenem had higher affinities for PBP-2 and -1A . SM-7338 induced this organism to filamentous cells at a concentration lower than its MIC, bulge cells at 2-fold MIC, and spherical cells at 4-fold MIC, while imipenem principally induced round cell formation at each concentration . These morphological differences in P . aeruginosa may be due to the differences in binding profiles to PBPs . We also studied the affinities for PBPs using radioactive SM-7338 . The data obtained supported these results. APMIS, 1990 Mar, 98(3), 203 - 11 Induction of experimental chronic Pseudomonas aeruginosa lung infection with P . aeruginosa entrapped in alginate microspheres; Pedersen SS et al.; Alginate-producing, mucoid P . aeruginosa is frequently found in the lungs of patients with cystic fibrosis (CF), where it causes a chronic infection . The importance of alginate in the pathogenesis was demonstrated by the ability to establish chronic P . aeruginosa lung infection in rats if P . aeruginosa entrapped in minute alginate-beads were inoculated transtracheally . Alginate beads containing P . aeruginosa were formed by nebulizing a suspension of seaweed sodium-alginate and P . aeruginosa into a calcium solution . The alginate bead method of establishing infection was compared to an agar-bead method and proved to be quantitatively similar after 4 weeks . The ability of the two methods to induce formation of precipitins, IgA and IgG antibodies against P . aeruginosa antigens, including outer membrane proteins, flagella, exoenzymes and alginate, was assessed by crossed immunoelectrophoresis, enzyme-linked immunosorbent assay and immunoblotting . The two methods of inducing infection were comparable and infected rats had significantly higher antibody response than rats inoculated with sterile beads . We suggest that the alginate bead model closely resembles the later stages of CF-lung infection and that it offers the theoretical advantage of using a substance which is chemically similar to the alginate produced in vivo by P . aeruginosa. Appl Environ Microbiol, 1990 Mar, 56(3), 788 - 95 Kinetics of Pseudomonas aeruginosa adhesion to 304 and 316-L stainless steel: role of cell surface hydrophobicity; Vanhaecke E et al.; Fifteen different isolates of Pseudomonas aeruginosa were used to study the kinetics of adhesion to 304 and 316-L stainless steel . Stainless steel plates were incubated with approximately 1.5 X 10(7) CFU/ml in 0.01 M phosphate-buffered saline (pH 7.4) . After the plates were rinsed with the buffer, the number of adhering bacteria was determined by a bioluminescence assay . Measurable adhesion, even to the electropolished surfaces, occurred within 30 s . Bacterial cell surface hydrophobicity, as determined by the bacterial adherence to hydrocarbons test and the contact angle measurement test, was the major parameter influencing the adhesion rate constant for the first 30 min of adhesion . A parabolic relationship between the CAM values and the logarithm of the adhesion rate constants (In k) was established . No correlation between either the salt aggregation or the improved salt aggregation values and the bacterial adhesion rate constants could be found . Since there was no significant correlation between the bacterial electrophoretic mobilities and the In k values, the bacterial cell surface charge seemed of minor importance in the process of adhesion of P . aeruginosa to 304 and 316-L stainless steel. J Bacteriol, 1990 Mar, 172(3), 1340 - 4 The CAM-OCT plasmid enhances UV responses of Pseudomonas aeruginosa recA mutants; McBeth DL; The effect of the CAM-OCT plasmid on responses to UV irradiation of Pseudomonas aeruginosa recA mutants was characterized . Mutant alleles examined included rec-1, rec-2, and recA7::Tn501 . The plasmid substantially enhanced both survival and mutagenesis of RecA- cells after treatment with UV light . Survival of the RecA-(CAM-OCT) cells after UV irradiation was intermediate between that seen in the wild-type P . aeruginosa PAO1 and the increased survival seen in PAO1(CAM-OCT) cells . Mutability was quantitated by the reversion to carbenicillin resistance of strains carrying a bla(Am) mutation on a derivative of plasmid RP1 . UV-induced mutagenesis of CAM-OCT carrying recA mutants occurred at levels comparable to that seen in PAO1(CAM-OCT) . The ability of CAM-OCT plasmid to suppress the recombination deficiency in recA mutants was tested by assaying for bacteriophage F116L-generalized transduction of a Tn7 insertion in the alkane utilization genes of CAM-OCT . Transduction of the Tn7 insertion was not detected in RecA-(CAM-OCT) strains but was easily seen in PAO1(CAM-OCT), indicating that the plasmid does not encode a recA analog . The results indicate that the CAM-OCT UV response genes are expressed in RecA- cells, which differs from results seen with other UV response-enhancing plasmids . The results suggest that CAM-OCT either encodes several UV responses genes itself or induces chromosomal UV response genes by an alternate mechanism. Infect Immun, 1990 Mar, 58(3), 808 - 15 Inhibitory and stimulatory effects of Pseudomonas aeruginosa pyocyanine on human T and B lymphocytes and human monocytes; Ulmer AJ et al.; Pyocyanine, a pigment produced by Pseudomonas aeruginosa, has dual dose-dependent stimulatory as well as inhibitory effects on immune responses in vitro as measured by DNA synthesis of human T and B lymphocytes, interleukin-2 (IL-2) production by human T lymphocytes, immunoglobulin production by human B lymphocytes, and monokine production by human monocytes . In general, stimulatory activity was found at low concentrations of pyocyanine, whereas high concentrations of the pigment resulted in an inhibition of responses . At a pyocyanine concentration of 0.1 micrograms/ml or less the proliferation of T and B lymphocytes was enhanced, but at 0.5 micrograms/ml it was suppressed . IL-2 production by T lymphocytes was enhanced at concentrations up to 0.5 micrograms/ml but totally inhibited at 1.0 micrograms/ml . The differentiation of B lymphocytes to become immunoglobulin-producing cells was also enhanced in the presence of low doses of pyocyanine, whereas secretion of immunoglobulin by B lymphocytes was suppressed at all concentrations of pyocyanine . In contrast to the dual effects of pyocyanine on lymphocyte response, lipopolysaccharide-induced IL-1 and tumor necrosis factor release by monocytes was markedly enhanced by low as well as high concentrations of pyocyanine . From these results we conclude that this property of pyocyanine may lead to suppression of specific defense mechanisms and enhance harmful inflammatory reactions of the host during infection with Pseudomonas aeruginosa. Infect Immun, 1990 Mar, 58(3), 659 - 66 Characterization of phospholipase C from Pseudomonas aeruginosa as a potent inflammatory agent; Meyers DJ et al.; Phospholipase C (PLC) from Pseudomonas aeruginosa induced a marked inflammatory response when injected intraperitoneally in C3H/HeJ mice . This inflammation was characterized by the accumulation of inflammatory cells and plasma protein and the release of arachidonic acid metabolites (6-trans-12-epi-leukotriene B4 {LTB4}, 6-trans-LTB4, LTB4, 5-HETE (5-hydroxyeicosatetraenoic acid), LTC4, LTD4, LTE4, prostaglandin E2 {PGE2}, PGF2-alpha, and thromboxane B2 {TxB2}) in the peritoneal cavity of the mice . Heat-inactivated PLC did not evoke any of these effects, suggesting that enzyme activity is necessary for PLC-induced inflammation . When human granulocytes were incubated with PLC in vitro, 6-trans-12-epi-LTB4, 6-trans-LTB4, LTB4, 5-HETE, and PGE2 were generated . Mouse peritoneal cells stimulated with PLC released 6-trans-LTB4, LTB4, PGE2, PGF2-alpha, and TxB2 . Both human granulocytes and mouse peritoneal cells stimulated with PLC generated significantly increased levels of arachidonic acid metabolites as compared with cells incubated with heat-inactivated PLC . Leukotriene production by both populations of cells was inhibited when the cells were preincubated with nordihydroguaiaretic acid and subsequently stimulated with PLC . Similarly, both cell types released significantly lower amounts of cyclooxygenase pathway products when they were preincubated with indomethacin and subsequently stimulated with PLC. J Infect Dis, 1990 Mar, 161(3), 541 - 8 The effect of piliation and exoproduct expression on the adherence of Pseudomonas aeruginosa to respiratory epithelial monolayers; Saiman L et al.; The adherence properties of Pseudomonas aeruginosa strains with known pilin DNA sequences were studied . A polar pilus clearly contributed to adherence, as 35S-labeled pilus-positive (Pil+) strains bound significantly more to bovine trachea epithelial monolayers than did pilus-negative (Pil-) mutants (P less than .05) and minimally more than hyperpiliated strains . A pil- mutant PAK/NP, constructed by gene replacement, demonstrated low levels of attachment (3.8% of the inoculum adherent compared with 7% for the wild-type strain PAK), suggesting that other adhesins are functional . The Pil-, flagellum-negative strain PAO1150.1 bound the least (0.3% of the inoculum adherent), confirming the importance of motility in the binding process . The pilin sequences of strains P1 and PA1244 were virtually identical, although P1 bound threefold more than did PA1244 . P1 produced 10-fold more proteinase than did PA1244, and a proteinase-negative mutant of P1, isolated by transposon mutagenesis, had binding equivalent to that of PA1244 . The adherence of PAO1 was increased 60% in the presence of bacterial supernatants from phosphate-limited cultures and correlated with phospholipase C activity in the supernatant . Thus, the expression of several Pseudomonas genes may be required to promote efficient binding to epithelial surfaces. Biotechnology (N Y), 1990 Mar, 8(3), 228 - 30 Enhanced removal of Exxon Valdez spilled oil from Alaskan gravel by a microbial surfactant; Harvey S et al.; Remediation efforts for the oil spill from the Exxon Valdez tanker in Alaska have focused on the use of pressurized water at high temperature to remove oil from the beaches . We have tested a biological surfactant from Pseudomonas aeruginosa for its ability to remove oil from contaminated Alaskan gravel samples under various conditions, including concentration of the surfactant, time of contact, temperature of the wash, and presence or absence of xanthan gum . The results demonstrate the ability of the microbial surfactant to release oil to a significantly greater extent (2 to 3 times) than water alone, particularly at temperatures of 30 degrees C and above. Nucleic Acids Res, 1990 Feb 25, 18(4), 979 - 88 The roles of indoleglycerol phosphate and the TrpI protein in the expression of trpBA from Pseudomonas aeruginosa; Chang M et al.; The TrpI protein belongs to the LysR-family of procaryotic regulatory proteins . Members of this family share a characteristic similarity of their N-terminal amino acid sequences, and many of them are activators of divergently transcribed genes or operons . In Pseudomonas aeruginosa, the genes for tryptophan synthase, trpBA, are regulated by indoleglycerol phosphate (InGP) and TrpI . We demonstrate here that in the absence of InGP, the binding site of TrpI is located in the -52 to -77 region of the trpBA promoter; in the presence of InGP, the binding region is extended to the -32 region . In addition, two major, slow moving protein-DNA complexes are seen in gel retardation assays: the faster moving complex is formed in the absence of InGP and the amount of the slower moving complex is greatly enhanced in the presence of InGP . These results suggest that the binding of a second TrpI protein molecule, promoted by InGP, plays a crucial role in activating the expression of the trpBA gene pair. FEBS Lett, 1990 Feb 12, 261(1), 196 - 8 Cloning and sequencing of the gene encoding cytochrome c-551 from Pseudomonas aeruginosa; Arai H et al.; The cytochrome c-551 gene from Pseudomonas aeruginosa was cloned by using two oligonucleotide probes, which had been synthesized based on the known primary structure of the protein . The restriction map of the cloned DNA and sequence analysis showed that the cytochrome c-551 gene is located 50 bp downstream of the nitrite reductase gene, which has recently been cloned and sequenced . DNA sequence analysis also indicated that cytochrome c-551 is synthesized in vivo as a precursor having an amino-terminal signal sequence consisting of 22 amino acid residues. Clin Pharm, 1990 Feb, 9(2), 102 - 18 Treatment of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis; Horton MW et al.; The epidemiology, etiology, pathogenesis, diagnosis, and pharmacotherapy of peritonitis in patients with end-stage renal disease treated with continuous ambulatory peritoneal dialysis (CAPD) are reviewed . CAPD-associated peritonitis is a localized infection of the peritoneal cavity . Approximately 70% of the cases are caused by a single gram-positive microorganism indigenous to the patient's skin or upper respiratory tract that infects the peritoneal cavity . Gram-negative microorganisms cause 25% of the cases; fungi, anaerobes, and mycobacteria cause approximately 5% . Clinical manifestations include a cloudy, turbid peritoneal dialysate effluent and abdominal pain or tenderness . Diagnosis is confirmed by the detection and isolation of microorganisms in the peritoneal dialysate effluent . Of patients with CAPD-associated peritonitis, 70-80% can be successfully treated on an outpatient basis with intraperitoneal (i.p.) instillation of antimicrobials . Vancomycin, cephalosporins, and aminoglycosides are the agents most commonly used to treat CAPD-associated peritonitis . Most recently, alternative dosing regimens using intermittent i.p . administration of vancomycin have been used . In certain types of CAPD-associated peritonitis (those caused by Pseudomonas aeruginosa or fungi), removal of the peritoneal catheter may be required to achieve a cure . Approximately two thirds of the patients transferring to another form of dialysis from CAPD do so because of peritonitis . Currently available data indicate that the most effective therapy for CAPD-associated peritonitis is i.p . administration of antimicrobial agents with activity against the suspected microorganism. J Surg Res, 1990 Feb, 48(2), 147 - 53 The effect of blood transfusions on immune function . V . The effect on the inflammatory response to bacterial infections; Waymack JP et al.; Blood transfusions have been shown to be associated with increased bacterial infection rates in colon cancer patients and in multiple animal studies . This increased susceptibility appears due to impairments in the systemic resistance to infections and not to alterations in the local response . Specifically, transfusions in a rat model were not found to alter the peritoneal cavity's response to an Escherichia coli challenge or the burn wound's response to a Pseudomonas aeruginosa challenge . Transfusions did impair the macrophage's ability to phagocytose and kill bacteria . Transfusions also increased the serum level of the immunosuppressive glucocorticoid, corticosterone. Nihon Kyobu Shikkan Gakkai Zasshi, 1990 Feb, 28(2), 300 - 7 {Clinical and ultrastructural study on primary ciliary dyskinesia}; Amitani R et al.; We evaluated laboratory and radiological findings and examined tracheobronchial cilia by transmission electron microscopy in 9 patients with primary ciliary dyskinesia (PCD), in order to elucidate the clinical pictures of PCD and the relationship between PCD and diffuse panbronchiolitis (DPB) which was proposed as a new disease entity in Japan in 1969 . The clinical pictures of our PCD patients were almost the same as that already described in several articles in Europe and North America; early onset of respiratory symptoms, high incidence of chronic sinusitis and otitis media exudative as well as infertility, continuous infections in the lower respiratory tracts (Hemophilus influenzae, Pseudomonas aeruginosa etc.) . Tracheobronchial cilia obtained by brushing technique were immotile (6 out of 8 patients) or dyskinetic (2 out of 8 patients) . Ultrastructural study of cilia revealed the lack of dynein arms in all patients: the lack of both outer and inner arms (4 patients), the lack of outer arms (2 patients), the lack of inner arms (2 patients) . Chest X-ray films revealed situs inversus in six out of nine patients . According to the radiological findings (chest X-ray film, CT-scan, bronchogram), the patients were divided into three groups; I: localized bronchiectasis (5 patients), II: diffuse micronodular lesions without definite bronchiectasis (3 patients), III: diffuse micronodular lesions with bronchiectasis (1 patient) . Two patients of the second group satisfied the clinical diagnostic criteria for DPB (Chest 83:63, 1983) . In conclusion, PCD can cause a variety of respiratory tract lesions such as bronchiectasis, DPB and other types of peripheral airway disorders. J Med Assoc Thai, 1990 Feb, 73(2), 106 - 10 Early versus late onset neonatal septicemia at Children's Hospital; Prasertsom W et al.; An analysis was made of 695 cases of neonatal sepsis at Children's Hospital from 1982 to 1986 . The incidence of neonatal sepsis and septicemia were 6.5 and 2.4 per 1,000 livebirths respectively . There were 178 cases of septicemia with onset during the first four days of life (early onset group) and 77 cases with onset after four days of life (late onset group) . Both groups did not differ significantly in sex, birth weight and gestational age . Most of the cases had low birth weight and were premature . Pneumonia was the common associated infection . Omphalitis was found more frequently in the early onset of septicemia, whereas, NEC and skin infection were found more in the late onset group . Pseudomonas aeruginosa and Klebsiella pneumoniae were the major causes of infection in both groups . Staphylococcus was more common in late septicemia . No statistical difference in major complications was found between the two groups . Fatality rate in early and late septicemia was 32.6 and 28.2 per cent respectively. Harefuah, 1990 Feb 1, 118(3), 149 - 50 {Pseudomonas aeruginosa arthritis and discitis in systemic lupus erythematosus}; Mader R et al.; Patients with systemic lupus erythematosus (SLE) are prone to develop opportunistic infections . Nevertheless, arthritis due to Pseudomonas aeruginosa in SLE is very rare and seems to be related to corticosteroid therapy and previous penetrating injury . A 17-year-old girl with SLE and Pseudomonas arthritis and discitis which followed laparotomy is described . Arthritis is a common manifestation of SLE, but arthritis due to infection with Pseudomonas is very serious and the diagnosis should not be missed. Curr Eye Res, 1990 Feb, 9(2), 129 - 38 Aging alters the phagocytic capability of inflammatory cells induced into cornea; Hazlett LD et al.; The changes in mouse corneal inflammatory cell population and the phagocytic capability of these cells were studied quantitatively at 24 and 48 hours after eliciting inflammatory cells into the cornea by Pseudomonas aeruginosa inoculation . Mice were selected for study according to their ability (young adult Swiss-Webster) or inability (aged Swiss-Webster) to restore corneal clarity after bacterial inoculation . Inflammatory cells were recovered from enzymatically disaggregated corneas, nucleated cells counted, and cell viability assessed to be 95% by trypan blue dye exclusion . Polymorphonuclear neutrophilic leukocytes (PMN) and macrophages recovered in this manner showed no significant differences in cell population contribution to the differential leukocyte count, but did show significantly fewer phagocytically active cells in aged when compared with young adult mice . These phagocytosis data were confirmed in a separate study using peripheral blood cells obtained from uninoculated mice of each age . The impaired phagocytic function seen in aged mice may contribute to the failure to resolve corneal clarity observed in these animals after Pseudomonas infection. Klin Monatsbl Augenheilkd, 1990 Feb, 196(2), 70 - 5 {The extent of bacterial contamination of keratoplasty donor eyes post mortem}; Ritter E et al.; In order to determine the initial bacterial contamination of corneal donor material the abraded epithelia from 125 donors, i.e., 250 globes, were examined immediately after enucleation . Of these, 49 (19.6%) were sterile, while 201 (80.4%) were contaminated . Monoinfection was identified in 174 globes and mixed infection in 27 . The pathogen most frequently isolated was Pseudomonas aeruginosa . Neither the donor's age not the time elapsed between death and enucleation had any influence on the contamination rate . Prolonged hospitalization of donors leads to an increase in gram-negative bacteria . The necessity of antibacterial prophylaxis prior to keratoplasty is pointed out. Circ Shock, 1990 Feb, 30(2), 117 - 27 Ranitidine compared to cimetidine in multiagent pharmacological treatment of porcine Pseudomonas ARDS; Byrne K et al.; The effects of two pharmacologically distinct histamine H2 receptor antagonists were studied in combination with ibuprofen (I) and diphenhydramine (D) in a porcine model of septic ARDS . Cimetidine (C) is reported as having direct oxygen radical scavenging abilities and is an inhibitor of cytochrome P-450, whereas ranitidine (R) acts solely by H2 receptor blockade . Four groups were studied: Group Ps (n = 8) received a continuous infusion of live Pseudomonas aeruginosa 5 x 10(8) CFU/ml at 0.3 ml/20kg/min, Group C (n = 6) received a control saline infusion, and the treatment groups received I (12.5 mg/kg) and D (10 mg/kg) in combination with either C (150 mg, CID, n = 6) or R (25 mg, RID, n = 5) given at 20 and 120 minutes after the onset of Ps . Pulmonary (PAP) and systemic (SAP) arterial pressures, cardiac index (CI), PaO2, thermal cardiogreen extravascular lung water (EVLW) and scintigraphically determined pulmonary albumin flux (slope index, SI) were measured . Ps infusion produced significant (p less than 0.05) cardiovascular collapse, hypoxemia and increased EVLW and SI . Both CID and RID temporarily reversed pulmonary arterial hypertension and maintained PaO2, EVLW, SAP and CI at control levels throughout the study, and significantly improved SI at 180 min . These results suggest that cimetidine and ranitidine act in this combination therapy primarily as H2 receptor antagonists. J Ky Med Assoc, 1990 Feb, 88(2), 66 - 8 Hot tub (Pseudomonas) folliculitis; Fowler JF Jr et al.; Folliculitis caused by Pseudomonas aeruginosa is a rare, adverse effect of the therapeutic or recreational use of hot tubs, whirlpools, and occasionally swimming pools . The condition is characterized by painful, papulopustular skin lesions often accompanied by low-grade fever, malaise, and other systemic symptoms . Prompt recognition and treatment may shorten the duration of the disease and, more importantly, prevent further cases by identifying the source of exposure. Acta Anaesthesiol Scand, 1990 Feb, 34(2), 167 - 70 Spondylitis without epidural abscess formation following short-term use of an epidural catheter; Lynch J et al.; A 42-year-old patient had undergone total hip replacement for aseptic femoral head necrosis 9 years previously . He now presented with loosening of the prosthesis and pseudoarthrosis sustained following a femoral shaft fracture 7 months earlier . A total hip replacement was carried out in general anaesthesia combined with an epidural catheter . The epidural catheter was removed on the third postoperative day, after which the patient complained of persistent lumbar pain which was associated with meningismus, fever, leucocytosis and a raised erythrocyte sedimentation rate . In spite of intensive laboratory and radiological investigation, 15 weeks elapsed before a radiological diagnosis of spondylitis of L1 and L2 could be made . Aspiration biopsy of the L1/L2 disc space yielded a growth of Pseudomonas aeruginosa . Antibiotic therapy was begun immediately but could not prevent spread of infection to the adjacent disc-space T12/L1 and the vertebral body T12 . The patient made a slow recovery and was discharged in a satisfactory condition wearing a lumbar brace some 9 months after the operation . No evidence of epidural abscess formation was found at any stage and no direct connection between the use of the epidural catheter and spondylitis could be established. Ann Otol Rhinol Laryngol, 1990 Feb, 99(2 Pt 1), 117 - 9 Aural irrigation with water: a potential pathogenic mechanism for inducing malignant external otitis? Rubin J, Yu VL, Kamerer DB, Wagener M. We hypothesized that the forcible introduction of water containing Pseudomonas aeruginosa into the ear canal of a susceptible host (an elderly diabetic with cutaneous hypoperfusion secondary to microangiopathy) was the inciting factor in the development of malignant external otitis . Tap water irrigation of the ears by a physician preceded the onset of symptoms in 61.5% (8/13) of cases of malignant external otitis . Two control subjects with known diabetes mellitus were matched for each patient by sex and age . Both groups were questioned on the nature and degree of aural water exposure, as we