Pneumococcal puerperal mastitis in a lactating mother

Introduction

A case of pneumococcal mastitis in a breast-feeding mother 6 months postpartum is described. Mastitis is usually caused by Staphylococcus aureus. A review of the literature from 1950 to March 2018 revealed only four other cases in which the causative organism was Streptococcus pneumoniae.

Case presentation

The nursing mother presented with high fever and the four cardinal signs of inflammation of the left breast: calor, dolor, rubor, tumour. In milk culture Streptococcus pneumoniae was isolated in numbers exceeding 10⁵  c.f.u. ml⁻¹ . The strain was of polysaccharide serotype 11 not included in Prevnar-13. Susceptibility testing showed full sensitivity to β-lactam antibiotics as well as to macrolides, lincosamides, vancomycin and tetracycline.

Conclusion

Streptococcus pneumoniae should be considered as a possible causative agent of puerperal mastitis.

Prospective monitoring of BK virus replication in renal transplant recipients

BACKGROUND

BK virus-associated nephropathy (BKVAN) can be diagnosed only with renal graft biopsy. Definitive diagnosis of BKVAN requires demonstration of BK virus (BKV) replication in renal allograft tissues. Non-invasive analysis of urine and blood is considered essential in screening renal transplant recipients.

PATIENTS AND METHODS

This study evaluated prospectively the replication of BKV in plasma and urine with qualitative and quantitative real-time polymerase chain reaction in 32 de novo (group A) and 34 chronic (group B) renal transplant recipients and the long-term impact on graft function.

RESULTS

In group A, 456 samples (228 plasma, 228 urine) were examined and BKV was detected in 31 (31/228, 14%) samples of plasma and 57 (57/228, 25%) samples of urine in 20 (20/32, 62.5%) and 23 (23/32, 72%) recipients, respectively. Incidence of viremia and viruria increased during the first 6 months presenting a peak the third postoperative month (viremia: 28% and viruria: 31%). Immune suppressive treatment with tacrolimus showed significant relation with viremia. Renal graft function in de novo renal transplant recipients remained stable throughout the follow-up period without influence of BKV replication. In group B, incidence of viremia and viruria were 3% (1/34) and 9% (3/34) correspondingly, indicating that after the first post-transplant year the risk of BKV re-activation is diminished.

CONCLUSION

The highest incidence of BK viremia and viruria is observed the third post-transplantation month, confirming previously published studies in Europe and the United States, and long-term follow up shows that BKV replication decreases significantly after the third post-transplant month and even transient viremia or viruria does not have an impact on renal function.

Group B streptococcus colonization of Greek pregnant women and neonates: prevalence, risk factors and serotypes

OBJECTIVE

To evaluate the prevalence and risk factors of group B streptococcus (GBS) colonization among pregnant women and their neonates in Greece, and to examine the serotype distribution of the GBS strains isolated and their susceptibility to antibiotics.

METHODS

A vaginal and a rectal swab were obtained from 1014 pregnant or parturient women followed at public and private hospitals in Athens and in a city of northern Greece. Cultures were also taken 24 h after birth from 428 neonates born to these women.

RESULTS

The overall maternal and neonatal colonization rates were 6.6% and 2.4%, respectively. The vertical transmission rate was 22.5%. By logistic regression analysis, multiparity (>/=III) was associated with a lower colonization rate (odds ratio 4.4, 95% confidence interval 1.08-18.63). In contrast with other studies, middle-class women followed privately were more frequently colonized (10%) than those followed at the public hospital (3.9%) (odds ratio 3.1, 95% confidence interval 1.83-5.42). A higher number of prenatal visits was also associated with a higher colonization rate (change in true odds ratio when visits increased by one, 1.3; 95% confidence interval 1.14-1.60). No association was found between colonization and maternal age, previous obstetric history, marital status, nationality, prematurity, Caesarean section, or infant birth weight. The most common serotypes were II (26.9%), III (22.4%), Ia (19%), Ib (12%), and V (9%). A considerable proportion of the isolated strains was resistant to erythromycin (4.5%), clindamycin (6%), or both (6%).

CONCLUSION

The rate and risk factors of maternal and neonatal GBS colonization may vary in different communities. These rates, as well as the incidence of neonatal disease, need to be thoroughly evaluated in each country to allow the most appropriate preventive strategy to be selected.

Surgical adjuvant therapy of rectal carcinoma: a controlled evaluation of leucovorin, 5-fluorouracil and radiation therapy with or without interferon-alpha2b

BACKGROUND

The aim of this study was to determine whether the efficacy of the combination of 5-fluorouracil (5-FU), leucovorin (LV) and radiation therapy (RT) could be improved by the addition of interferon-alpha2b (IFN-alpha) in patients who have had a 'curative' resection, for rectal adenocarcinoma (Dukes' B2/C; T3 N0, T4 N0, N1-3).

PATIENTS AND METHODS

A total of 207 eligible patients with a performance status of 0 or 1 were randomized postoperatively between days 21 and 70 to one of the two treatment groups: group A, LV 20 mg/m2 i.v. bolus and 5-FU 425 mg/m2 i.v. days 1-5 and 29-33, LV 20 mg/m2 and 5-FU 400 mg/m2 days 57-60 and 85-88, LV 20 mg/m2 and 5-FU 380 mg/m2 days 1-5 and 29-33 with the second day 1 occurring 28 days after the completion of RT (45 Gy); group B, LV, 5-FU and RT as in group A, and IFN-alpha 5 x 10(6) IU s.c. three times during each week chemotherapy is given.

RESULTS

104 patients were randomized into group A and 103 into group B. There was no statistically significant difference in either disease-free survival or overall survival between the two groups. Toxicity was also the same, except for the flu-like syndrome associated with the IFN-alpha administration.

CONCLUSIONS

There was no difference in efficacy between the two combinations. Toxicity was greater with the LV + 5-FU + IFN-alpha regimen because of the flu-like syndrome.

Campylobacter jejuni O:19 serotype-associated Guillain-Barré syndrome in a child: the first case reported from Greece

We present a case of Guillain-Barré syndrome (GBS) following Campylobacter jejuni HS serotype O:19 infection in a child. Antibodies against C. jejuni and autoantibodies to the peripheral nerve gangliosides GM1 were positive, a pattern correlating well with the existence of an inflammatory neuropathy like GBS. The patient shared the HLA-B35 and HLA-DR8 antigens, which have been found to be increased in GBS patients with previous C. jejuni infection. As this is the first diagnosed C. jejuni-associated GBS case reported from Greece, further clinical and epidemiologic investigations are warranted.

Microscopy, PCR and ELISA applied to the epidemiology of amoebiasis in Greece

Detection and differentiation between Entamoeba histolytica and E. dispar are of great importance both for diagnosis and epidemiological studies. The present study was aimed to estimate the prevalence of these species in Greece and to assess the performance of microscopy, ELISA and PCR in the field. Our results indicate that the prevalence of these parasites is very low in Greece and that PCR and ELISA are by far better than microscopy. When it comes to the choice between ELISA and PCR, it seems that in real situations the advantages of PCR are outweighed by those of ELISA.

Variations in the prevalence of strains expressing an extended-spectrum beta-lactamase phenotype and characterization of isolates from Europe, the Americas, and the Western Pacific region

To evaluate the prevalence of extended-spectrum beta-lactamase (ESBL)-producing strains among species of Enterobacteriaceae, a microdilution susceptibility test was performed with strains of Klebsiella pneumoniae, Escherichia coli, Proteus mirabilis, and Salmonella species that were isolated as part of the SENTRY project. The highest percentage of ESBL phenotype (defined as a minimum inhibitory concentration [MIC] > or =2 microg/mL for ceftazidime, ceftriaxone, or aztreonam) was detected among K. pneumoniae strains from Latin America (45%), followed by those from the Western Pacific region (25%), Europe (23%), the United States (8%), and Canada (5%). P. mirabilis and E. coli strains for which MICs of extended-spectrum cephalosporins or monobactams were elevated also were more prominent in Latin America. Testing with ceftazidime revealed more isolates with elevated MICs than did testing with ceftriaxone or aztreonam. ESBL strains showed high levels of co-resistance to aminoglycosides, tetracycline, trimethoprim-sulfamethoxazole, and ciprofloxacin. Imipenem remains highly effective against ESBL strains. Organisms expressing an ESBL are widely distributed worldwide, although prevalence rates are significantly higher in certain geographic regions.

A nested, multiplex, PCR assay for the simultaneous detection and differentiation of Entamoeba histolytica and Entamoeba dispar in faeces

The detection of and differentiation between Entamoeba histolytica and Entamoeba dispar are of great importance, both for diagnosis and for epidemiological studies. Most PCR-based methods for the discrimination of these two species employ complex procedures for DNA extraction and require different protocols for E. histolytica and E. dispar, leading to relatively high expenditure, labour costs and turnaround times. A simple, rapid, cost-effective and yet sensitive and specific multiplex PCR technique has now been developed for the simultaneous detection and differentiation of E. histolytica and E. dispar in faecal samples. The detection limit is 200 trophozoites of E. dispar or 1000 trophozoites of E. histolytica/g stool sample. The sensitivity of the assay remains practically unchanged, even in the presence of 20,000 trophozoites of the other species/g stool sample. Thus, this technique may also easily reveal mixed infections, without the danger of misdiagnosis caused by one strain displacing the other in culture.

Incidence of antibiotic resistance in blood and urine isolates from hospitalized patients. Report from a European collaborative study. European Study Group on Antibiotic Resistance (ESGAR)

During 1992-93, 2544 isolates from blood cultures, comprising 52% gram-negative bacilli, 24% Staphylococcus aureus, 15% other staphylococci, 7% Enterococcus faecalis and 2% E. faecium, were consecutively collected and identified in 30 laboratories in 21 European countries. In addition 2512 urine isolates, comprising 82% gram-negative bacilli, 3% S. aureus, 4% other staphylococci and 11% enterococci were collected. The bacteria were sent to 3 laboratories for susceptibility testing by the microdilution method in Mueller-Hinton broth. The MICs of penicillins and aztreonam for all susceptible gram-negative bacilli were 0.25-8 mg/l, penems 0.032-2 mg/l, cefotaxime, ceftazidime and cefpirome or cefepime 0.032-0.25 mg/l, gentamicin, tobramycin and netilmicin 0.125-2 mg/l, amikacin 0.5-4 mg/l, ciprofloxacin 0.016-1 mg/l, trimethoprim 0.25-1 mg/l and tetracycline 1-2 mg/l. For susceptible staphylococci the MICs of erythromycin were 0.25-0.5 mg/l, clindamycin 0.125-0.25 mg/l, methicillin 2-8 mg/l, vancomycin and trimethoprim 1-4 mg/l, ciprofloxacin 0.25-1 mg/l, gentamicin and tobramycin 0.25-1 mg/l. For the enterococci the MICs of ampicillin and vancomycin were 2-4 mg/l and of imipenem, teicoplanin and trimethoprim 0.5-1 mg/l. The antibiotic resistance rates varied between laboratories, being lower in northern Europe, except for the penems, cefpirome and cefepime, which showed uniformly lower resistance rates. Compared to the earlier European studies the resistance rates to beta-lactam antibiotics among the gram-negatives have not changed except with an increase to cefotaxime and ceftazidime in central Europe. Resistance to aminoglycosides had also increased in central Europe from 7-8% to 20-21%, but decreased in southern Europe from 22-24% to 13-14% among the blood isolates and from 12-28% to 6-7% among the urine isolates. There was an increase in resistance to ciprofloxacin and gentamicin in staphylococci from southern Europe. The prevalence of MRSA was significant in central and southern Europe. It is of importance that collaborative national and international studies on the incidence of antibiotic resistance are being performed on a repetitive basis.

Assessment of resolution and intercenter reproducibility of results of genotyping Staphylococcus aureus by pulsed-field gel electrophoresis of SmaI macrorestriction fragments: a multicenter study

Twenty well-characterized isolates of methicillin-resistant Staphylococcus aureus were used to study the optimal resolution and interlaboratory reproducibility of pulsed-field gel electrophoresis (PFGE) of DNA macrorestriction fragments. Five identical isolates (one PFGE type), 5 isolates that produced related PFGE subtypes, and 10 isolates with unique PFGE patterns were analyzed blindly in 12 different laboratories by in-house protocols. In several laboratories a standardized PFGE protocol with a commercial kit was applied successfully as well. Eight of the centers correctly identified the genetic homogeneity of the identical isolates by both the in-house and standard protocols. Four of 12 laboratories failed to produce interpretable data by the standardized protocol, due to technical problems (primarily plug preparation). With the five related isolates, five of eight participants identified the same subtype interrelationships with both in-house and standard protocols. However, two participants identified multiple strain types in this group or classified some of the isolates as unrelated isolates rather than as subtypes. The remaining laboratory failed to distinguish differences between some of the related isolates by utilizing both the in-house and standardized protocols. There were large differences in the relative genome lengths of the isolates as calculated on the basis of the gel pictures. By visual inspection, the numbers of restriction fragments and overall banding pattern similarity in the three groups of isolates showed interlaboratory concordance, but centralized computer analysis of data from four laboratories yielded percent similarity values of only 85% for the group of identical isolates. The differences between the data sets obtained with in-house and standardized protocols could be the experimental parameters which differed with respect to the brand of equipment used, imaging software, running time (20 to 48 h), and pulsing conditions. In conclusion, it appears that the standardization of PFGE depends on controlling a variety of experimental intricacies, as is the case with other bacterial typing procedures.

Beneficial effect of Salmonella typhimurium infection and of immunoglobulins from S. typhimurium-infected mice on the autoimmune disease of (NZB x NZW) F1 mice

Various infections can precede or aggravate autoimmune diseases. Yet a beneficial effect of infection has also been described an various mechanisms have been postulated to explain this effect. The aim of this study was to examine the hypothesis that infection can have an immunoregulatory effect on the autoimmune process via the increased production of natural polyreactive antibodies. The effect of Salmonella typhimurium infection on the lupus-like disease of (NZB x NZW)F1 (B/W) mice was therefore studied. The effect of IgM and IgG preparations isolated from the serum of S. typhimurium-infected C57B1/6 and CBA mice on the autoimmune disease of B/W mice was also tested. C57B1/6 and CBA mice were chosen because they are respectively genetically susceptible and resistant to S. typhimurium infection and they differ in their antibody response during the early phase of infection. CBA mice can mount a specific anti-bacterium antibody response, whereas C57B1/6 mice present increased production of polyreactive antibodies. The infection effect was evaluated on several disease parameters, i.e. survival, incidence of high grade proteinuria and serum IgM and IgG antibody activity directed against a panel of autoantigens. Our main findings were: (i) infection of B/W mice with an attenuated strain of S. typhimurium delayed the course of the autoimmune disease when performed before the appearance of autoimmune symptoms; and (ii) IgM and IgG preparations from S. typhimurium-infected C57B1/6 mice had a similar effect whereas the IgM and IgG preparations from infected CBA mice, as well as from normal C57B1/6 and CBA mice, were ineffective. These results suggest that S. typhimurium infection can beneficially influence the development of the autoimmune disease of B/W mice. The immunoregulatory effect of the infection seems to be related at least partially, to the increase of a particular population of antibodies, the polyreactive antibodies.

Sparfloxacin for the treatment of community-acquired pneumonia: a pooled data analysis of two studies

A pooled data analysis of two double-blind studies encompassing 1137 episodes of community-acquired pneumonia in hospitalised adults, of which 560 were treated with sparfloxacin and 577 were randomised to comparator antibacterial agents (amoxycillin/clavulanic acid, erythromycin or amoxycillin administered at reference dosages), was performed. The global efficacy rate at the end of treatment in evaluable patients treated with sparfloxacin was 88.3% compared with 84.1% in those who received comparator antibacterial agents. This analysis verified the efficacy of this new aminofluoroquinolone, given orally once daily, in the treatment of community acquired pneumonia. The overall outcome favoured sparfloxacin for use in the empirical treatment of community-acquired pneumonia.

Treatment of community-acquired pneumonia: a randomized comparison of sparfloxacin, amoxycillin-clavulanic acid and erythromycin

The treatment of community-acquired pneumonia is empirical in most cases and must cover a wide range of potential pathogens, such as Streptococcus pneumoniae, including penicillin-resistant strains, Haemophilus influenzae and intracellular microorganisms. The objective of this double-blind, randomized, parallel group study was to compare the efficacy and safety of sparfloxacin (400 mg loading dose, followed by 200 mg o.d.) with that of oral amoxycillin-clavulanic acid (500/125 mg t.i.d.) or oral erythromycin (1 g b.i.d.), during 7-14 days in 808 patients with confirmed community-acquired pneumonia. The overall success rates for sparfloxacin (87%), amoxycillin-clavulanic acid (80%) and erythromycin (85%) were similar in evaluable patients, and the equivalence hypothesis used for the statistical analysis showed at least an equivalent efficacy for the three antibiotics tested. The analysis of microbiologically documented infections (40% of the patients) showed that overall success rates were similar for S. pneumoniae and H. influenzae infections. Treatment withdrawal was necessary in 3.5, 2.5 and 7.7% of the patients treated with sparfloxacin, amoxycillin-clavulanic acid and erythromycin, respectively. This study indicates that sparfloxacin was at least as effective as amoxycillin-clavulanic acid or erythromycin in the treatment of mild-to-moderate community-acquired pneumonia and that the adverse effects were similar in the three groups.

Evaluation of commercial amplification kit for detection of Legionella pneumophila in clinical specimens

A commercial kit (EnviroAmp) designed to detect the DNA of Legionella species in environmental water samples using PCR and reverse dot hybridization was applied to clinical specimens. Results correlated well with culture for bronchoalveolar lavages. In addition, this test was easy to perform and showed good sensitivity.

Detection of sperm-bound antibodies in the male partners of infertile couples using the immunobead test

The aim of this investigation was to determine the incidence of sperm-bound antibodies in the male partners of an unselected infertile population using an immunologically specific test (IBT). With this method 34 out of 450 infertile men (7.55%) were positive for one or more of the immunoglobulins IgA, IgG and IgM. For IgG and IgA, the majority of antibody binding was located on the entire sperm with a minor amount bound to the head or tail. For the IgM, the majority of the binding was detected to the tail tip, and tail binding was observed only in a minority of cases.

Overwhelming postsplenectomy infection in patients with thalassemia major

The efficacy of pre- and post-operative protection against overwhelming postsplenectomy infection was evaluated in a prospective study of 98 patients with thalassemia major. All patients were vaccinated four to ten weeks pre-operatively with a polyvalent antipneumonococcal vaccine; after their discharge from the hospital they received 1,000,000 units (625 mg) of oral penicillin daily for one to two years and have been closely followed up since then. The incidence of overwhelming infection among our patients was 1.02%. This very low incidence suggests that vaccination and prophylactic penicillin administration, combined with careful follow-up, provide adequate protection against overwhelming infection in splenectomized patients with thalassemia major.

Anaerobic bacteria in jaw cysts

The bacterial flora of the fluid content of 54 cysts of the jaws with a history suggestive of infection were studied. Forty-seven of these cysts were subsequently considered to be infected and from 78.6% of these, positive bacterial cultures were developed. Of the bacterial strains 89.2% were anaerobes and only 10.8% were pure aerobes or facultative anaerobes. Microorganisms isolated from each specimen ranged from 1 to 4 bacterial species. Gram positive anaerobic cocci revealed to be the most frequent bacterial group (36.9%), followed by Gram negative anaerobic rods (29.8%), Gram positive aerobic cocci being the third most common group of the isolates (19.0%). Antibiotic sensitivity tests of the isolated anaerobic cocci to a group of nine antibiotics revealed chloramphenicol and minocycline as the most effective. All anaerobic rods tested, were sensitive to metronidazole.

The effect of pentosanpolysulphate and carbenoxolone on bacterial adherence to the injured urothelium

The effect of the glycosaminoglycan (GAG) layer on the adherence of Escherichia coli to the bladder urothelium of rats has been studied. The study was performed by destroying the GAG layer and the changes were observed using the electron microscope. Bacterial adherence to the bladder with a destroyed GAG layer was much higher than to the normal bladder. Following the destruction of the GAG layer, the instillation of sodium pentosanpolysulphate significantly reduced the adhesion of bacteria. Prophylactic intramuscular administration of carbenoxolone increased the speed of regeneration of the destroyed GAG layer.

Concentration of metronidazole in rat serum and mandible

The levels of metronidazole in rat serum and mandibular bones was measured 2, 5 and 8 h after oral administration of three doses of 200 mg/kg. Effective levels of the drug in serum and mandible were found at all time intervals as well as a higher concentration in mandible than in serum.

Microbiological findings of infected root canals and adjacent periodontal pockets in teeth with advanced periodontitis

The purpose of the present study was to examine the flora from the root canals and periodontal pockets of teeth with advanced periodontal disease in order to compare the predominant cultivable microflora from the canals with those found in the adjacent periodontal pockets. Three samples were collected from each of sixteen patients, one from the root canal and two from the adjacent periodontal pocket in two different sites. Criteria for inclusion in the survey were pocket depth of greater than or equal to 7 mm, intact clinical crowns, and lack of periapical lesions. The study has demonstrated that the microorganisms present in the root canals of caries-free teeth with advanced periodontitis generally resembled those found in the adjacent periodontal pockets. The similarity in the recovery of organisms in the current study suggests that the pocket could be the source of the root canal infections. Further investigation is needed to clarify whether such factors as duration of periodontitis and age of the patient play a role in pulpal pathosis and whether the presence of specific bacterial species is also a factor in the etiology and pathogenesis of pulp disease.

Use of the gallbladder neck in the reconstruction of the bifurcation of the main hepatic ducts

A case of successful resection of an adenocarcinoma of the junction of the right, left and common hepatic ducts is reported. The right hepatic duct was anastomosed to the gallbladder neck and the left hepatic to the common hepatic duct in order to restore the continuity of the biliary tract. This unusual technique offered effective decompression. It may prove, in selected patients with a normal gallbladder and a wide cystic duct, to be a useful alternative to other commonly performed internal drainage procedures.