[Aerococcus urinae. A newcomer among pathogenic bacteria in clinical and microbiological practice]

A decade ago we discovered a hitherto unrecognized Aerococcus-like organism (ALO) in urine specimens from patients with urinary tract infection. Further microbiological and clinical investigations enabled us to classify it as a human pathogen also causing urogenic septicaemia and endocarditis, the latter often with lethal outcome. The organism is now designated Aerococcus urinae.

Morbidity and mortality of ischaemic heart disease in high-risk breast-cancer patients after adjuvant postmastectomy systemic treatment with or without radiotherapy: analysis of DBCG 82b and 82c randomised trials. Radiotherapy Committee of the Danish Breast Cancer Cooperative Group

BACKGROUND

Radiotherapy in addition to systemic treatment after mastectomy prolongs survival in high-risk breast-cancer patients. However, adjuvant radiotherapy has a potential association with ischaemic heart disease. We assessed morbidity and mortality from ischaemic heart disease in patients treated with postmastectomy radiotherapy.

METHODS

Between 1982 and 1990, we randomly assigned 3083 women at high risk of breast cancer, after mastectomy, adjuvant systemic treatment with (n=1538) or without (n=1545) radiotherapy. An anterior photon field was used against the periclavicular region and the axilla. The chest wall was treated through two anterior shaped electron fields, one including the internal mammary nodes. The intended dose was 48-50 Gy in 22-25 fractions, at four to five fractions per week. We obtained information on morbidity and mortality of ischaemic heart disease over a median of 10 years. Analysis was by intention to treat.

FINDINGS

More women in the no-radiotherapy group than in the radiotherapy group died of breast cancer (799 [52.5%] vs 674 [44.2%]), whereas similar proportions of each group died from ischaemic heart disease (13 [0.9%] vs 12 [0.8%]). The relative hazard of morbidity from ischaemic heart disease among patients in the radiotherapy compared with the no-radiotherapy group was 0.86 (95% CI 0.6-1.3), and that for death from ischaemic heart disease was 0.84 (0.4-1.8). The hazard rate of morbidity from ischaemic heart disease in the radiotherapy group compared with the no-radiotherapy group did not increase with time from treatment.

INTERPRETATION

Postmastectomy radiotherapy with this regimen does not increase the actuarial risk of ischaemic heart disease after 12 years.

Endocarditis caused by Abiotrophia species

Two cases of endocarditis with nutritionally variant streptococci are presented. Such strains have recently been included in the new genus Abiotrophia. A total of 12 additional Abiotrophia strains, including the type strains of Abiotrophia defectiva and Abiotrophia adiacens, were characterized in order to comment on their microbiological characteristics.

Aerococcus urinae: intraspecies genetic and phenotypic relatedness

A number of Aerococcus-like organisms were recently recognized as human pathogens. Five Aerococcus-like strains were proposed as members of the new species Aerococcus urinae (with type strain E2 [= NCTC 12142]) on the basis of the results of a 16S rRNA sequence analysis. The intraspecies phenotypic and genetic relatedness of 22 selected A. urinae strains was investigated, and a hitherto unrecognized esculin hydrolysis-positive biotype was identified. A total of 14 of the 15 more common esculin-negative strains exhibited very high DNA relatedness as determined by the hydroxyapatite method (the levels of relatedness were greater than 90% in 55 and 70 degrees C reactions, with 1.5% or less divergence in related sequences). The DNA relatedness among the six esculin-positive strains was more heterogeneous, and two DNA hybridization subgroups were formed. Our results are compatible with the hypothesis that both biotypes are members of the single species A. urinae, which contains two or more genetic subspecies. The putative subspecies have not been formally proposed since they cannot be definitively differentiated. The inclusion of A. urinae in the genus Aerococcus is supported by the results of 16S rRNA sequencing. The rRNA sequence data also is compatible with placing both biotypes in a single species.

Serum antibody response to outer membrane proteins of Moraxella (Branhamella) catarrhalis in patients with bronchopulmonary infection

A Western blot (immunoblot) method for detecting antibodies against outer membrane protein (OMP) epitopes of Moraxella (Branhamella) catarrhalis was evaluated. Paired serum samples from patients suspected of M. catarrhalis (n = 38) and non-M. catarrhalis (n = 25) bronchopulmonary infection were examined for the presence of antibodies of the immunoglobulin M (IgM), IgG, and IgA classes to OMPs from M. catarrhalis by a gel electrophoresis-immunoperoxidase technique (Western blotting); sera from 40 healthy adult blood donors were also included. A significantly (P = 0.004) more frequent occurrence of IgM-class antibodies and/or an increase in the number of IgG-class antibodies against different M. catarrhalis OMPs from acute- to convalescent-phase serum samples was found for patients with M. catarrhalis (79%) than for patients without M. catarrhalis (40%). IgM-class antibodies against OMPs of M. catarrhalis were found in acute- and/or convalescent-phase serum samples form 58% of patients with M. catarrhalis and 32% of patients without M. catarrhalis. Fifty percent of patients with M. catarrhalis and 16% of patients without M. catarrhalis had, from acute- to convalescent-phase serum samples, an increased number of IgG-class antibodies directed against different OMPs. A total of 34% of patients with M. catarrhalis and 4% of patients without M. catarrhalis had, from acute- to convalescent-phase serum samples, an increased number of IgA-class antibodies directed against different OMPs. The present study indicates that M. catarrhalis is one of the bacteria involved in acute exacerbations of chronic bronchitis.

Aerococcus-like organisms: use of antibiograms for diagnostic and taxonomic purposes

Recently, some Aerococcus-like organisms (ALOs), isolated from urine and blood of elderly patients with urinary tract infection, have been described. In this study ALOs and related taxons were tested for susceptibility by agar diffusion and agar dilution methods to 15 selected antimicrobial agents for diagnostic and taxonomic considerations. ALOs were susceptible to a wide range of antimicrobials including beta-lactams, but resistant to aminoglycosides, sulphonamides, trimethoprim and nalidixic acid. By using tablets containing vancomycin, furazolidone and bacitracin, it was possible to separate ALOs from related taxons. Clustering based on antibiotic susceptibilities showed that there is little similarity between Aerococcus viridans and ALOs.

Bacteremia/septicemia due to Aerococcus-like organisms: report of seventeen cases. Danish ALO Study Group

Some Aerococcus-like organisms (ALOs) have recently been described in Denmark. The bacteria were originally isolated from the urine of elderly patients with urinary tract infections. Since 1987, we have identified 17 cases of bacteremia/septicemia in which ALOs have been isolated in pure culture of blood; we report the data from these cases. Six of the patients presented with endocarditis, eight presented with urosepticemia, and three presented with septicemia. In all but one of the reports, the urinary tract was suspected as the focus of infection, and ALOs were isolated from the urine of nine patients. All but one patient had predisposing illnesses; these were predominantly of urinary or cardiac origin. Five patients died of their infection, two survived the infection but eventually died during hospitalization, and 10 recovered. All of the patients received adequate antimicrobial therapy.

Moraxella (Branhamella) catarrhalis: restriction enzyme analysis typing with HinfI, HaeIII and PstI

Restriction enzyme analysis typing with HinfI, HaeIII and PstI was performed on Moraxella (Branhamella) catarrhalis strains consecutively collected from children suspected of respiratory tract infection and the type strain. Use of HinfI gave the most distinct patterns. Great polymorphism was seen among strains.

Serum antibody response to proteins of Moraxella (Branhamella) catarrhalis in patients with lower respiratory tract infection

We searched for antibodies against Moraxella (Branhamella) catarrhalis proteins in the sera of patients with lower respiratory tract infection. Sera from 48 patients with M. catarrhalis and 39 patients without M. catarrhalis in their lower respiratory tract specimens were studied by a gel electrophoresis-immunoperoxidase technique; sera from 23 healthy adult blood donors were also included. Immunoglobulin G (IgG) antibodies against a 28-kDa protein were found significantly more frequently in patients with M. catarrhalis in lower respiratory tract specimens (71%) than in patients without M. catarrhalis in lower respiratory tract specimens (28%) or healthy adult blood donors (22%). Seroconversion, from the acute to the convalescent stages, occurred in at least eight patients with M. catarrhalis and in one patient without detectable M. catarrhalis. IgG antibodies against other M. catarrhalis proteins were found in most sera, including those obtained from blood donors. By adsorption experiments the 28-kDa protein was demonstrated to be surface exposed. IgM antibodies against an 85-kDa protein were found in serum from one patient from whom M. catarrhalis and Streptococcus pneumoniae were isolated from the lower respiratory tract, while IgA antibodies against M. catarrhalis proteins could not be detected in any serum specimen.

Lautropia mirabilis gen. nov., sp. nov., a gram-negative motile coccus with unusual morphology isolated from the human mouth

An organism that seems to be identical to Orskov's 'Sarcina mirabilis' [Orskov, J. (1930) Acta Pathol Microbiol Scand Suppl III, 519-541] has been rediscovered in specimens from the upper respiratory tract of humans. Six strains were studied, and the results, which conformed to Orskov's description of S. mirabilis, were as follows. Rough to smooth colonies grow on many plated media and show extremely polymorphic cell morphology with round cells with diameters from 1 to > 10 microns. The smallest cells were often motile with circular movements. Strains were Gram-negative, facultatively anaerobic, oxidase and urease positive, and weakly catalase positive. Nitrate and nitrite were reduced, and glucose, fructose, sucrose and mannitol were fermented. Polysaccharide was produced on sucrose agar. Electron microscopy showed coccoid cells with a bundle of three to nine flagella, a Gram-negative cell-wall morphology, and aggregates of irregular cells held together by a common surface layer. The mean mol% (G+C) of the organisms was 65.0. 16S-ribosomal RNA sequencing revealed that the organism belongs to the beta subgroup of Proteobacteria, separate from all other described genera, but most closely related to Burkholderia. The name Lautropia mirabilis is proposed for this organism.

Genotypic and phenotypic relatedness of 80 strains of Branhamella catarrhalis of worldwide origin

80 clinical Branhamella catarrhalis strains of worldwide origin were examined for genotypic relatedness and phenotypic characteristics. Using a quantitative bacterial dot method for DNA-DNA hybridization the strains were found to form a homogeneous group with delta Tm-values ranging from 0.0-2.3 degrees C, In Minibact-N, an identification kit for oxidase positive, Gram-negative diplococci using eight phenotypic characteristics, all isolates were correctly identified and also demonstrated complete homogeneity except for beta-lactamase production. Type strains representing the genera Branhamella, Moraxella and Neisseria were also examined for comparison. B. catarrhalis strain NCTC 4103-known to be atypical-had a delta Tm-value of 5.7 degrees C and produced gamma-glutamylaminopeptidase, in contrast to all other B. catarrhalis strains. In GN MicroPlate, a kit which tests utilizable carbon sources, B. catarrhalis strains were found to be able to utilize up to 16 to 95 carbon sources.

Group-delay diagnostic for measuring vapor column density

We describe a technique for determining Nfl by measuring the group-velocity delay of a probe laser beam propagating through a vapor. This diagnostic has wide dynamic range, is simple to implement, and can be used as a high-bandwidth vapor rate monitor. In addition, it can be used to measure column density, Nl, number density, N, oscillator strengths, f, or absorption cross sections, collisional line broadening, and vapor group-velocity delay.

Aerococcus-like organism, a newly recognized potential urinary tract pathogen

During the last 10 to 15 years, Aerococcus-like organisms have been isolated from urinary tract specimens from hospitalized patients at Bispebjerg Hospital, Copenhagen, Denmark, with signs of urinary tract infection, and a single strain has been deposited at the National Collection of Type Cultures (NCTC 12142). An additional 63 isolates from the urine specimens of as many patients with suspected urinary tract infection have been identified from seven departments of clinical microbiology in Denmark. Clinical information indicates that this organism may be involved in urinary tract infection. These strains and ten previously collected strains, two of which were from blood cultures, were characterized phenotypically. By comparing the results with data on other gram-positive, catalase-negative cocci or coccobacillary organisms, the identified organisms seem to represent a separate taxon.

[Treatment of cervix cancer in Denmark]

The current status of cervical cancer treatment in Denmark is discussed. Diagnostic aspects and problems of classification are presented briefly supplemented with a comment on new prognostic parameters based on a semiquantitative score system and flow cytometry. Surgery is the treatment of election for the early stages whereas radiotherapy is the treatment of choice in advanced stages. Chemotherapy should only be employed in the framework of clinical trials. It is concluded that centralised treatment should be maintained.

Fatal septicaemia with Selenomonas sputigena and Acinetobacter calcoaceticus. A case report

A 38-year-old man with a history of alcohol abuse developed rapidly fulminating septicaemia and died. Selenomonas sputigena and Acinetobacter calcoaceticus were isolated from a blood culture. Selenomonas sputigena is a motile anaerobic gram-negative rod rarely associated with systemic disease. Difficulties in isolation and taxonomic identification are discussed.

Urosepticemia and fatal endocarditis caused by aerococcus-like organisms

Two cases of invasive infections with aerococcus-like organisms (ALO) are presented: an 81-year-old man with fatal endocarditis and a 63-year-old man with urosepticemia. No antigenic relationship was found between ALO and Aerococcus viridans (NCTC 8251) in crossed immunoelectrophoretic assay.

Evaluation of radiotherapy in high-risk breast cancer patients: report from the Danish Breast Cancer Cooperative Group (DBCG 82) Trial

The role of postmastectomy irradiation together with systemic treatment was evaluated in high-risk patients included in the Danish Breast Cancer Cooperative Group (DBCG) protocol 82. As of June 1989, a total of 1473 pre- and menopausal patients were randomized to postmastectomy irradiation + CMF versus CMF alone (protocol 82-b). A total of 1202 postmenopausal patients were randomized to postmastectomy irradiation + Tamoxifen versus Tamoxifen alone (protocol 82-c). At 5 years the actuarial loco-regional recurrence rate was significantly lower in the irradiated patients (82-b: 9% vs 28%, 82-c: 6% vs 36%). Further, disease-free survival was significantly improved in both pre- and postmenopausal irradiated patients compared with those who had only systemic treatment (82-b: 54% vs 47%, 82-c: 52% vs 38%). At present, overall survival is significantly different in 82-b patients (68% vs 63%) but not in post-menopausal 82-c patients (62% vs 61%). Thus, adjuvant systemic treatment alone (chemotherapy or tamoxifen) did not prevent loco-regional recurrences in high-risk patients after mastectomy and axillary lymph node sampling. However, a longer observation time is necessary to evaluate the consequence of primary optimal loco-regional tumor control in high-risk breast cancer patients with respect to overall survival.

Antimicrobial susceptibility and beta-lactamase characterization of Branhamella catarrhalis isolates from 1983/1984 and 1988

Branhamella catarrhalis isolates from lower respiratory tract specimens collected in 1983/84 (n = 50) and 1988 (n = 30) were examined for beta-lactamase production. The percent of beta-lactamase-producing strains increased from 25% to 63% from 1983/84 to 1988. beta-lactamases from 30 strains could be typed, and of these 28 were of the BRO-1 type and two the BRO-2 type. The two beta-lactamase inhibitors, clavulanic acid and brobactam were very active against beta-lactamase extracts whether of the BRO-1 or the BRO-2 type. Susceptibility to a number of antimicrobial agents or combinations of agents was determined by a plate dilution method (MICs) and by a tablet diffusion method. The penicillin tablet (Rosco Neo-Sensitabs) was found to be useful in discriminating between beta-lactamase-producing and non-beta-lactamase- producing strains of B. catarrhalis.

Haemophilus isolated from unusual anatomical sites

During a 15-year period Haemophilus species were isolated from unusual anatomical sites in 80 patients, mostly adults. The origin of specimens was pus and swabs from suppurative lesions, fluids from serosal cavities and gall bladder, gut content, and blood in cases with a supposed tissue focus. In 17 patients Haemophilus species were isolated in pure culture, in 63 patients in conjunction with other bacteria. 17 patients had gynaecological complaints: bartholinitis, salpingitis, and vaginal discharge. 22 patients had gastrointestinal complaints, comprising 17 with appendicitis, peritonitis following perforation of gastric ulcer, gall-duct infections, and an abscess in the stomach wall, and 5 patients with colonization of the gut. 41 patients had soft tissue and bone infections.

Aerococcus-like organism--an unnoticed urinary tract pathogen

Aerococci are only occasionally isolated from urinary tract specimens. A 4-month' survey revealed 29 patients suspected of urinary tract infection (UTI), from whom an Aerococcus-like organism (ALO) was isolated in significant numbers from urinary tract specimens and singly in 11 cases. Approximately 0.8% of all urinary tract specimens examined during the period yielded growth of ALO. The median age of patients was 75 years. Half of the patients were found to have conditions predisposing to UTI. 9 of 11 patients without indwelling catheter, having ALO isolated in pure culture from the urine, showed one or more typical signs of UTI (fever, dysuria and/or pollakisuria and pyuria). A phenotypic comparison was made between 29 strains of ALO and 6 related organisms, including Aerococcus viridans, Streptococcus faecium, Streptococcus sanguis, Streptococcus bovis, Streptococcus Group Q and Streptococcus Group R. ALO and A. viridans showed many similarities, but, owing to characteristic differences with regard to colony morphology, biochemical reactions and antibiotic susceptibility pattern, the strains were easily separated.