Adolescent twin sisters with severe acute respiratory syndrome (SARS).

A novel coronavirus-associated communicable respiratory disease, severe acute respiratory syndrome (SARS), spread worldwide after an outbreak in Guangdong Province of the People's Republic of China in November 2002. Since late February 2003, there has been an epidemic in Hong Kong involving both adult and pediatric patients. The clinical course, intensive care, and outcome of adolescent twin sisters with SARS are described. Adolescents infected with SARS may develop severe illness as adults, and close monitoring for disease progression in terms of both clinical and radiologic deterioration is warranted.

Evaluation of the efficacy of treatment of Kawasaki disease before day 5 of illness.

We evaluated the efficacy of treating Kawasaki disease earlier than Day 5 of illness with a standard dose of immunoglobulin and aspirin. We performed a case-control study of patients with Kawasaki disease admitted to Princess Margaret Hospital from 1994 to 1999. Patients with pretreatment coronary aneurysm or those treated after day 10 of illness were excluded. All patients received immunoglobulin (2 g/kg) and aspirin (80-100 mg/kg/day) until fever subsided for 48 hours. Immunoglobulin retreatment was given for persistent fever 48 hours after the first dose of immunoglobulin or recrudescent fever. The case group consisted of 15 patients who received treatment earlier than day 5 of illness, and the control group consisted of 66 patients who were treated on or after day 5. Patients' sex, age, duration of posttreatment fever, need for additional immunoglobulin, and coronary artery status were noted. Treatment efficacy was assessed by the duration of posttreatment fever and the prevalence of coronary artery aneurysms. Eighty-one patients were included in this study. There were 15 patients in the case group and 66 in the control group. No significant difference was noted in age and sex between the case and control groups. Thirty-three percent (5/15) and 8% (5/66) of the case and control groups, respectively, had persistent/ recrudescent fever 48 hours after the first dose of immunoglobulin that required retreatment ( p = 0.017). Thirteen percent (2/15) and 5% (3/66) of the case and control groups, respectively, had coronary aneurysms ( p = 0.158). Treatment of Kawasaki disease before day 5 of illness was associated with persistent/recrudescent fever that required retreatment. However, there was no significant increase in the prevalence of coronary aneurysm if retreatment was given.

Intestinal transport of gentamicin with a novel, glycosteroid drug transport agent.

PURPOSE: The objective was to investigate the ability of a glycosteroid (TC002) to increase the oral bioavailability of gentamicin. METHODS: Admixtures of gentamicin and TC002 were administered to the rat ileum by injection and to dogs by ileal or jejunal externalized ports, or PO. Bioavailability of gentamicin was determined by HPLC. 3H-TC002 was injected via externalized cannulas into rat ileum or jejunum, or PO and its distribution and elimination was determined. The metabolism of TC002 in rats was evaluated by solid phase extraction and HPLC analysis of plasma, urine and feces following oral or intestinal administration. RESULTS: The bioavailability of gentamicin was substantially increased in the presence of TC002 in both rats and dogs. The level of absorption was dependent on the concentration of TC002 and site of administration. Greatest absorption occurred following ileal orjejunal administration. TC002 was significantly more efficacious than sodium taurocholate, but similar in cytotoxicity. TC002 remained primarily in the GI tract following oral or intestinal administration and cleared rapidly from the body. It was only partly metabolized in the GI tract, but was rapidly and completely converted to its metabolite in plasma and urine. CONCLUSIONS: TC002 shows promise as a new drug transport agent for promoting intestinal absorption of polar molecules such as gentamicin.

Development of trimethoprim-resistance in Salmonella typhi during therapy.

A typhoid patient was infected with a fully-sensitive, plasmidless strain of Salmonella typhi which acquired resistance to kanamycin, sulfamethoxazole and trimethoprim during cotrimoxazole therapy. The resistant post-treatment strain harboured 4 plasmids of 62, 4.1, 3.8 and 3.0 Md in size. Kanamycin-, sulfamethoxazole- and trimethoprim-resistance were borne on a transferable 62 Md plasmid which was compatible with groups FI, FIme, FII, FIV, H1, H2, B, I1, I2, J, K, M, N, T, X, W and P. Sulfamethoxazole-resistance was also borne on the 4.1 Md plasmid. The 3.8 Md plasmid was not transferable; the 3.0 Md plasmid was transferable but did not confer antibiotic resistance. Excluding the strain described here, only 5 out of 35 other S typhi isolates contained plasmids. This is the first report of trimethoprim-resistant S typhi in Hong Kong.

Orientational disorder in solvent-free solid c70.

The high-temperature structure of solvent-free C(70) has been determined with high-resolution x-ray powder difraction and electron microscopy. Samples crystallized from solution form hexagonal close-packed crystals that retain an appreciable amount of residual toluene, even after prolonged heating. Samples prepared by sublimation, which contain no detectable solvent, are primarily face-centered cubic with some admixture of a hexagonal phase. The relative volume of the hexagonal phase can be further reduced by annealing. The structures of both phases are described by a model of complete orientational disorder. The cubic phase contains an appreciable density of stacking faults along the [111] direction.

Evaluation of Cathra system for identifying gram negative aerobic bacteria.

The Cathra system is a commercial multipoint inoculation method for the identification of aerobic Gram negative bacteria. The system uses a replicator technique in which 21 different agar media can be inoculated simultaneously with 36 organisms. Identifications are made by use of a special computer database. The performance of this system was compared with that of the API 20E for the identification of 372 clinical isolates of Enterobacteriaceae and 133 miscellaneous Gram negative bacteria. For enterobacteria, the Cathra system was in 97% agreement with API 20E at species level and 98% at genus level. For miscellaneous Gram negative strains the two systems were in 59% agreement at species level and 77% at genus level. The Cathra system is suitable for use in diagnostic laboratories, especially those with a heavy workload and a wish to use break-point sensitivity testing. The identification database for miscellaneous Gram negative organisms, however, needs to be expanded.

Antimicrobial susceptibilities of Haemophilus species in Hong Kong.

Altogether 403 Haemophilus spp. were isolated in seven hospital laboratories in Hong Kong during June 1986, mostly from sputum. Of these 73% were Haemophilus influenzae and 27% Haemophilus parainfluenzae. All the isolates of H. influenzae were non-capsulated; Haemophilus spp. were not isolated from blood or cerebrospinal fluid (CSF) during the period of the study. Antimicrobial resistance, including multiple resistance, was common. Of all the strains of H. influenzae, 20% were resistant to 1 mg/l ampicillin, (all except one by production of TEM-1 beta-lactamase), 65% were resistant to 0.5 mg/l erythromycin, 25% to 1 mg/l tetracycline, 14% to 1 mg/l chloramphenicol (mediated by the production of a chloramphenicol-destroying enzyme) and less than 1% to 8 mg/l cefaclor and 0.5 mg/l trimethoprim. All isolates were susceptible to cephamandole and cefuroxime. Haemophilus parainfluenzae showed similar susceptibilities, except that a greater proportion of strains was sensitive to erythromycin and chloramphenicol. Only 50% of the ampicillin-resistant strains of H. influenzae and H. parainfluenzae contained detectable plasmids of 2-55 Mdal arranged in six to nine different plasmid profiles. Resistance to ampicillin and chloramphenicol has increased markedly in isolates of H. influenzae in Hong Kong over the last 5 years. This resistance may be associated with transposable genes.

Antimicrobial susceptibilities of halophilic vibrios.

Two hundred and forty-four clinical and environmental strains of nine species of halophilic vibrios isolated in Hong Kong were tested for their susceptibilities to 23 antimicrobial agents by an agar dilution method using unsupplemented Mueller-Hinton agar, an inoculum size of 10(5) cfu per spot and incubation for 18 h at 30 degrees C. Most strains were resistant to sulphamethoxazole, trimethoprim, penicillins and older cephalosporins, and most were susceptible to chloramphenicol, tetracycline, cotrimoxazole, the aminoglycosides, the newer cephalosporins, aztreonam, imipenem and the quinolones. However, there were significant differences between species, especially in their patterns of beta-lactam susceptibility.

Evaluation of the Microbact-24E bacterial identification system.

The Microbact 24E (MB24E) system is a commercial microsystem for the identification of common clinical isolates of Enterobacteriaceae and non-fermenting Gram negative bacilli, and consists of dehydrated substrates distributed in the wells of microtitre trays. This system was compared with the API20E for the identification of 386 bacterial isolates, which included 284 clinical and 102 environmental organisms. There was 97% and 91% agreement for the identification of clinical isolates of Enterobacteriaceae and other Gram negative bacilli, respectively. The identification of environmental isolates by both systems was less satisfactory. The API20E has a more extensive database than the MB24E and is thus more reliable for the identification of rare or unusual organisms, but the MB24E is cheaper, is easy and convenient to use, and is suitable for a routine microbiology laboratory.

Susceptibility of Hong Kong isolates of methicillin-resistant Staphylococcus aureus to antimicrobial agents.

Two hundred and sixty-six non-replicate Hong Kong isolates of methicillin-resistant Staphylococcus aureus were tested for their susceptibility to various anti-staphylococcal agents. Multiple resistance was common. More than 95% of patient isolates were resistant to both gentamicin and tetracycline, 68% to erythromycin, 37% to chloramphenicol, 10% to trimethoprim, 5% to rifampicin and 2% to fusidic acid. No isolate was resistant to all these agents, but nineteen different patterns of resistance were identified. Selected gentamicin-resistant isolates were tested against other aminoglycosides, and were sensitive to amikacin and netilmicin. The pattern of aminoglycoside resistance indicated that all isolates produced the aminoglycoside-modifying enzymes APH-(2") and AAC-(6')-I. All isolates were sensitive to vancomycin and teicoplanin. A single strain was resistant to three of the five quinolones tested, but resistance to all the quinolones could be induced easily in vitro by exposure to increasing subinhibitory concentrations of norfloxacin in broth.

Determination of methicillin-resistance in Staphylococcus aureus by agar dilution and disc diffusion methods.

Four-hundred and seventy-six isolates of Staphylococcus aureus from patients in Hong Kong were tested for methicillin-resistance by agar dilution and disc diffusion methods, using heavy inocula. With Mueller-Hinton agar incubated at 30 degrees C for 24 h, 216 (MRSA) isolates were resistant to 8 mg/l of methicillin and grew up to the edge of a 10 micrograms methicillin disc, and 260 strains were susceptible to greater than or equal to 4 mg/l methicillin and produced inhibition zones of at least 20 mm diameter. Incubation for 48 h, the addition of sodium chloride, or the use of a 5 micrograms disc had little effect on these results, but a significant number of MRSA strains produced inhibition zones when disc diffusion tests were incubated at 35 degrees C, and many sensitive strains showed scanty growth on salt-containing agar at high methicillin concentrations in agar dilution tests. Iso-Sensitest agar did not appear to support the growth of the minority resistant populations of MRSA unless supplemented with menadione and thiamine, and even with supplemented Iso-Sensitest medium a few presumptively resistant strains appeared methicillin-sensitive in both disc diffusion and agar dilution tests.

Lambdoid coliphage HK139 integrates between his and supD.

Phage HK139 is UV inducible and lambda homoimmune and has the host range of phi80. It can recombine with lambda as well as with phi80, and in the prophage form it is found integrated between the loci his and supD.

Accessory replicons of species of Salmonella and Shigella.

Shigella and Salmonella strains isolated from clinical samples were examined. Out of 42 Shigella strains tested, 17 (40%) were found to be colicinogenic and another 3 were lysogenic. All three lysogens yielded a phage antigenically homologous to coliphage P2. Out of 30 strains tested, only 1 was found to be resistant to both neomycin and sulfamethoxazole. Out of 48 strains of Salmonella tested for drug resistance, only 2 showed multiple drug resistance. In contrast to Shigella isolates, the Salmonella isolates were infrequently (approximately 5%) bacteriocinogenic. The frequency of lysogeny in Salmonella strains was found to be 6% when tested on Salmonella typhimurium LT2, but by using a set of five indicators belonging to species Salmonella potsdam, Salmonella mbadanka, Salmonella dublin, Salmonella london, and Salmonella wandsworth, 50% of the strains were shown to be lysogenic. Salmonella phages related to P22 were recoverable from Salmonella saintpaul, Salmonella indiana, and Salmonella heidelberg. Some isolates of S. typhimurium yielded a temperature-sensitive and P22-heterologous phage which was found to be a more efficient transducer of bacterial genetic markers than P22. EcoRI-generated fragments of the DNA of some phages permitted the establishment of a clonal descent for some of the wild-type lysogenic bacterial strains. This last observation points out the potential usefulness of prophages as epidemiological markers.