Auxotrophy of Pseudomonas aeruginosa in cystic fibrosis

Seventy-four of 403 (18.4%) sputum isolates of Pseudomonas aeruginosa from 49 of 136 (36.0%) adults with cystic fibrosis (CF) were auxotrophic mutants. Two of 11 (18.2%) isolates of P. aeruginosa taken from patients with non-CF bronchiectasis were also auxotrophic. All 99 strains taken from non-bronchiectatic sources were prototrophic. Forty-six of 55 (83.6%) CF auxotrophs required one or more of 36 growth factors tested; the requirements for the remaining 9 isolates were not identified. Methionine was the sole factor required by 17 of 22 (77.3%) isolated which depended on a single factor. We conclude that auxotrophy is a feature of P. aeruginosa infection in cystic fibrosis.

[Antibody-coated bacteria and quantitative culture in sputum samples from patients with bronchiectasis]

The results of the quantitative culture of sputum samples from patients with bronchiectasis were compared with those obtained in the same samples with the detection of antibody-coated bacteria (ACB), in the acute phase of the disease (group I), after antibiotic therapy (group II), and in the phase of clinical stability (group III). In quantitative cultures at least one potentially pathogen species was isolated, at a concentration of greater than or equal to 10(6) colony forming units/ml in the 7 sputum samples from group I, in 4 of the 5 samples from group II, and in 10 of the 11 samples from group III. The immunofluorescence technique detected ACB in all samples from group I and group II, and in 10 of the 11 from group III. The sample from group III in which ACB were not detected was the same in which potentially pathogen organisms were not detected by culture.

[Cefotetan treatment of suppurative bronchopulmonary syndromes sustained by anaerobic germs]

The Authors have analyzed the effect of Cefotetan in 20 patients affected by bronchopulmonary pathologies supported by anaerobic bacterium. During 7 days doses of 50 mg. pro Kg/pro die were given. From beginning to end of the treatment clinical, hematochemical and radiological data were evaluated. Bacteriological analysis was made on samples drawn with BFS according to a traditional method and with microbiology specimen brush. Almost all the patients (95%) realized improvements in clinical symptomatology and in radiological picture.

[Susceptibility of bacteria isolated from patients with lower respiratory tract infections to antibiotics (1986)]

Enlisting the help of various research institutions across the nation, Ikemoto et al. have been pooling cultures of clinical isolates of respiratory tract infections and mapping out the correlations between patient backgrounds and the causative bacteria and the changes in the sensitivity spectra of the bacteria to various antibacterial and antibiotic agents annually since 1981. The following is a report of the 1986 findings. During the period from September, 1986 to March, 1987, 558 cases of respiratory infections were reported at 17 institutions across the nation and a total of 657 apparent causative strains were isolated from sputum samples. Of these strains, 75 strains of Staphylococcus aureus, 108 of Streptococcus pneumoniae, 150 of Haemophilus influenzae, 107 of Pseudomonas aeruiginosa (non-mucoid production type), 21 of P. aeruginosa (mucoid production type), 32 of Klebsiella pneumoniae, 8 of Escherichia coli, and 55 of Branhamella catarrhalis were subjected to MIC determination of various antibacterial and antibiotic agents to map drug sensitivities. In addition, diagnoses, age distributions by diagnoses, frequencies of infectious diseases, types of isolated bacteria, and usage statuses of the antibacterial and antibiotic agents the times of at isolation were also investigated. MIC determinations were carried out to investigate susceptibilities of causative organisms of respiratory tract infections to various antibacterial and antibiotic agents. From the 558 cases of respiratory tract infections, 657 strains were detected at concentrations not less than 10(4-6)/ml and identified to be the causative organisms. Of these strains, 603 could be used for MIC determination. An overwhelming majority of major causative bacteria, inclusive of H. influenzae and S. pneumoniae, showed sensitivity patterns similar to the sensitivity patterns found a year earlier, P. aeruginosa alone, however, showed some increase in its susceptibility to penicillin and cephem antibiotics. Regarding patient backgrounds, the age distribution was heavily biased towards the higher end of the scale, which patients with ages of 50 or higher accounting for 77.9%, compared to 73.5% in 1985. When the patients were classified by diagnoses, chronic bronchitis, bacterial pneumonia and bronchiectasis accounted for the majority of the infections: 28.7%, 23.3%, and 19.0%, respectively. The percentages of chronic bronchitis and bacterial pneumonia 28.7% and 23.3%, respectively, were somewhat higher in 1986 than in 1985. The disease which was comparatively frequent in all age groups was bronchiectasis, which accounted for 44.0% in patients with ages 29 years or lower, 18.4% in patients between 30 years and 69 years, and 16.7% in patients with ages 70 years or higher. The next most frequent infection was bacterial pneumonia.(ABSTRACT TRUNCATED AT 400 WORDS)

Ofloxacin compared with amoxycillin in treating infective exacerbations in bronchiectasis

Forty-one hospitalized adult patients of bronchiectasis (non-cystic fibrotic) with infective exacerbations were entered into a randomized, double-blind, placebo-controlled study comparing ofloxacin (200 mg tid) and amoxycillin (1 g tid) both orally for ten days. In the ofloxacin group (20 patients), improvement in sputum purulence was excellent in 14, and fair in five patients with one failure. In the amoxycillin group (21 patients), improvement in sputum purulence was excellent in eight, fair in five and poor in eight patients. Mean drug levels on day 5 were 4.1 mg l-1 for serum (2 h post-dosage) and 4.0 mg l-1 for sputum for ofloxacin, and 18.4 mg l-1 for serum and 0.3 mg l-1 for sputum for amoxycillin. Ofloxacin thus yielded higher sputum concentration and appeared to be more effective and also better tolerated than amoxycillin in infective episodes of bronchiectasis.

In situ hybridization studies of adenoviral infections of the lung and their relationship to follicular bronchiectasis

We have used a probe against the adenovirus genome to study cultured epithelial cells specifically infected with various types of adenovirus and Graham 293 cells, which contain few copy numbers of a fraction of the adenovirus genome. We have also examined lung tissue obtained from three cases of acute adenovirus pneumonia, two cases of adenovirus pneumonia that had passed through the acute phase, and nine cases of follicular bronchiectasis. Our purpose was to determine whether the probe was effective in detecting a wide variety of adenovirus types, to determine whether it could detect adenovirus in lung tissue that had been fixed and stored in paraffin blocks for several years, and to test the hypothesis that adenovirus was an important cause of follicular bronchiectasis. The results show that the probe was able to detect adenovirus from Genera B1, B2, C, D, and E with a sensitivity of 5 to 10 copies/cell. The probe also detected adenovirus in 14 of 14 slides from three cases of acute disease, but failed to obtain a positive result in the cases examined after an acute infection or in any of the cases of follicular bronchiectasis. We conclude that the in situ hybridization technique is useful in the investigation of active adenovirus infection of the lung. The failure to show that the virus persisted in the chronic respiratory disease that follows adenovirus infection, or that it was present in cases of follicular bronchiectasis could be due to either a true absence, or to its presence in a latent form that is below the level of sensitivity of this technique.

In vitro adherence of Streptococcus pneumoniae to oropharyngeal cells: enhanced activity and colonization of the upper respiratory tract in patients with recurrent respiratory infections

In vitro adherence of Streptococcus pneumoniae (S. pneumoniae) to oropharyngeal cells was assessed in 3 age matched groups of 29 subjects. The first group included patients with chronic pulmonary disease and recurrent respiratory infections due to S. pneumoniae or a recent respiratory infection caused by this organism. Patients of the second group has similar underlying pulmonary disease to the first group, but they had no S. pneumoniae respiratory infection for at least the past 3 years. Healthy subjects or patients without underlying pulmonary disease constituted the third group. The mean adherence of S. pneumoniae to oropharyngeal cells was 10.6 +/- 4.7 bacteria (bact.)/cell in the first group, 3.6 +/- 2.8 bact./cell in the second group and 1.9 +/- 2.1 bact./cell in the third group. A significant difference was found (p less than 0.01) when the mean of the first group was compared to those of the second and third groups, whereas there was no significant difference between the means of the second and third groups. In addition, a survey of bacterial colonization of the upper respiratory tract was conducted in all the subjects included in this study. Over 6 months, 5 of the 8 patients in the first group had throat cultures (5 cases) and nasal cultures (3 cases) positive for S. pneumoniae, while no one in the second or third group was a carrier of this bacterium in the upper respiratory tract during the same period. Patients with recurrent or recent respiratory infections caused by S. pneumoniae are characterised by an in vitro enhanced ability of this organism to adhere to their oropharyngeal cells. In vivo, this phenomenon is reflected by an increased susceptibility of the upper respiratory tract to colonization by S. pneumoniae.

The bacteriology of bronchiectasis in Hong Kong investigated by protected catheter brush and bronchoalveolar lavage

Bacteria often colonize the lower respiratory tract of patients with bronchiectasis. Although the role of these bacteria in the pathogenesis of the disease is uncertain, their accurate identification is important for epidemiologic and treatment purposes. Therefore, the aims of this study were: (1) to identify these bacteria in patients with bronchiectasis without cystic fibrosis using the protected catheter brush (PCB) in order to avoid oropharyngeal contamination, and (2) to compare the results of bronchoalveolar lavage (BAL) with PCB. Quantitative culture was performed on PCB and BAL specimens obtained from the most severely affected lobes of 23 patients with bronchiectasis. Results of PCB showed no significant growth (less than 10(3) colony-forming units [cfu]/ml) in nine patients and 17 significant isolates (greater than 10(3) cfu/ml) in the rest: H. influenzae, 5; P. aeruginosa, 4; K. ozaenae, 2; S. aureus, 2; P. fluorescens, 1; S. pneumoniae, 1; Veillonella, 1; and coag.-ve Staph., 1. For BAL, the results were the same (20 isolates) regardless of whether 10(4) or 10(5) cfu/ml was chosen as the cutoff point. More organisms were cultured from BAL specimens, and these included all but one of the organisms cultured from PCB. We conclude that the bacteriology of bronchiectasis in Hong Kong is different from that reported in sputum studies in the West (mainly H. influenzae, S. pneumoniae, and S. aureus), and with 10(4) cfu/ml as the cutoff point, BAL gives comparable results to PCB.

Simple method of monitoring colonising microbial load in chronic bronchial sepsis: pilot comparison of reduction in colonising microbial load with antibiotics given intermittently and continuously

Aerobic and anaerobic culture of sputum on selective bacteriological media, combined with a new method of plating and plate reading, permitted rapid identification and quantitation of three genera of bacteria commonly associated with chronic bronchial sepsis (Haemophilus spp, Pseudomonas aeruginosa, and Staphylococcus aureus) and avoided time consuming serial dilution of sputum and subculture of organisms. The accuracy of this new technique was assessed in patients with chronic bronchial sepsis and was used to detect changes in the colonising microbial load of Haemophilus spp and Ps aeruginosa in patients with bronchiectasis receiving one of three different antibiotic regimens: intermittent seven day courses of amoxycillin for exacerbations; or a six month course of continuous oral or nebulised amoxycillin. The colonising microbial load of Haemophilus spp was reduced only temporarily (+++ to ++) after each intermittent course of antibiotic, but a sustained and greater reduction in the colonising microbial load of both Haemophilus spp (+++ to +) and antibiotic resistant P aeruginosa (+++ to +) was seen during both continuous treatments. Sputum purulence decreased in parallel with colonising microbial load, reflecting a reduction in host inflammatory response to the colonising microbial load.

Selective medium that distinguishes Haemophilus influenzae from Haemophilus parainfluenzae in clinical specimens: its value in investigating respiratory sepsis

A medium is described, which is selective for the haemophilus genus and also distinguishes between the species Haemophilus influenzae and Haemophilus parainfluenzae isolated in primary culture from clinical material.

Short term response of patients with bronchiectasis to treatment with amoxycillin given in standard or high doses orally or by inhalation

The effect of three amoxycillin treatment regimens on purulent secretions of patients with bronchiectasis has been studied. On the basis of information recorded on a diary card the patients were divided into three groups, according to the usual nature of their secretions: seven who produced mucoid sputum, which occasionally became purulent; seven whose secretions were usually mucopurulent but occasionally purulent; and 19 whose secretions were persistently purulent. Treatment with capsules of amoxycillin in a dosage of 250 mg three times a day resulted in clearance of purulent secretions in patients of the mucoid group when they were treated for a clinical exacerbation. The sputum remained clear in these patients for long periods before a further exacerbation (median 6 1/2, range 1-11 months). The mucopurulent-purulent group also responded to this dosage but sputum purulence returned more rapidly (median 9, range 4-31 days). Only three of the 19 (17%) patients with persistently purulent secretions showed a macroscopic response to this dosage, whereas seven (60%) of 12 patients who received the higher dosage (3 g sachets twice a day) responded. Among the failures, some responded to nebulised amoxycillin, suggesting that higher levels of amoxycillin in secretions are required in these patients. Macroscopic clearance of purulent secretions was finally achieved in most of the patients studied. The response was not always predictable from the results of sputum culture. Clearance of secretions by antibiotics was also identified by the patients, using a diary card score. Improvements in well being and in symptoms were noticed even in the group who usually produced mucopurulent and purulent secretions even though they appeared to be clinically stable before treatment.

Use of gas liquid chromatography in the clinical diagnosis of anaerobic pleuropulmonary infection

Evidence of anaerobic infection was sought in 83 patients with pulmonary disease with anaerobic culture and gas liquid chromatography (GLC) of mucopurulent sputum, or pleural fluid where appropriate. Saliva samples from nine healthy controls and 14 patients with cystic fibrosis were examined by the same methods to assess anaerobic content. Clinically significant anaerobic pleuropulmonary infection was not found in our patients with bronchitis, bronchiectasis and cystic fibrosis and occurred in only some of our patients with empyema and lung abscess. GLC of pleural fluid (empyema) or sputum (lung abscess) was helpful in identifying these cases, when a strongly positive reading was obtained. The gas liquid chromatogram was negative or only weakly positive in those patients where the presence of anaerobes was clinically insignificant, most probably resulting from contamination of the sputum samples by saliva. Results were rapidly available and the need for transtracheal aspiration to obtain specimens of bronchial secretion uncontaminated by mouth flora was avoided. The semiquantitative GLC would therefore appear to be a useful method for investigating specimens from patients with suspected anaerobic pleuropulmonary infection.

Isolation of spheroplastic forms of Haemophilus influenzae from sputum in conventionally treated chronic bronchial sepsis using selective medium supplemented with N-acetyl-D-glucosamine: possible reservoir for re-emergence of infection

The isolation rate of Haemophilus influenzae from patients with persistent production of purulent sputum has been increased by the routine use of a selective medium. Nevertheless, some purulent sputum still fails to yield a pathogen. The selective medium was supplemented with N-acetyl-D-glucosamine to encourage primary isolation of colony forming, spheroplastic H influenzae, which reverted to normal forms on subculture. On the basis of in vitro experiments it is postulated that these spheroplastic forms of H influenzae may be induced by inadequate antimicrobial chemotherapy and may be responsible for re-emergence of symptoms in these patients during or shortly after stopping chemotherapy.

Effect of antibiotic treatment on sputum elastase in bronchiectatic outpatients in a stable clinical state

Broad spectrum antibiotic treatment was given on 21 occasions to 15 patients with bronchiectasis who regularly produced purulent, elastase positive secretions. Although the results showed that sputum clearing--that is, changing from purulent to mucoid--largely depended on the pathogenic organism isolated, this was not exclusively the case and in some cases sputum growing sensitive organisms failed to clear whereas clearing occurred in other samples containing resistant organisms or no obvious pathogens. Clearing of sputum was achieved eventually in 12 of the patients and this was associated with the disappearance of elastase activity, although it returned in 10 patients within one week of stopping treatment. There was no change in sputum elastase where the sputum failed to clear. The clearance of elastase activity was associated with a decrease in protein transudation into the lung secretions. The sputum:serum albumin concentration ratio fell (p less than 0.005) from a mean (SD) of 2.32 (1.56) X 10(-2) in these 12 patients before treatment to 1.09 (0.40) X 10(-2) within the first week of treatment, but rose again to 2.07 (1.29) X 10(-2) within one week of stopping treatment. The results suggest that antibiotic treatment when patients are in a stable state may have a beneficial effect on the pathogenic nature of lung secretions and inflammation within the lung.

[Etiology of the infectious process in chronic pneumonia in children]

During the phase of exacerbation in chronic pneumonia in children Streptococcus pneumoniae and/or Haemophilus influenzae were isolated practically from all patients under examination. In the mild form of chronic pneumonia in children the high occurrence of H. influenzae (65.5-69%) was observed. During the whole acute phase of the disease, irrespective of the activity of the infectious process and the character of therapeutic measures, the degree of contamination of bronchial washings from the patients with these microorganisms was 5.95-6.6 lg/ml. In the bronchiectatic variant of chronic pneumonia the high activity and stability of the infectious processes induced by S. pneumoniae and H. influenzae were found to be linked with the considerable spread of these processes or with deeper morphological and functional changes in the bronchial stem and branches. During the phase of clinical remission in chronic pneumonia in 36.8-58.8% of children the release of S. pneumoniae and H. influenzae was observed. The geometric mean of their concentration varied within 3-5.3 lg/ml.

Pseudomonas aeruginosa mucoid strain. Its significance in adult chest diseases

Isolation of mucoid strains of Pseudomonas aeruginosa from bronchial secretions has occurred usually in the setting of cystic fibrosis. This association has been so strong that it is considered a sign of the presence of cystic fibrosis. We reviewed the records of 31 patients in whom this strain was isolated; in contract to previous experiences, we found that only 2 of our patients could be considered to have cystic fibrosis. The remainder all had a chronic pulmonary disease, and common to all was the presence of bronchiectasis. We conclude that isolation of mucoid strains of Pseudomonas aeruginosa from bronchial secretions of adults with a chronic pulmonary process indicates the presence of underlying bronchiectasis.

[Microflora of the bronchial contents in chronic lung diseases]

The parallel bacteriological and mycological study of the contents of the bronchi in patients with various forms of chronic pneumonia provided a clearer picture of the causative agents of the disease. The composition of microflora in the bronchial contents corresponded to the severity of the process. Uncomplicated chronic pneumonia took its course with a bacterial monoculture, belonging predominantly to the family of pyogenic cocci, present in the discharges. The formation of abscesses and the development of bronchioectases proceeded of bacterial and mycotic associations. The development of malignant tumors was accompanied by the colonization of the pulmonary ways by a variety of organisms, including bacteria of the fecal flora.

[Frequency of fungal infection in chronic bronchitis and bronchiectasis (author's transl)]

Among 1 161 patients with chronic bronchitis and 172 patients with bronchiectasis treated for a longer time with antibiotics or with antibiotics and corticosteroids and examined all for fungi in bronchial secretion, 34 = 0.9% showed a secondary infection with fungi (32 Candida, 2 Aspergillus fumigatus).

Pulmonary infection with Petriellidium boydii

A 52-year-old woman with pulmonary involvement with Petriellidium boydii in a bronchiectatic lung segment is described. Pulmonary involvement with this organism has been most frequently described in patients with underlying systemic diseases or compromised immune systems. This patient apparently had neither problem and was normal in all other aspects. Surgical resection was done to avoid local pulmonary parenchymal invasion or dissemination of this fungus. The patient is now in good health two years after operation.

Human infection caused by penicillin-insensitive pneumococci

Three cases of infection, including two fatal ones, caused by pneumococci relatively resistant to penicillin are reported. The patients were a 19-year-old New Guinean with fatal multisegmental pneumonia, a 10-week-old Caucasian infant who died suddenly from purulent meningitis, and an Australian Aboriginal child aged two years with bronchiectasis complicated by pneumococcal bacteraemia. The pneumococci isolated (serotypes 6, 16 and 19) showed minimal inhibitory concentrations of penicillin G ranging from 0-1 microgram/ml to 1-0 microgram/ml (resistance ratios five to 50) and were also relatively resistant to penicillin V, methicillin, cloxacillin and cephalosporins.

Respiratory disease in a colony of rats. II. Isolation of Mycoplasma pulmonis from the natural disease, and the experimental disease induced with a cloned culture of this organism

Mycoplasma pulmonis was isolated from the pneumonic lung of a rat. Two groups of mycoplasma-free rats were inoculated, one with a culture of the M. pulmonis strain which had been cloned four times (group A) and the other with a lung homogenate of the rat from which the strain had been isolated (group B). A third group (C) consisted of uninoculated control animals. Each group was kept in strict isolation and allowed to breed so that the progeny was naturally exposed to any pathogens present in the inoculated animals. After different periods of exposure, rats were autopsied, respiratory tracts and inner ears were cultured for mycoplasmas and bacteria, and sera were tested for complement-fixing antibodies to murine mycoplasmas.In group-A rats, M. pulmonis was consistently isolated from the inner ears or lungs from 50 to 715 days after exposure. Complement-fixing antibody to M. pulmonis was detected 20 days after inoculation, but in the naturally exposed progeny antibody took longer than 50 days to develop. Antibodies to the other known mycoplasmas of murine origin, M. arthritidis and M. neurolyticum, were never found. Purulent otitis interna was consistently found from day 55 onwards, while lung lesions were first observed at 85 days and persisted to 715 days. Pulmonary lesions developed more slowly in inoculated parents than in exposed progeny. Similar results were found in group-B rats, which were examined up to 441 days after inoculation. Uninoculated group-C rats were examined up to 768 days of age, but M. pulmonis was not recovered; of the 54 animals whose serum was tested all were negative to the three species of mycoplasmas, except one which had a titre of 16 with M. pulmonis. Pneumonia, bronchiectasis or lymphoreticular hyperplasia were not seen in any of these control rats. Bacterial respiratory pathogens were not isolated from rats in any of the groups, nor was antibody to Sendai virus detected.The results suggest that M. pulmonis alone can cause pneumonia and bronchiectasis in rats since mechanical carry-over of another pathogen with the initial cloned inoculum is very unlikely and there was no evidence for the participation of any other rat pathogen. The respiratory disease induced by the cloned culture was comparable with that induced by the lung homogenate, and with the well-known syndrome of chronic respiratory disease and bronchiectasis in the rat.