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Abstract
Spontaneous bacterial peritonitis is a frequent and serious infection in cirrhotic patients with ascites. A high index of suspicion is required for early diagnosis and rapid institution of treatment. The common micro-organisms involved in SBP are the aerobic Gram-negative bacilli and Gram-positive cocci that inhabit the intestine. Empiric antibiotic therapy active against these organisms should be instituted as soon as possible to improve survival. Third generation cephalosporins are very effective and safe as the initial empiric antibiotic regimen. Alternatives include beta-lactam-clavulanic acid combinations and other broad-spectrum antibiotics, although cost benefit considerations are important in selection. If cultures and susceptibility tests allow, antibiotic therapy should be altered to provide optimum narrow-spectrum and cost-effective treatment. Recent evidence suggests that (at least in the case of cefotaxime), 5-day treatment is equally effective as 10-day treatment. Except in patients awaiting liver transplantation, antibiotic prophylaxis of SBP is not recommended at present, as the few trials performed have not been able to demonstrate superior results for survival, hospital admissions or cost-effectiveness, over prompt diagnosis and therapy of individual episodes of SBP.
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Abstract
The epidemiology, clinical features, microbiology and outcome of 30 episodes of nosocomial endocarditis occurring over a 13-year period were reviewed and compared with 148 cases of community-acquired endocarditis. Twenty-eight patients (93%) had been in hospital for > 1 week and 10 patients (33%) for > 1 month when they developed endocarditis. Left-sided infection was most frequent; only 3 cases involved the tricuspid valve. Compared with community-acquired infection, patients tended to be older, had a greater incidence of congestive cardiac failure (p = 0.001) or hypotension (p = 0.0008) at presentation and were more likely to have bacteremia after an invasive procedure (83 vs 31%; p < 0.00001). Intravascular devices were the presumed source of bacteremia in 11 cases (37%); the same organism was isolated from both the blood and the suspected source of infection. Staphylococcus aureus was the most frequent causative organism, accounting for 17 episodes (57%), including 4 (13%) due to methicillin-resistant strains. Nosocomial endocarditis had a significantly higher mortality than did community-acquired infection (40 vs 18%; p = 0.02). Eight patients (27%) needed valve replacement. Proper adherence to protocols for management of intravascular devices and appropriate antimicrobial prophylaxis before procedures may have prevented endocarditis in 15 of 30 patients.
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Muller M, Sorrell TC. Leukotriene B4 omega-oxidation by human polymorphonuclear leukocytes is inhibited by pyocyanin, a phenazine derivative produced by Pseudomonas aeruginosa. Infect Immun 1992; 60:2536-40. [PMID: 1316878 PMCID: PMC257193 DOI: 10.1128/iai.60.6.2536-2540.1992] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Human polymorphonuclear leukocytes (PMNL) metabolize the potent chemotaxin leukotriene B4 (LTB4) by omega-oxidation to 20-hydroxyl-LTB4 and 20-carboxy-LTB4. The ability of unstimulated human PMNL to metabolize exogenous LTB4 was found to be inhibited by pyocyanin, a phenazine derivative produced by Pseudomonas aeruginosa, in a dose-dependent manner. 1-Hydroxyphenazine (1-OHP), a metabolite of pyocyanin, was not inhibitory under identical conditions. The initial enzymic step in the conversion of LTB4 is catalyzed by an NADPH-dependent cytochrome, P-450. Reduction of the phenazine derivatives by NADPH was measured spectrophotometrically. Pyocyanin was reduced by NADPH in vitro in a pH-dependent manner, while 1-OHP was poorly or negligibly reduced under similar conditions. Formation of NADP+ was 20.3 +/- 1.8 nmol min-1 for pyocyanin (10 microM) at pH 5.5, compared with 0.6 +/- 0.2 nmol min-1 for 1-OHP (10 microM), while at pH 7.5 a value of 2.2 +/- 1.3 nmol min-1 was obtained for pyocyanin, with no detectable activity for 1-OHP. This indicates that inhibition of LTB4 omega-hydroxylase activity by pyocyanin might be achieved by competition for NADPH. Incorporation of exogenous 5-hydroxyeicosatetraenoic acid by PMNL into lipid pools was not affected by either phenazine derivative. The ability of bacterial pyocyanin to limit the omega-oxidation of LTB4 may have important implications for PMNL LTB4 receptor status and chemotaxis in vivo.
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Sorrell TC, Muller M, Sztelma K. Bacterial metabolism of human polymorphonuclear leukocyte-derived arachidonic acid. Infect Immun 1992; 60:1779-85. [PMID: 1563765 PMCID: PMC257073 DOI: 10.1128/iai.60.5.1779-1785.1992] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Evidence for transcellular bacterial metabolism of phagocyte-derived arachidonic acid was sought by exposing human blood polymorphonuclear leukocytes, prelabelled with [3H]arachidonic acid, to opsonized, stationary-phase Pseudomonas aeruginosa (bacteria-to-phagocyte ratio of 50:1) for 90 min at 37 degrees C. Control leukocytes were stimulated with the calcium ionophore A23187 (5 microM) for 5 min. Radiochromatograms of arachidonic acid metabolites, extracted from A23187-stimulated cultures and then separated by reverse-phase high-performance liquid chromatography, revealed leukotriene B4, its omega-oxidation products, and 5-hydroxy-eicosatetraenoic acid. In contrast, two major metabolite peaks, distinct from known polymorphonuclear leukocyte arachidonic acid products by high-performance liquid chromatography or by thin-layer chromatography, were identified in cultures of P. aeruginosa with [3H]arachidonic acid-labelled polymorphonuclear leukocytes. Respective chromatographic characteristics of these novel products were identical to those of two major metabolite peaks produced by incubation of stationary-phase P. aeruginosa with [3H]arachidonic acid. Production of the metabolites was dependent upon pseudomonal viability. UV spectral data were consistent with a conjugated diene structure. Metabolism of arachidonic acid by P. aeruginosa was not influenced by the presence of catalase, superoxide dismutase, nordihydroguaiaretic acid, ethanol, dimethyl sulfoxide, or ferrous ions but was inhibited by carbon monoxide, ketoconazole, and 1,2-epoxy-3,3,3-trichloropropane. Our data suggest that pseudomonal metabolism of polymorphonuclear leukocyte-derived arachidonic acid occurs during phagocytosis, probably by enzymatic epoxidation and hydroxylation via an oxygenase. By this means, potential proinflammatory effects of arachidonic acid or its metabolites may be modulated by P. aeruginosa at sites of infection in vivo.
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Mitchell DH, Sorrell TC. Pancoast's syndrome due to pulmonary infection with Cryptococcus neoformans variety gattii. Clin Infect Dis 1992; 14:1142-4. [PMID: 1600018 DOI: 10.1093/clinids/14.5.1142] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Immunocompetent hosts usually do not require antifungal therapy for pulmonary cryptococcosis. We present a case of right lung mass and Pancoast's syndrome due to locally invasive Cryptococcus neoformans variety gattii in a normal host. Lobectomy followed by therapy with amphotericin B and flucytosine was curative.
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81
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Kazazi F, Mathijs JM, Chang J, Malafiej P, Lopez A, Dowton D, Sorrell TC, Vadas MA, Cunningham AL. Recombinant interleukin 4 stimulates human immunodeficiency virus production by infected monocytes and macrophages. J Gen Virol 1992; 73 ( Pt 4):941-9. [PMID: 1634880 DOI: 10.1099/0022-1317-73-4-941] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Recombinant interleukin 4 (IL-4) stimulated extracellular (EC) and intracellular (IC) production of human immunodeficiency virus (HIV) from infected human blood-derived monocytes and macrophages when incubated with the cells after but not before virus inoculation. Significant stimulation was observed in 20 of 27 experiments with monocytes (inoculated with HIV immediately after adherence) and 10 of 13 experiments with macrophages (inoculated after 5 days adherence) using a total of 30 normal donors of monocytes and macrophages, and 11 recent isolates of monocytotropic HIV strains (after one passage in mononuclear cells). Marked increases in EC and IC HIV antigen were observed in some experiments, which were comparable with the maximal stimulatory effects of other cytokines such as IL-2. IL-4 also had similar effects on infectious HIV concentration as measured by reverse transcriptase and TCID50 assays. Antibody to IL-4 prevented the stimulatory effect of the cytokine. The proportion of monocytes and macrophages infected by HIV, as determined by in situ hybridization, also increased after incubation with IL-4 for 7 days. The most marked effects were observed with HIV-infected macrophages, for which the proportion of unstimulated infected cells was lower (35 to 45% increasing to 66 to 70% with IL-4 treatment). There was also an increased proportion of cells with high granule concentrations, suggesting that IL-4 increases the intracellular concentration of viral nucleic acids. This was supported by semi-quantitative hybridization experiments showing that total HIV RNA increased in IL-4-stimulated monocytes 48 to 96 h after HIV inoculation. A marked increase in aggregates was observed on day 7 in HIV-infected monocytes treated with IL-4, compared to that in HIV-infected cells alone or IL-4-treated uninfected monocytes. These findings suggest that IL-4 stimulates HIV replication in the early phases of infection and may also facilitate virus transmission by aggregate formation.
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82
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May GL, Dunlop LC, Sztelma K, Berndt MC, Sorrell TC. GMP-140 (P-selectin) inhibits human neutrophil activation by lipopolysaccharide: analysis by proton magnetic resonance spectroscopy. Biochem Biophys Res Commun 1992; 183:1062-9. [PMID: 1373606 DOI: 10.1016/s0006-291x(05)80298-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Proton magnetic resonance spectroscopy has been used to monitor the effect of GMP-140 on the stimulation of human peripheral blood neutrophils. Stimulation of neutrophils by lipopolysaccharide gives rise to a high resolution lipid spectrum from the intact cells. Fluid phase GMP-140, which prevents adhesion and development of inflammatory responses of neutrophils, was found to inhibit these changes in the lipid spectrum by up to 40%. Anti-GMP-140 Fab fragments reversed this effect while non-immune Fab fragments did not affect the observed inhibition by GMP-140.
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83
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Foley P, Kazazi F, Biti R, Sorrell TC, Cunningham AL. HIV infection of monocytes inhibits the T-lymphocyte proliferative response to recall antigens, via production of eicosanoids. Immunology 1992; 75:391-7. [PMID: 1572689 PMCID: PMC1384730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Human monocytes infected in vitro with human immunodeficiency virus (HIV) soon after adherence to plastic substrate demonstrated a significantly decreased ability to restimulate autologous immune T-lymphocyte proliferation after exposure to soluble (tetanus toxoid) and particulate [herpes simplex virus (HSV)] antigen. Incubation with the cyclo-oxygenase inhibitor, indomethacin (2-5 microM), prevented inhibition of antigen-stimulated lymphocyte proliferation. The inhibitory activity was identified in ultrafiltrates containing the low molecular weight fraction (less than 3000 MW) of supernatants from HIV-infected monocyte cultures. This activity was significantly and markedly reduced in similar ultrafiltrates prepared from indomethacin-treated cultures. Increased concentrations of prostaglandin E2 (PGE2) were detected in ultrafiltrates from HIV-infected monocyte cultures compared with uninfected cultures and cultures preincubated with indomethacin. Ultrafiltrates were inhibitory when added during the presentation of antigen to T lymphocytes but not when removed from monocyte cultures prior to the addition of lymphocytes. In addition, ultrafiltrates inhibited antigen-stimulated lymphocyte proliferation and PHA-induced lymphocyte proliferation to the same extent. These data indicate that cyclo-oxygenase products of arachidonic acid, including PGE2, are produced in excess by HIV-infected monocytes and that PGE2 and perhaps other cyclo-oxygenase products are implicated in the inhibition of antigen-stimulated lymphocyte proliferation via a direct effect on T lymphocytes.
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84
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Muller M, Sorrell TC. Effect of pyocyanin and 1-hydroxyphenazine on the assay of lactate dehydrogenase activity. J Infect Dis 1991; 164:610-2. [PMID: 1869850 DOI: 10.1093/infdis/164.3.610a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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85
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Muller M, Sorrell TC. Production of leukotriene B4 and 5-hydroxyeicosatetraenoic acid by human neutrophils is inhibited by Pseudomonas aeruginosa phenazine derivatives. Infect Immun 1991; 59:3316-8. [PMID: 1652564 PMCID: PMC258173 DOI: 10.1128/iai.59.9.3316-3318.1991] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Pyocyanin, a phenazine pigment produced by Pseudomonas aeruginosa, and its metabolite 1-hydroxyphenazine inhibited leukotriene B4 and 5-hydroxyeicosatetraenoic acid production by up to 70% in human neutrophils stimulated with the calcium ionophore A23187 (5 microM). This potential anti-inflammatory effect was dose dependent and occurred at low concentrations (10 to 50 microM) that did not inhibit neutrophil viability.
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86
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Chen SC, Lawrence RH, Packham DR, Sorrell TC. Cellulitis due to Pseudomonas putrefaciens: possible production of exotoxins. REVIEWS OF INFECTIOUS DISEASES 1991; 13:642-3. [PMID: 1925285 DOI: 10.1093/clinids/13.4.642] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Pseudomonas putrefaciens has been described as a rare cause of both lower-limb cellulitis and septicemic illness with significant morbidity. We report a case of P. putrefaciens infection in a patient with refractory lower-limb cellulitis and ulceration complicated by thrombocytopenia, hypotension, and mental obtundation in the apparent absence of bacteremia. This scenario raises the possibility of significant production of exotoxins by P. putrefaciens in vivo.
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87
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Fletcher JP, Dryden M, Sorrell TC. Infection of vascular prostheses. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1991; 61:432-5. [PMID: 2059176 DOI: 10.1111/j.1445-2197.1991.tb00257.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Graft infection occurred in 11 of 322 patients (3.4%) who had insertion of a vascular prosthesis for peripheral vascular disease during a 4-year period. The groin was the most common site of infection and multiple resistant Staphylococcus aureus (MRSA) was the most common organism responsible. Six of 7 MRSA infections occurred following a procedure involving a previously placed graft and/or a groin incision. Prophylactic antibiotics effective against MRSA are recommended for patients having a revisional procedure, especially involving the groin.
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88
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May GL, Sztelma K, Sorrell TC, Mountford CE. Comparison of human polymorphonuclear leukocytes from peripheral blood and purulent exudates by high resolution 1H MRS. Magn Reson Med 1991; 19:191-8. [PMID: 2046533 DOI: 10.1002/mrm.1910190119] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Human pus samples from various sites, including soft tissue and pleural cavity, as well as sputum from patients with cystic fibrosis have been analyzed by 1H magnetic resonance spectroscopy (MRS) and found to generate high resolution spectra. Assignments have been made for neutral lipid, amino acids, taurine, and lactate. Human peripheral blood polymorphonuclear leukocytes have also been examined and a similar spectrum containing these lipid and metabolite resonances was detected in cells stimulated with lipopolysaccharide. In unstimulated cells, only resonances from taurine and lactate were observed, suggesting that the presence of the lipid and metabolite resonances is an indicator of cellular activation of polymorphonuclear leukocytes. This is the first report of 1H MRS applied to intact human polymorphonuclear leukocytes and extends available documentation as to which types of normal and/or diseased tissue contain MR visible molecules.
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89
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Roger SD, Chen SC, Lawrence S, Sorrell TC. Pseudomonas putrefaciens bacteraemia in a peritoneal dialysis patient. Nephrol Dial Transplant 1991; 6:73. [PMID: 2057122 DOI: 10.1093/ndt/6.1.73] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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90
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Chen SC, Sorrell TC, Dwyer DE, Collignon PJ, Wright EJ. Endocarditis associated with prosthetic cardiac valves. Med J Aust 1990; 152:458, 461-3. [PMID: 2381336 DOI: 10.5694/j.1326-5377.1990.tb125303.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Clinical features, microbiology, therapy and outcome of 26 episodes of prosthetic valve endocarditis occurring at Westmead Hospital from 1979 to 1989 were examined retrospectively. Presentation with a new or changed cardiac murmur was associated with early onset infection (within 12 months of prosthetic valve insertion; P = 0.0033). Corynebacteria were the commonest cause of early onset endocarditis (4 of 11 episodes) and Streptococcus viridans of late onset endocarditis (4 of 15 episodes). Nine of 11 episodes responded to antimicrobial therapy and 12 of 15 to medical-surgical therapy. There was a trend towards increased mortality in patients with early onset endocarditis presenting with a new or changed cardiac murmur (4 of 9 v. 1 of 17, P = 0.068), suggesting early surgery should be considered in this group. Analysis of antibiograms and published reports indicated that vancomycin and an aminoglycoside should be recommended as empirical therapy for endocarditis occurring 12 to 18 months after prosthetic valve insertion.
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91
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Shanker S, Lee A, Sorrell TC. Horizontal transmission of Campylobacter jejuni amongst broiler chicks: experimental studies. Epidemiol Infect 1990; 104:101-10. [PMID: 2307180 PMCID: PMC2271727 DOI: 10.1017/s0950268800054571] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Horizontal transmission of Campylobacter jejuni was investigated in campylobacter-free broiler chicks. One hundred and twenty chicks housed individually, were provided with water containing 10(2)-10(9) c.f.u./ml C. jejuni. Colonization was rapid [47 of 73 (64%) positive cloacal cultures within 3 days and 65 of 73 (89%) within 7 days], dependent on C. jejuni strain and inoculum size but independent of chick age. Groups of 5-24 chicks in isolators were exposed to C. jejuni-contaminated water or colonized seeder chicks. Transmission occurred in 2-7 days concurrent with a gradual increase of C. jejuni in litter, water and feed. Environmental samples were culture-negative within 3 days following removal of colonized chicks. Treatment of 1-day-old chicks with adult caecal microbiota did not affect colonization. Treated and control chicks were all C. jejuni-positive within 3 days of seeder challenge.
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92
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Sorrell TC, Rochester CP, Breen FN, Müller M. Eicosanoids produced during interactions between Pseudomonas aeruginosa and alveolar macrophages are species-dependent. Immunol Cell Biol 1989; 67 ( Pt 3):169-76. [PMID: 2507445 DOI: 10.1038/icb.1989.27] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Eicosanoid production during phagocytosis of pyogenic bacteria by rabbit alveolar macrophages was studied as a model of early events in the pathogenesis of pneumonia. Adherent alveolar macrophages, prelabelled with [3H]-arachidonic acid (AA), were incubated with live, opsonized Staphylococcus aureus or Pseudomonas aeruginosa (bacteria:macrophage ratio of 50:1) at 37 degrees C for 90 min. Supernatant eicosanoids were extracted and separated by reverse phase high performance liquid chromatography (RP-HPLC). While the amounts of labelled PGE2, TXB2, and PGD2 produced in response to the two organisms were equal, the amount of PGF2 alpha elicited by S. aureus amounted to three times that released during macrophage challenge with P. aeruginosa. Overall, preferential release of cyclooxygenase products occurred during phagocytosis of S. aureus. In contrast, eicosanoids identified presumptively as oxygenated metabolites of AA predominated in cultures challenged with opsonized P. aeruginosa. Live, non-opsonized P. aeruginosa elicited the same profile of eicosanoids, but in reduced amounts. Inhibitor studies indicated that these AA derivatives were not synthesized via the macrophage lipoxygenase pathway. Their production was dependent on the viability of P. aeruginosa. Macrophages challenged with opsonized, heat-killed P. aeruginosa resulted in production of an eicosanoid profile similar to that elicited by S. aureus. Secondary metabolism by P. aeruginosa of eicosanoids released from the macrophage did not contribute to the unique profile produced during the interaction of this organism with labelled macrophages. Our data indicate that during binding to macrophages, the primary human pathogen, P. aeruginosa, specifically modulates the profile of eicosanoids produced. This effect on inflammatory mediators may be of biological significance in the pathogenesis of pneumonia.
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93
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Shanker S, Lee A, Sorrell TC. Experimental colonization of broiler chicks with Campylobacter jejuni. Epidemiol Infect 1988; 100:27-34. [PMID: 3338504 PMCID: PMC2249203 DOI: 10.1017/s0950268800065523] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Minimal colonization inocula for two broiler strains of Campylobacter jejuni were determined in broiler chicks aged 2-3 days and 2 weeks. Individually housed chicks were exposed to a single oral or cloacal challenge. Diarrhoeal symptoms were absent in all 380 chicks included in the study. Chick susceptibility to the two C. jejuni strains varied. Colonization was effected by less than 10(2)-10(4) colony forming units (c.f.u.) via cloacal challenge and 10(4)-10(6) c.f.u. via the oral route. Colonization inocula for 2- to 3-day and 2-week-old chicks were similar. Treatment of 1-day-old chicks with fresh adult caecal flora or an anaerobic broth culture of adult caecal flora did not inhibit colonization after challenge with low-dose C. jejuni. Susceptible chicks were colonized rapidly. C. jejuni was detected in 167 of 189 (88%) colonized chicks within 3 days of challenge and persisted during the 2-week monitoring period. Our data suggest that colonization of broiler chicks with C. jejuni is effected more easily by the cloacal than the oral route and is independent of age.
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94
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Dwyer DE, MacLeod C, Collignon PJ, Sorrell TC. Extrapulmonary tuberculosis--a continuing problem in Australia. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1987; 17:507-11. [PMID: 3128259 DOI: 10.1111/j.1445-5994.1987.tb00110.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Extrapulmonary tuberculosis (TB) remains a major health problem in Australia, with 24.3% of all new tuberculosis notifications in 1984 of extrapulmonary origin. We have reviewed our recent experience to assess the epidemiology and clinical features that may allow the earlier recognition and treatment of patients at risk for this disease. From 1980-1985, 51 cases of extrapulmonary TB were identified at Westmead Hospital. Thirty-eight patients were born outside Australia, mainly in South-East Asia and Europe. The commonest sites of disease were the lymph nodes, genitourinary tract, pleura and bone. Tuberculous lymphadenitis occurred predominantly in South-East Asians, whilst genitourinary tract disease was confined to Caucasians. A history of previous exposure to tuberculosis was obtained in 45% of patients. Fever, sweats and weight loss were noted in less than half of the cases. Changes consistent with old pulmonary disease were found on routine chest X-ray in 34% of cases. Laboratory confirmation of TB was made in 88% of cases, with typical histopathology in 90% and isolation of Mycobacterium tuberculosis in 69% of specimens submitted for analysis. Drug resistance was confined to isolates from South-East Asian patients.
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95
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Collignon PJ, Munro R, Sorrell TC. Propionibacterium acnes infection in neurosurgical patients. Experience with high-dose penicillin therapy. Med J Aust 1986; 145:408-10. [PMID: 3762478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Propionibacterium acnes is an underestimated but significant cause of cerebrospinal fluid (CSF) infection after neurosurgical procedures and in the presence of prosthetic devices. The most effective therapy for such infections has not been defined. We report here our experience with the use of high-dose penicillin in the treatment of six patients with postoperative infection which was caused by P. acnes. All patients received 3-4 million units of penicillin by the intravenous route every four hours, in combination with surgical drainage and removal of prosthetic devices where appropriate. All but one of the patients recovered from their infection. The remaining patient responded to penicillin but died of a massive intraventricular haemorrhage after 12 days. Isolates of P. acnes had minimal inhibitory concentrations to penicillin that ranged from 0.03-0.12 mg/L. No adverse reactions to penicillin were recorded. We conclude that high-dose intravenous penicillin therapy, in combination with surgical drainage and removal of foreign bodies, constitutes appropriate therapy for CSF infections that are due to P. acnes.
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96
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Collignon PJ, Soni N, Pearson IY, Woods WP, Munro R, Sorrell TC. Is semiquantitative culture of central vein catheter tips useful in the diagnosis of catheter-associated bacteremia? J Clin Microbiol 1986; 24:532-5. [PMID: 3771741 PMCID: PMC268965 DOI: 10.1128/jcm.24.4.532-535.1986] [Citation(s) in RCA: 109] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Semiquantitative culturing of catheter tips has been used as an index of catheter-related bacteremia. As the sensitivity and predictive values of this test have not been determined, we studied 780 tips from central vein catheters inserted into 440 critically ill patients in an intensive care unit. The results were correlated with clinical data for 30 bacteremic episodes which occurred in these patients, 14 of which were catheter related. When five or more colonies per plate were taken as a positive result, the sensitivity of the method was 92%, and the specificity was 83%. Although the predictive value of a negative result was excellent (99.8%), the predictive value of a positive result was low (8.8%) in our patient population, which had a relatively low incidence of catheter-related bacteremia (2%). We conclude that a semiquantitative culture technique is useful in the diagnosis of bacteremia associated with central vein catheters.
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97
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Collignon PJ, Sorrell TC, Garret PJ. Unsuccessful search for anaerobic bacteria in thrombophlebitis associated with peripheral venous catheters. N Engl J Med 1986; 314:1323-4. [PMID: 3702937 DOI: 10.1056/nejm198605153142019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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98
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Abstract
Bactobilia is a frequent accompaniment of obstruction in the biliary tract, organisms present being normal intestinal aerobes and anaerobes. Bacterial colonisation of the bile may occur asymptomatically, may predispose to infection postoperatively, or may be associated with an attack of acute cholecystitis, occurring secondary to obstruction. The choice of an antimicrobial regimen for biliary infection should take into account the expected antibiotic sensitivities of organisms colonising bile, whether biliary obstruction or bacteraemia is present, and the activity of the antibiotic in bile. Often, high biliary concentrations of an antibiotic cannot be achieved due to obstruction, and in many cases high blood and tissue concentrations are of greater importance. Surgical prophylaxis should be reserved for patients at high risk of bactobilia (e.g. the elderly), when obstruction is present, for immunosuppressed patients, and those with artificial heart valves. A single perioperative dose of a 'first' or 'second generation' cephalosporin, gentamicin, or co-trimoxazole is effective. Antibiotic therapy for acute cholecystitis should be instituted if there is evidence of systemic toxicity, when surgery is to be delayed, or in patients with identified risk factors for bactobilia. Ampicillin or a cephalosporin may be appropriate in less severe disease, while in seriously ill patients, an aminoglycoside or cephalosporin with metronidazole or clindamycin is appropriate. Oral regimens include amoxycillin, an oral cephalosporin, or co-trimoxazole, in combination with metronidazole. In acute cholangitis, systemic therapy similar to that recommended for acute cholecystitis is indicated. Patients with recurrent cholangitis may have relatively antibiotic-resistant bacteria and efforts should be made to obtain a bacteriological diagnosis. Long term suppressant therapy with oral agents such as amoxycillin, cephalexin, or co-trimoxazole may be tried.
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99
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Abstract
The role of broiler eggs in the transmission of Campylobacter jejuni to broiler grow-out flocks was investigated. Six breeder flocks supplying broiler eggs to hatcheries were examined for cloacal carriage of C. jejuni. Of 240 birds tested, 178 (74%) were C. jejuni-positive. Eggs from these birds examined for C. jejuni penetration of the egg shell indicated that 185 of 187 were campylobacter-free. Eggs from breeder flocks of unknown C. jejuni status were also examined for C. jejuni shell penetration. C. jejuni was not isolated from 142 eggs examined. A further 193 hatchery eggs incubated and hatched in the laboratory were campylobacter-free. Six farms containing the progeny of C. jejuni-positive breeder flocks were monitored. Eight hundred and forty birds from 14 flocks in these grow-out farms were campylobacter-free during their 6-week grow-out period. Experimental egg-penetration studies indicated that C. jejuni transmission via the egg is not easily effected. Of 257 eggs surface-challenged with C. jejuni, 162 hatched; all were campylobacter-free. Of 167 eggs injected with C. jejuni, 12 hatched; 2 of these were colonized with C. jejuni. Our data do not support a role for vertical transmission of C. jejuni in commercial broiler production.
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Müller M, Sorrell TC. Quantitation of sulfidopeptide leukotrienes by reversed-phase high-performance liquid chromatography. JOURNAL OF CHROMATOGRAPHY 1985; 343:213-8. [PMID: 2999171 DOI: 10.1016/s0378-4347(00)84589-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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