Significance of atypical pathogens among community-acquired pneumonia adult patients admitted to hospital in Kuwait

The aim of this study is to determine the microbial etiology and severity of community-acquired pneumonia [CAP] in Kuwait. The severity of consecutive adult CAP cases admitted to 3 hospitals over a 1-year period was classified according to the Pneumonia Outcome Research Team [PORT] severity index. The microbial etiology was determined using st and ard methods for bacteria and serological tests for atypical and viral pathogens. The study population was 124 of the 135 admissions; 63 female, 61 male; mean age 41.3 +/- 18 years. The severity class distribution was: class 131%, class II 37%, class III 17%, class IV 13%, and class V 2%. Etiological agents were identified from 44 patients [35%], with one pathogen in 31 [25%], two in 9 [7%], and three or more in 4 [3%]. The most common pathogens identified were: Mycoplasma pneumoniae in 14 patients [11%], Legionella pneumophila in 10 [8%], Chlamydia pneumoniae in 8 [6%], influenza B virus in 8 [6%], influenza A virus in 5 [4%], Haemophilus influenzae in 4 [3%], Streptococcus pneumoniae in 3 [2%], Staphylococcusaureus in 3 [2%], gram-negative enterobacteria in 5 [4%], Moraxella catarrhalis in 2 [2%], and viruses in 4 [3%]. The yields from laboratory tests were 48% for paired serology, 20% from adequate sputum sample, and 3% from blood culture. Our study shows that a large percentage of mild CAP cases are admitted to hospitals in Kuwait, Atypical pathogens have a significant role in the etiology of CAP. There is overtreatment of CAP with a combination treatment consisting mainly of third-generation chephalosporins and macrolides

Antimicrobial susceptibility, phage typing and plasmid profile of salmonella enterica serotype paratyphi A strains isolated in Kuwait

To determine the antimicrobial susceptibility, phage type and plasmid profile pattern of Salmonella enterica serotype paratyphi A strains isolated in Kuwait. Material and From January 1995 to December 1999, 106 strains of S. enterica serotype paratyphi A isolated from an equal number of cases of enteric fever, attending the Infectious Disease and Mubarak Al-Kabeer Hospitals in Kuwait were investigated. The isolates were tested for antimicrobial susceptibility to 8 commonly used antimicrobial agents. Their phage type and plasmid profile patterns were determined using an international set of phages and Qiagen plasmid mini kit, respectively. All of the isolates were susceptible to ciprofloxacin, cefuroxime, ceftazidime, piperacillin and co-trimoxazole. One hundred isolates were susceptible to ampicillin, 99 to chloramphenicol and 98 to tetracycline. None of the isolates was multidrug resistant. Sixty-six% of the isolates were phage type I, 27.4% phage type II and 6.6% were untypable. All phage type I and untypable strains had 3 plasmids of 2.2, 5 and 20 kb, whereas phage type II strains had only 1 plasmid of 20 kb. The findings indicate that while all of the isolates of the S. enterica serotype paratyphi A were susceptible to 4 of the drugs tested, some were resistant to ampicillin, chloramphenicol or tetracycline, thereby indicating the need for continued surveillance and monitoring of antimicrobial susceptibility of these isolates

Adhesion of staphylococcus epidermidis to a human cardiac cell line mediated by lipoteichoic acid

Staphylococcus epidermidis is a common cause of endocarditis. This study was carried out to examine the early steps of its pathogenesis, i.e. bacterial adhesion. Adherence of S. epidermidis to human, bovine and murine endothelial cell lines with and without pretreatment of cell lines with lipoteichoic acid [LTA] and pretreatment of bacteria with polyclonal anti-LTA antibodies, human albumin and lipase was carried out. S. epidermidis binding to human continuous endocardial cell line was 3% of the inoculum. This was blocked with LTA [65%], polyclonal anti-LTA antibodies [50%], human albumin [60%] and lipase [60-70%]. LTA is an important though not the sole adhesin for bacterium host cell receptor interaction in this experimental model

Detection of Mycobacterium tuberculosis complex and non-tuberculous mycobacteria by multiplex polymerase chain reactions

The ability of two-band and three-band multiplex polymerase chain reactions to detect and differentiate Mycobacterium tuberculosis complex from non-tuberculous mycobacteria was evaluated. The polymerase chain reactions differentiated between M. tuberculosis and non-tuberculous mycobacteria when standard strains and clinical isolates of mycobacteria were tested. The sensitivity of the two-band and three-band techniques to detect M. tuberculosis in clinical specimens, compared with smear and/or culture, was 88% and 75% respectively. Although both techniques showed 100% specificity, the superior sensitivity of the two-band technique suggests that it could be more useful in the diagnosis of tuberculosis and in differentiating M. tuberculosis complex from non-tuberculous mycobacteria

Systemic mycoses: the changing spectrum in contemporary medicine

The last twenty years have witnessed a dramatic increase in the incidence of systemic fungal infections throughout the world. While acquired immunodeficiency syndrome [AIDS] has emerged as a single most important risk factor for endemic mycoses, a variety of iatrogenic and other factors continue to predispose a significant proportion of immunosuppressed patients to infection with fungal pathogens. Amongst the endemic mycoses, histoplasmosis has become an important opportunistic infection largely in mid-west, coccidioidomycosis in south-west and blastomycosis in south-central of the USA. In southeast Asia, penicilliosis due to Penicillium marneffei has emerged as a major endemic mycosis of AIDS patients. Opportunistic yeast infections have become more common than infections caused by filamentous fungi, occupying fourth position in the list of bloodstream pathogens in some centers. Also, their incidence, pattern of clinical presentation and species spectrum has significantly altered, largely due to more frequent and prolonged use of antifungal drugs and subsequent development of resistance. Consequently, infections with less susceptible yeast species such as Candida lusitaniae, C, krusei, C. tropicalis, C. glabrata, and Trichosporon beigelii have been reported with greater frequency. The problem of antifungal resistance is likely to expand in future as more and more patients with AIDS, bone marrow transplant, and neutropenia will need chemoprophylaxis cover. Amongst other fungal infections, aspergillosis has emerged as an important disease in bone marrow transplant recipients, cryptococcosis and penumocystosis in patients with AIDS, fusariosis in leukemics receiving cytotoxic therapy, zygomycosis in diabetics and in haemodialysis patients on deferoxamine therapy and Malassezia furfur infection in patients receiving intravenous lipid emulsions. Never before in the history of medicine, opportunistic systemic mycoses were so important as they are today. The factors contributing to the rising incidence of these life-threatening infections are unlikely to recede; rapidly expanding population of AIDS patients in Africa and Asia is just one example. Under this rapidly changing scenario, the need to create a greater awareness about their epidemiology, diagnosis and therapy is imperative