[Bacteremia in 13 general hospitals of the province of Barcelona. Prospective study of 1,674 episodes. Group of Microbiologists of the County Hospitals of Catalonia]

BACKGROUND

Clinical and microbiological description of bacteremias seen in 13 regional hospitals of Barcelona.

METHODS

From January to December of 1991 a multicenter prospective study of bacteremia in regional hospitals was performed. The filiation, clinical findings and microbiological results were registered according to a common protocol.

RESULTS

We studied 1674 episodes of bacteremia (13.8 per 1000 admissions). Patients were distributed into 3 groups according to age: under 14: 204 patients, between 14 to 65: 759 and over 65: 711 patients. Men account for 55% and women for 45% of episodes. The bacteremia was hospital-acquired in 24.4% of cases. The most common foci of infection were: urinary tract (32%), respiratory tract (14%), intestinal tract (8%), intravascular catheter (7%), biliary tract (7%) and unknown (10%). The most commonly isolated strains were: Escherichia coli 544 cases, Streptococcus pneumoniae 212, Staphylococcus aureus 139, coagulase negative staphylococi 85, Non-typhoid Salmonella 66, Neisseria meningitidis 63, Pseudomonas sp. 59, Enterococcus sp. 59 and Bacteroides sp. 58. Polimicrobial bacteremia was detected in 83 episodes (5%). Related mortality rate was 9.6% (161 patients).

[Spontaneous mononucleosis caused by cytomegalovirus in the immunocompetent adult]

BACKGROUND

The first Spanish series of spontaneous infectious mononucleosis (IM) by cytomegalovirus (CMV) in immunocompetent adults is reported.

METHODS

Patients whose clinical manifestations, physical exam, analysis and serology were compatible with acute CMV infection from 1984 to 1993 were retrospectively reviewed.

RESULTS

Thirty patients with a mean age of 36 years fulfilled the diagnostic criteria. All presented fever, alone or associated with other symptoms, with a mean duration of 18 days, which persisted over 3 weeks in 36%. Physical exam showed lymph node enlargement (50%), hepatomegaly (33%), splenomegaly (20%) and was normal in 8 patients (26%). Mean leukocyte count was 9.75 x 10(9) (+/- 4.63 x 10(9) with more than 50% lymphomonocytic cells in 22 patients (76%) and reactive lymphocytes, principally from the outset, although this was observed on days 2 and 60 in 11 cases (36%). LDH, ASAT and ALAT were moderately elevated and ESR was normal. Serologic diagnosis was established from IgM (13%) seroconversion or positive IgM in the two samples with IgG four-fold increase (23%), as well as the presence of positive IgM and invariable high IgG in both determinations (26%) or all IgM positive titers in a single sample (36%).

CONCLUSIONS

Infectious mononucleosis by cytomegalovirus is an infrequently diagnosed disease which should be considered in any young patient with fever despite a little demonstrative initial physical exam absence of atypical lymphocytes or a lack of diagnostic serology.

Numerical taxonomy of an 'atypical' population of gram-positive cocci isolated from freshly dressed lamb carcasses

One hundred Gram-positive, catalase-positive strains were isolated from freshly dressed lamb carcasses. They were randomly selected from a non-selective medium and tested for 75 characters. Only nine cultures could be identified by conventional methods. A numerical taxonomic study was conducted on the whole population and 25 reference strains. At the 80% similarity level (Ssm), ten clusters were formed. Five of them were entirely composed of reference strains. Phena V and VIII contained seven isolates and two reference strains of Micrococcus. Phena VI (six unidentified isolates), VII (nine staphylococci) and IX (69 unidentified isolates) were more related to M. kristinae than to the remaining reference strains. Properties with possible implications in meat spoilage were: strong lipolytic activity (76%), anaerobic growth (85%), tolerance to 15% (w/v) NaCl (95%) and ability to grow at 15 degrees C (95%) and 4 degrees C (26%).

Effect of three commercial starters on growth of Staphylococcus aureus and enterotoxins (A-D) and thermonuclease production in broth

The growth of four enterotoxigenic Staphylococcus aureus strains was partially inhibited by three commercial starters used in the meat sausage industry when grown in APT broth at 30 degrees C statically. Starter SP318 (a mixture of selected strains of Lactobacillus sake, Pediococcus pentosaceus and Staphylococcus xylosus) showed the most inhibitory activity. Staphylococcal enterotoxins (A, B, C1 and D) synthesis was totally inhibited by the growth of the three starters, whereas staphylococcal thermonuclease production was partially inhibited in mixed cultures.

Bioavailability of levamisole administered by subcutaneous and oral routes in rabbits

The bioavailability of levamisole in rabbits was determined after subcutaneous and oral administration at three dose levels of 12.5, 16.0 and 20.0 mg/kg. After non-compartmental analysis the mean values obtained were: Cmax = 3.54, 4.51 and 5.39 micrograms/ml; tmax = 12.0, 22.0 and 20.0 min; F = 134.8, 105.4 and 124.1% after subcutaneous administration for each dose, respectively, and Cmax = 0.71, 1.32 and 1.77 micrograms/ml; tmax = 46.0, 96.0 and 84.0 min; F = 53.0, 62.0 and 80.7% after oral administration. The extent and rate of absorption from the two routes differed significantly, except for tmax at the 12.5 mg/kg dose. After compartmental analysis the pharmacokinetics of levamisole was characteristic of a two-compartment open model in 13 rabbits and of a one-compartment open model in two rabbits after subcutaneous administration, while it was two compartmental in nine and one compartmental in six rabbits after oral administration. The ka values were 0.321, 0.145 and 0.145 min-1 after subcutaneous administration and 0.054, 0.023 and 0.027 min-1 after oral administration. There were no significant differences between the values of Cmax, tmax and AUC calculated by compartmental and non-compartmental analysis.

Long-term outcome in renal transplantation with terminal cutaneous ureterostomy

We have reviewed the complications and follow-up in 6 patients who underwent kidney transplantation with cutaneous ureterostomy. Four patients had tuberculosis, 1 myelomeningocele and another congenital stenosis of the posterior urethra. Cutaneous ureterostomy was performed by suturing the edges of the distal end of the ureter to the skin. The mean follow-up was 40.6 months (range 2-105). The patient and graft survival rates were 83.3% and 66.6% respectively during the 249 months of total follow-up. Significant bacteriuria and leukocyturia were constantly present and the incidence of urinary infection was 3.1 episodes/patient/year. The early complications of the stoma were partial necrosis in 1 case and haematoma in another. The most frequent late complication was stomal stenosis requiring periodic dilatation. A plasma creatinine of 61.88 to 114.92 mumol/l reflected good long-term graft function in the remaining patients. Terminal cutaneous ureterostomy is a simple technique with good long-term results.

Rapid high-performance liquid chromatographic assay of ethynyloestradiol in rabbit plasma

A method for the determination of ethynyloestradiol in samples of rabbit plasma containing pentobarbital and heparin, the former used as an anaesthetic and the latter as an anticoagulant, has been developed. Quantification was carried out using a reversed-phase high-performance liquid chromatographic (HPLC) method in isocratic mode at room temperature, with electrochemical detection at an applied potential of +1 V vs. Ag/AgCl. Under these conditions, the retention time for ethynyloestradiol was ca. 2.9 min, the average recovery from plasma was 74.5%, and the limit of detection was 10 pg, corresponding to a plasma concentration of 50 pg/ml using 1 ml of plasma. Natural oestrogens, oestriol, oestradiol and oestrone showed peaks that did not interfere with ethynyloestradiol, and retention times of ca. 0.8, 2.4 and 3.4 min, respectively.

Pharmacokinetics of levamisole in rabbits after intravenous administration

A compartmental and non-compartmental pharmacokinetic study was carried out on rabbits after intravenous (i.v.) administration of levamisole at the three dose rates: 12.5, 16.0 and 20.0 mg/kg body weight. Using compartmental analysis, the disposition of levamisole best fitted a two-compartmental open model with mean values of alpha = 0.1278, 0.1019 and 0.1282 min-1; beta = 0.0139, 0.0126 and 0.0124 min-1; A = 6.24, 5.27 and 10.58 micrograms/ml and B = 2.14, 3.83 and 5.08 micrograms/ml for each dose, respectively. The statistical moment theory was mainly used for non-compartmental analysis. Values for mean residence time (MRT) of 69.2, 71.7 and 73.1 min were obtained for each dose. The mean values for volume of distribution at steady state (Vd(ss)), determined by compartmental analysis, were 3879, 3279 and 2735 ml/kg for each dose, and values obtained using the statistical moment theory were 3760, 3015 and 2943 ml/kg; there were no statistically significant differences using Student's paired t-test. Identical conclusions were obtained using both methods when the parameters beta, AUC and Cl were compared.

Uptake and accumulation of ajmalicine into isolated vacuoles of cultured cells of Catharanthus roseus (L.) G. Don. and its conversion into serpentine

Isolated vacuoles from ajmalicine-producing cell suspensions of Catharanthus roseus accumulated the alkaloid ajmalicine. Dissipation of the transtonoplast pH gradient with nigericin abolished ajmalicine accumulation, whereas dissipation of the transtonoplast potential with valinomycin had no effect. Addition of Mg-ATP resulted in a higher ajmalicine accumulation. Serpentine produced by the cells was largely recovered in isolated vacuoles; in contrast, ajmalicine was lost. Ajmalicine was converted in vitro into serpentine by horseradish basic peroxidases (EC 1.11.1.7). In cultured cells there was a striking conformity between the time course of serpentine content and that of the activity of basic peroxidases. Ajmalicine was converted efficiently into serpentine by basic peroxidases extracted from vacuoles and by intact isolated vacuoles. The results are consistent with the hypothesis that ajmalicine accumulates by an ion-trap mechanism and that the accumulated ajmalicine is converted into serpentine inside the vacuoles. By the transformation of ajmalicine into the charged serpentine a trap is created to retain the alkaloids more efficiently in the vacuole.

[Gastric ulcer as a unique and symptomatic manifestation of infection by cytomegalovirus in a healthy adult]

A previously healthy female without risk factors had cytomegalic inclusion disease with symptomatic gastric involvement and without evidence of systemic cytomegalovirus (CMV) infection. Multiple ulcerations with a fibrinous bottom were discovered by fibrogastroscopy in the gastric body and antrum. Histological study showed cells with intranuclear inclusions and basophilic nuclear cytoplasm. The detection of specific IgM and its subsequent negativization suggest an active CMV infection. Gastric infection may be the isolated and symptomatic feature of the disease in the healthy adult.

Frequency of Mycobacterium tuberculosis bacteremia in patients with tuberculosis in an area endemic for AIDS

Mycobacterium tuberculosis bacteremia has recently been reported in patients infected with the human immunodeficiency virus (HIV). At our institution, tuberculosis occurs commonly among patients with and without HIV infection. We sought to determine the frequency of M. tuberculosis bacteremia among patients with newly diagnosed tuberculosis. During a 4-month period, mycobacterial blood cultures were obtained on all identifiable patients with newly diagnosed tuberculosis. Fifteen percent (9/59) of consecutive patients with tuberculosis had positive blood cultures for M. tuberculosis. Twenty-six percent (7/27) of patients known to be infected with HIV had positive mycobacterial blood cultures; two intravenous drug users who refused HIV-serologic testing also had positive mycobacterial blood cultures. M. tuberculosis bacteremia occurred at a higher rate among HIV-infected patients with an AIDS-defining opportunistic infection in addition to tuberculosis (3/3) than among HIV-infected patients without such an opportunistic infection (4/24; p less than 0.02). M. tuberculosis bacteremia occurred in 83% (5/6) of patients with disseminated tuberculosis and in 8% (4/53) of patients without disseminated tuberculosis (p less than 0.001). In all cases, tuberculosis was diagnosed in patients with M. tuberculosis bacteremia or else they died prior to the blood cultures demonstrating mycobacterial growth (mean time to detection of mycobacterial growth: 43 days). However, the frequent occurrence of M. tuberculosis bacteremia in HIV-infected patients with disseminated tuberculosis suggests that mycobacterial blood cultures may help confirm the diagnosis of tuberculosis in this group of patients.

Ceftriaxone treatment of penicillinase-producing Neisseria gonorrhoeae infections in children

The incidence of penicillinase-producing Neisseria gonorrhoeae (PPNG) among adults with gonorrhea in Brooklyn now exceeds 24%. Because children usually acquire their infection from adults, it follows that we have had a concomitant rise in PPNG among sexually abused children. The Centers for Disease Control now recommends ceftriaxone for the first line treatment of gonorrhea but there are no data as to its use in children for this indication. From May, 1987, through March, 1989, 33 children, 4 days to 10 years of age, were admitted to Kings County Hospital for 34 episodes of gonorrhea. Nine (26.5%) were caused by PPNG. Twenty-three were female; 10 were male. There were 17 isolates from the vagina, 3 from the urethra, 9 from the pharynx, 9 from the rectum and 6 from the eye. Eight children (all girls) had infections at greater than or equal to 1 site; 2 were infected at 3 sites. Twenty-eight children were sexually abused and 5 were neonates with ophthalmia (1 PPNG). All isolates were susceptible to ceftriaxone by disc diffusion testing. Agar dilution was performed for 18 isolates; minimal inhibitory concentrations to ceftriaxone were less than or equal to 0.06 mg/liter. The 5 PPNG isolates tested had minimal inhibitory concentrations to penicillin of 2 to 16 mg/liter and 3 isolates were resistant to tetracycline with minimal inhibitory concentrations of 32 mg/liter. Twenty-eight children were treated with a single dose of ceftriaxone, including the 5 neonates with ophthalmia; the dose was 125 mg if less than 45 kg or 250 mg if greater than 45 kg.(ABSTRACT TRUNCATED AT 250 WORDS)

Microsomal enzyme induction by permethrin in rats

The synthetic pyrethroid, permethrin, was evaluated for its ability to alter hepatic microsomal drug-metabolizing function. The influence of permethrin (25:75 cis-trans) on plasma antipyrine kinetics and gamma-glutamyl transpeptidase (gamma-GTP) activity were studied in rats. After 3 days of administration of 90 mg permethrin/kg/day, there was no significant change in the antipyrine half-life and the area under the curve, while the apparent volume of distribution and clearance were significantly increased. Treatment with 190 mg permethrin/kg/day for 3 days decreased antipyrine half-life and the area under the curve, and increased the apparent volume of distribution and the clearance significantly. The gamma-GTP activity was significantly increased within 21 days and 14 days after the start of permethrin administration, at doses of 90 and 190 mg permethrin/kg/day, respectively. The antipyrine kinetics results indicate that permethrin is capable of producing a dose-dependent marked enzyme-inducing effect.

Plasma protein binding of an N-pyrrolyl derivative penicillin in several mammalian species

The extents of protein binding of an N-pyrrolyl derivative penicillin in plasma of different species were determined in vitro by the equilibrium dialysis technique and spectrophotometry determination. The percentage of binding was determined in cows, sheep, pigs and dogs. The percentage of drug that was protein bound was independent of drug concentration for this penicillin within the range studied (5 to 40 micrograms ml-1). The extent of binding was determined at 20 micrograms ml-1. There was a significant difference in the extent of penicillin binding between species (t test P less than 0.005) except for between cows and dogs (t test P less than 0.05) and sheep and pigs (where it was not significantly different). In the species studied the extent of penicillin binding ranged from 41 to 55 per cent.

Cytomegalovirus mononucleosis-associated antral gastritis simulating malignancy

A 44-year-old man with epigastric pain, fever, and atypical lymphocytosis was found to have severe antral gastritis with radiologic and endoscopic features suggestive of malignancy. Histopathologic and serologic findings were diagnostic of cytomegalovirus gastric infection. Clinical involvement of the stomach in the course of cytomegalovirus mononucleosis is unique, and this case expands further the spectrum of clinical disease in the otherwise healthy adult.

Comparison of HEp-2 cell culture and Abbott respiratory syncytial virus enzyme immunoassay

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection in children. Rapid identification of RSV infections would allow for specific chemotherapy. We evaluated a means of rapid diagnosis, the Abbott enzyme immunoassay (EIA), by using 314 stored nasopharyngeal aspirates. RSV antigens were identified in 62 of 66 RSV culture-positive specimens. An additional 37 specimens from which RSV was not isolated were positive in the EIA. Of these, 29 were confirmed as truly positive by a blocking assay, for a total of 95 (66 + 29) positive specimens. The sensitivity of the EIA for total positive samples was 96% (91/95) versus 69% (66/95) for cell culture. The specificity of the EIA was 96% (211/219). In these stored specimens, Abbott EIA was superior to cell culture for the detection of RSV.

Epidemiologic study of visceral leishmaniasis in Honduras, 1975-1983

Between 1975 and 1983, 53 patients with parasitologically proven visceral leishmaniasis (VL) and 16 patients with suspected VL were diagnosed in Honduras. The patients' ages ranged from 3 months to 10 years, but 95% were younger than 3 years old. Since 1978, when 16 patients were reported, the yearly incidence has declined, and in 1982 only 4 patients were reported. We located and interviewed the families of 57 of the 69 patients. At the onset of illness, all 57 patients lived in rural areas, and 55 lived in southern Honduras. All the patients who were discharged from the hospital alive were still living at the time of the interview. A case-control study, using age-matched neighbors as controls, showed that patients were significantly more likely to have lived in poorly constructed, wood-stick houses. We used an indirect immunofluorescence test to analyze blood samples for Leishmania antibodies from 218 family members of patients, 170 family members of controls, and 156 children living on the island of El Tigre, where 4 of the 5 most recently diagnosed patients lived. Although 15 specimens gave a positive reaction to L. donovani antigen, each gave a stronger reaction when tested against Trypanosoma cruzi antigen, suggesting that the reactions to L. donovani were false positives. A serosurvey of 279 dogs of cases and controls and from El Tigre showed that 24 had positive reactions to L. donovani antigen, but only 4 (1.4%) had higher titers to L. donovani than to T. cruzi.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects of acidosis and alkalosis on the sarcoplasmic reticulum of the heart]

Some functions of dog cardiac sarcoplasmic reticulum have been studied in acidosis and alkalosis conditions in a range of pH from 6.0 to 7.8. Intravesicular water content at pH 6.0 is 4.7 microliter per mg of protein and diminished to 4 microliter, (15%) at pH 8.0; this correlates with a drop of 13.5% in turbidity. Ca2+-dependent ATPase has an optimal pH of 7.2 and a specific activity of 580 nanomoles of ATP hydrolyzed/min/mg protein. The activity of Basal ATPase or Mg2+-dependent is insensitive to changes of pH. Maximal calcium uptake attains 45.1 +/- 1.4 nanomoles per mg protein between pH 6.0 and 6.6. The accumulated calcium diminished progressively when pH was raised. The rate of calcium transport in steady state shows an optimal pH of 6.7. The calcium transport kinetics constants shows that reticulum has a maximal affinity for calcium between pH 6.87 and 7.02. The maximal velocity for transport diminished progressively between pH 6.1 to 7.16. During the calcium transport process pH is changed from acid to alkaline and the accumulated calcium is release proportionally to the pH increment. This effect shows to be reversible. Calcium accumulation and ATP hydrolysis are uncoupled at pH values higher than 6.6 because to the increase in the rate of calcium release. Values of pK and number of protons per mg of protein that dissociates from ionizable residues are 6.53 and 0.68 respectively for calcium dependent ATPase; 7.09 and 0.60 for calcium transport and 7.41 and 0.39 for calcium release. We conclude that the rate of transport and affinity of cardiac sarcoplasmic reticulum for calcium are optimal between pH 6.8 and 7.0 that is the reported range of intracellular pH of normal cardiac tissue. The data are in close agreement with the fall of contractility in acidosis. It is proposed a calcium release pathway sensitive to pH and different from that of calcium pump, exclusively for entrance.

Prevalence of Neisseria meningitidis in family members of patients with meningococcal infection

The aim of the study was first, to determine the prevalence of Neisseria meningitidis among the family members living with patients suffering from meningococcal infections, and second, to ascertain the distribution among these family members of strains epidemiologically related to those isolated from patients. Forty-two family groups were studied and 135 nasopharyngeal samples were taken from family members living with patients. Twenty family groups were found to contain meningococcal carriers, and of these 20, 13 contained a carrier of the strain that caused the infection (65%). Among the family members who were carriers, the mother and father most frequently yielded the strain which caused the illness. The serotypes most frequently encountered both in patients and carriers were 2 and 8, as well as nontypable strains. The polyacrylamide gel electrophoretic patterns (PAGE) most frequently found were II and IV. A notable feature of the study is the high resistance of the strains to sulphadiazine, since more than 90% of the strains found in patients and more than 75% of those from carriers possessed a minimum inhibitory concentration greater than or equal to 10 micrograms/ml.

[Changes induced by hypertonic solutions in the transportation of calcium by the cardiac reticular sarcoplasma]

In the sarcoplasmic reticulum of the myocardium, celular organell which function is to regulate the cytoplasmic concentration of calcium in contraction and relaxation, we have studied the effect of hypertonic solutions of sucrose between 1 and 6.96 times the normal tonicity in order to observe the behavior of the internal linked or free calcium of this structure, as well as to prove the hypothesis that hypertonic solutions encourage the calcium exit of the sarcoplasmatic reticulum with the resulting signs of contractures. The following results were obtained: 1. The ATP hydrolisis and calcium transport rate are 14% and 90% respectively of the maximum speeds of 10(-5) M in calcium, while for concentrations of 10(-7) M or ess of the said cation, the transport rates and the ATPase do not reach 5% of the maximum values. 2. Between 1 and 2.54 times of the normal tonicity the calcium uptake remains between 400 and 500 nmoles of calcium/mg protein/min, the transported amount of calcium varies between 14 and 16 nmoles/mg protein and the rate of the ATP hydrolysis increases a 37% to 0.4 M in sucrose. 3. Between 0.4 and 1.2 M in sucrose of 2.54 to 6.96 times the isotonicity, the calcium transport rate velocity as well as the ATP hydrolisis are strongly inhibited. The vesicles volume minimizes and the amount of linked calcium remains within the control values, proving that the capacity of linking this cathion is independent from sarcoplasmic reticulum volume. These results show that the sarcoplasmic reticulum is involved in the contractures induced by hypertonic solutions in intact cells, since the osmolarity increase produces changes of volume which results in a decrease of the calcium transportation velocity or in an increase of the exit of said cathion.