Childhood brucellosis in Israel.

BACKGROUND: Brucellosis has become a major medical problem in Israel particularly in the Muslim Arab population. METHODS: Eighty-eight children with acute brucellosis are described. Sixty-seven were studied retrospectively during 1987 through 1988, and 21 children were studied prospectively during 1989 through 1992. Epidemiologic, clinical and laboratory features were evaluated, and the outcome of 4 antimicrobial regimens are compared. RESULTS: Although the clinical manifestation varied, the classical triad of fever (91%), arthralgia or arthritis (83%) and hepato- and/or splenomegaly (63%) characterized most patients. Sixty-one percent of the children had elevated liver enzymes. Brucella melitensis was isolated from 61% of blood cultures. The relapse rate in patients who were treated with monotherapy (doxycycline) was 43% compared with 14% with regimens of combined therapy with rifampin and doxycycline, streptomycin and doxycycline or rifampin and trimethoprim-sulfamethoxazole (P < 0.049). Eleven children (33%) who were treated for 3 weeks had relapse compared with 1 patient (3.5%) treated for 4 weeks or longer. The total relapse or reinfection rate was 20%. All patients with relapse recovered after a second course of antibiotic therapy. During the 2 years of follow-up one child progressed to chronic osteomyelitis. CONCLUSIONS: Combination therapy and extending treatment for 4 weeks or longer gave significantly better results than monotherapy or shorter courses of therapy and resulted in fewer relapses.

Gram negative bacteria isolated from blood cultures in a general hospital.

This study reviews 2205 significant positive blood cultures from 534 patients treated at the Meir General Hospital during the period 1988-1990. In addition, a comparison was made with a previous survey performed twelve years ago (1976-1978). Gram negative rods accounted for 68% of the septicemia cases indicating a small increase since the former survey (61.2%). The order of Gram negative frequencies was E. coli, Urea positive Gram negative bacteria (UPGNB) Klebsiella, Enterobacter, Pseudomonas (in a decreasing order). E. coli was most predominant in both surveys in the internal wards while UPGNB were predominant in the geriatric-rehabilitation wards. A significant rise in frequency of cephalothin and sulfamethoxazole-trimethoprim resistant E. coli isolates was noticed. In UPGNB, Klebsiella and Pseudomonas a significant increase in resistant isolates to cephalothin, gentamicin, sulfamethoxazole-trimethoprim and chloramphenicol was found. As for tobramycin, amikacin and mezlocillin, it is clear that the Gram negative bacteria have gained resistance to these drugs over recent years. Resistance frequencies of above 20% were found in Enterobacter and Pseudomonas for the newer antimicrobial agents such as: ceftriaxone, cefotaxime or ceftazidime. Low resistance is still seen in all above bacteria against ciprofloxacin and ofloxacin. The minimal inhibitory concentrations (M.I.C.) of gentamicin, cephalothin, cefotaxime, ceftazidime ceftriaxone and sulfamethoxazole-trimethoprim do not exceed the range of 30 micrograms/ml. The M.I.C. range of the quinolone ciprofloxacin does not exceed 6 micrograms/ml.

Safety of transrectal prostatic biopsy through double-glove technique without antibiotic prophylaxis.

We studied 143 men who underwent transrectal prostatic biopsies using the double-glove technique. No patient received any antimicrobial therapy before the procedure. Clean catch urine cultures were obtained at admission and two, four, and twenty-four hours, and two weeks after biopsy. Aerobic and anaerobic blood cultures were performed at admission, and at thirty minutes and four hours after the procedure. In addition, clinical parameters were monitored closely in the hospital for twenty-four hours after the biopsy. A total of 132 patients were considered evaluable. Temperatures of 37.6 degrees C or higher occurred in 3.8 percent of the patients. In no case was rigors recorded. In 4 of the patients studied (3%) post-biopsy urine cultures were infected with Escherichia coli. All post-biopsy blood cultures, both aerobic and anaerobic, were negative. Our data indicate that with the use of the double-glove technique, prophylactic administration of antibiotics is not necessary to prevent the infectious complications following transrectal biopsy of the prostate.

Salmonella paratyphi C osteomyelitis: report of two separate episodes 17 years apart.

Osteomyelitis secondary to salmonella infection is well documented in the literature. Infection in more than one focus has also been described. To the best of our knowledge this is the first report of recurrent osteomyelitis in a normal host (a 35-year-old man) with the same organism (S. paratyphi C) in different sites 17 years apart.

Virulence characteristics of male genital tract Escherichia coli isolated from semen of suspected infertile men.

The role of Escherichia coli isolates from the semen in the etiology of male infertility, was investigated in this study. Several possible virulence factors of E. coli, such as possession of O antigens or certain K antigens (K1, K5), the type of fimbriae, resistance to antimicrobial drugs and adherence studies to various mammalian sperm cells were examined. It was found that out of 181 E. coli isolates 76.4% belonged to four different urinary serotypes: O1, O2, O4 and O6 (5.7%, 7.5%, 17.0% and 46.2%, respectively). The predominant fimbrial phenotype (81.2%) was T1F+/P-, while 15.8% showed also the possession of P fimbriae (T1F+/P+). No isolate was found with the T1F-/P+ phenotype. The possession of antigens K1, K5 was found to be low (12% only). A relatively high level of adherence to different mammalian sperm cells was found among E. coli isolates. 43% of the E. coli isolates were resistant to doxycycline (the drug of choice) and additionally, most of these were resistant also to ampicillin. We suggest that there is a close subpopulation of E. coli which possess certain virulence properties and have the potential to adhere to sperm cells and to colonize on other target tissues in the male genital tract. Such virulent may cause asymptomatic male infertility and may be termed male genital tract (MGT)-E. coli.

Comparison of the Bactec and lysis concentration methods for recovery of Brucella species from clinical specimens.

In a comparison of the Bactec system and the lysis concentration procedure in the isolation of Brucella species in 54 patients the recovery rate was similar (60% and 55%, respectively). However, the recovery time was significantly shorter with the lysis concentration method than with the Bactec system (3.5 days versus 14 days). The lysis concentration procedure for the culture of Brucella is simple, inexpensive and reliable, and produces results for the clinician relatively quickly.

Population shift in mannose-specific fimbriated phase of Klebsiella pneumoniae during experimental urinary tract infection in mice.

The infection rate (percentage of mice shedding 10(5) organisms per ml of urine) in 27 mice infected intravesicularly with a mannose-specific (MS+) phenotype of Klebsiella pneumoniae was 85% at day 7, and all the bacteria shed during the 7 days exhibited strong MS activity as estimated by a yeast aggregation assay. In contrast, the outcome of infection with an MS- phenotype of the same strain in 47 mice was heterogeneous: one group of 25 mice continued to shed the originally injected phenotype (MS-) throughout the investigation period, whereas the second group (22 mice) shed bacteria with various degrees of phenotypic conversion to MS+. In the first group, the rate of infection at day 7 was significantly reduced (28%) compared with that of the second group (68%). Mice infected with a mixture of 5% MS+ bacteria and 95% of an MS- variant which lost its ability to undergo phase variation had an infection rate of 89%, but at day 7 95% of the excreted bacteria were MS+. The infection rate of mice injected with the MS- variant was 14%, and none of the mice shed MS+ bacteria. The incidence of kidney pathology was higher in mice inoculated with the MS+ phenotype (3 of 10) or in the group in which the MS+ overgrew the MS- phenotype (4 of 10) as compared with the group of mice in which no such shift occurred (1 of 11). The kidneys of four mice which excreted mostly MS+ organisms harbored a population predominantly of the MS- phenotype. These results suggest that the MS adhesin confers an advantage in the initial steps of the infectious process in the bladder but not in later stages of infection in the kidney, emphasizing the importance of phase variation in the survival of bacteria at the various stages of the infectious process.

Meningitis and bacteraemia due to Listeria monocytogenes in compromised hosts.

The clinical history of 3 adult patients infected by Listeria monocytogenes is presented. One patient with chronic lymphatic leukaemia developed purulent meningitis; the 2 others had chronic renal failure and were undergoing routine haemodialysis. Of the latter, one developed meningitis and the other bacteraemia after receiving 2 blood transfusions. Immuno-suppression, or the underlying disease of the hosts, probably played a role in permitting the infection to establish itself. The rural environment may also have been conducive to the transfer of this particular, rarely infectious, micro-organism to these patients.