Isolation of Mycoplasma species from a patient with seal finger.

The etiologic agent of seal finger (speck finger) is unknown. Seal finger occurs after a seal bite, and the symptoms include acute pain, swelling, discharge, and, in some cases, there is joint involvement. The discovery of Mycoplasma species in epidemics of seal disease prompted attempts to link seal finger to mycoplasma. Mycoplasma species were isolated in cultures of a specimen from the finger of an aquarium trainer who was bitten by a seal and of a specimen from the front teeth of the biting seal. The two Mycoplasma isolates were identical biochemically; they were serum-dependent and hydrolyzed arginine. The isolates were susceptible to tetracycline but resistant to erythromycin. By growth inhibition and immunofluorescent antibody tests, both strains were identified as Mycoplasma phocacerebrale, a mycoplasma isolated in an epidemic of seal disease occurring in the Baltic Sea. The patient's infection was treated successfully with tetracycline. To our knowledge, this is the first case in which a mycoplasma has been associated with seal finger.

In vitro detection of Mycoplasma fermentans binding to B-lymphocytes in fresh peripheral blood using flow cytometry.

Previous reports have shown, using fluorescent probes conjugated to the organism, that Mycoplasma fermentans fuses with about 12% of peripheral blood lymphocytes. However, no lymphocyte subset was specified. To elucidate the specific subset of lymphocytes involved, we developed a three-color flow cytometric assay to detect M. fermentans binding to fresh peripheral blood cells. In our assay, two strains of M. fermentans were grown in SP4 glucose broth, mixed with fresh whole blood samples (n > 20), and incubated at 37 degrees C. The blood samples were then stained with a polyclonal antibody to M. fermentans, a monoclonal antibody to B-lymphocytes (CD19), and a monoclonal antibody to T-lymphocytes (CD3). Using three-color flow cytometry, we obtained data confirming binding of M. fermentans to 10%-15% of peripheral blood lymphocytes with minimal granulocyte or monocyte staining detected. Flow cytometric analysis showed that early binding appears predominantly directed towards B-lymphocytes (86.7 +/- 9.0%), and that this binding could not be blocked by antibodies directed towards common B lymphocyte cell surface antigens. M. fermentans binding to B-lymphocytes occurred within 5 min of in vitro inoculation, reached a maximum within 30-60 min (94-97%), and thereafter plateaued. The binding was concentration dependent over a three log dilution using 10(3) color changing units as standard. Binding to T-lymphocytes was minimal (<5% positive). B lineage tumor cells or peripheral blood B cells obtained from HIV infected individuals demonstrated reduced binding of M. fermentans. This assay provides a good method to study the cellular interactions of mycoplasma and may help to elucidate pathogenic mechanisms of mycoplasma infections.

Computerized medication instruction for psychiatric inpatients admitted for acute care.

We studied the efficacy and feasibility of using computer-based instruction to provide medication information to hospitalized patients with acute psychotic conditions. Patients were randomly assigned to receive computer-based (n = 21) or personal instruction (n = 21); for the final analyses the computer group was expanded to include 13 patients from a pilot study. Outcome measures were knowledge retention (indicated by changes in test scores) and compliance with medication regimens after discharge (indicated by telephone follow-up at one week, one month, and three months). The subjects reacted positively to the computer program. Knowledge retention and compliance were similar in the computer and control groups. We conclude that psychiatric inpatients admitted for acute care can participate in, and learn from, computerized medication instruction.

Isolation of presumptive Streptobacillus moniliformis from abscesses associated with the female genital tract.

We report three cases in which Streptobacillus moniliformis was isolated from abscesses. Abscess material in each case contained small, pleomorphic, gram-negative to gram-variable bacilli. Anaerobic blood agar cultures yielded pinpoint colonies adjacent to small gray-white colonies. The pinpoint colonies did not gram stain, and the gray-white colonies varied from gram-variable coccobacilli to long, curly, gram-variable rods. The pinpoint colonies microscopically resembled L-forms on Dienes-stained agar preparation. Subculture to serum-supplemented thioglycolate broth demonstrated "puff ball" colonies. Fatty acid profiles obtained with use of gas chromatography coupled with mass spectrometry showed major peaks for C16:0, C18:2, C18:1, and C18:0 fatty acids, a profile characteristic of S. moniliformis. Results of biochemical testing of each isolate were equivocal. S. moniliformis, bacterial L-forms, and common isolates from genital tract abscesses are discussed.

Characterization of cytopathogenicity of aquarium seal mycoplasmas and seal finger mycoplasmas by light and scanning electron microscopy.

Two recent mycoplasma isolates (one from an aquarium seal and one from a patient with the clinical entity known as seal finger) have been evaluated for cytopathogenicity in tracheal explant cultures. Examinations were performed in direct comparison to Mycoplasma phocidae, an isolate from an epidemic of seal pneumonia along the New England coast (USA) in 1979-1980. The study revealed similar inhibitory effects on ciliated tracheal epithelial cells and clumping of cilia by attached mycoplasmas; no exfoliation of respiratory epithelial cells was observed. In addition, cytopathic effects caused by the mycoplasmas were distinguished from effects of aging in non-infected explants under long-term in-vitro cultivation conditions. The general meaning of mycoplasmas in seals is discussed in detail in this paper.

Mycoplasma phocidae sp. nov., isolated from harbor seals (Phoca vitulina L.).

In 1979 and 1980, more than 400 harbor seals (Phoca vitulina) along the New England coast of the United States died of epizootic pneumonia that was attributed to an influenza virus. Six mycoplasma isolates that were recovered from the respiratory tracts of affected seals were investigated and were found to be serologically identical and distinct from previously described species. These isolates required serum for growth, did not possess a cell wall, and did not hydrolyze urea. Arginine was hydrolyzed, glucose was not fermented, film and spots were observed on horse serum agar, phosphatase was produced, tetrazolium was not reduced, and serum and casein were not digested. The guanine-plus-cytosine content of the DNA was 27.8 mol%. We propose the name Mycoplasma phocidae for these isolates. The type strain of M. phocidae is strain 105 (= ATCC 33657).

Specific, high-affinity binding sites for angiotensin II on Mycoplasma hyorhinis.

Mycoplasmataceae are known to express various proteins that are similar to those present in mammals. We report a strain of Mycoplasma hyorhinis isolated from opossum kidney cells with specific, high-affinity binding sites for human angiotensin II (Kd = 5.1 +/- 1.9 nM). In contrast, two strains of M. hominis revealed no specific binding. These binding sites resembled mammalian angiotensin II receptors by their high affinity and by their sensitivity to dithiothreitol. However, they are different from mammalian angiotensin II receptors in that they bind angiotensin I with high affinity (Kd = 1.6 +/- 0.29 nM) but not angiotensin III (Kd approximately 330,000 nM). [125I]-angiotensin II binding was not inhibited by angiotensin receptor subtype antagonists DuP 753 and CGP 42112A but it was sensitive to bacitracin and aprotinin. Positions Asp1, Ile5, His6 and Pro7 were essential for binding to M. hyorhinis as deletion of these residues led to a more than 10,000-fold decrease in affinity.

Nongenitourinary infections caused by Mycoplasma hominis in adults.

Eleven new cases of Mycoplasma hominis infection occurring outside the genitourinary tract in adults not in the puerperium were evaluated in relation to the 25 cases previously reported. Cases of bacteremia (n = 14) were commonly associated with trauma or manipulation of the genitourinary tract and were often self-limited. Wound infections (n = 14) followed surgery by 4-14 days in most cases and may have arisen from contamination from the genitourinary or respiratory tract. Joint infections (n = 5) appeared to have resulted from bacteremic seeding in some cases and affected prosthetic joints in particular. Least frequent were central nervous system infections (one case of meningitis and two of brain abscess) and respiratory tract infections (three cases of empyema). The large majority of patients had fever, and infected fluid collections were commonly purulent. The response to therapy was difficult to assess in many cases, but responses to tetracycline, clindamycin, and drainage alone were observed. Identification of M. hominis requires clinical suspicion and alertness on the part of the bacteriology laboratory.

Women's knowledge and beliefs about breast cancer risk factors, symptoms, detection methods, and treatments.

This paper presents results from a survey of adult women that assessed knowledge, beliefs, and practices regarding the causes, symptoms, detection methods, and treatment of breast cancer. The study population was determined through random selection of household telephone numbers from the Buffalo, New York area telephone directory. Completed interviews were collected from 563 women over the age of 18. Telephone interviews were conducted by trained interviewers, between April and July of 1985. Survey results are compared to those found in the 1979 National Cancer Institute nationwide survey on breast cancer to evaluate if ther have been changes in public awareness about the disease. Differences in knowledge, beliefs, and practices regarding breast cancer were also studied in relation to age, race, and educational background. Overall, women's knowledge about breast cancer has significantly increased since the 1979 survey. However, while more women can name mammography as a diagnostic tool only 15% of women who have heard of mammography reported having had a mammogram. Generally, younger women, white women and those with some college education were more knowledgeable about breast cancer risk factors, symptoms, detection methods, and treatments. Results from this study suggest that although knowledge about breast cancer has improved, women have not adopted recommended early detection practices. Special efforts need to be directed toward health professionals, making mammography more accessible to women who are nonwhite, older and with no college education.

Tetracycline-resistant L-forms isolated from an antibiotic-susceptible strain of Listeria monocytogenes.

A tetracycline-susceptible strain of Listeria monocytogenes type 4b was converted to stable L-forms by penicillin. L-form variants resistant to tetracycline were then selected from a predominantly tetracycline-susceptible L-form population on plates containing penicillin and increasing concentrations of tetracycline. The origin of tetracycline-resistant L-forms from the parent Listeria strain was confirmed biochemically, by immunofluorescence, and by polyacrylamide gel electrophoresis. Scanning and transmission electron microscopy confirmed the typical L-form structure and the complete lack of cell wall in both L-form strains. The level of [3H]tetracycline uptake was lower in tetracycline-resistant than in susceptible cells.

Mycoplasma hominis septicemia.

We report a case of Mycoplasma hominis septicemia in a patient with chronic lymphocytic leukemia and prostatic obstruction. Signs of sepsis followed urinary catheterization, and M. hominis was recovered repeatedly from blood, urine, and pleural fluid. Detection in blood was accomplished by routine subculture from grossly negative blood culture bottles.

Mass mortality of harbor seals: pneumonia associated with influenza A virus.

More than 400 harbor seals, most of them immature, died along the New England coast between December 1979 and October 1980 of acute pneumonia associated with influenza virus, A/Seal/Mass/1/180 (H7N7). The virus has avian characteristics, replicates principally in mammals, and causes mild respiratory disease in experimentally infected seals. Concurrent infection with a previously undescribed mycoplasma or adverse environmental conditions may have triggered the epizootic. The similarities between this epizootic and other seal mortalities in the past suggest that these events may be linked by common biological and environmental factors.

Infection of a brain abscess of Mycoplasma hominis.

Persistent fever in a young man after evacuation of a subdural hematoma caused by a depressed skull fracture made it necessary to carry out a computerized tomographic exam of the head that demonstrated a left frontal lobe brain abscess. Mycoplasma hominis was recovered from this abscess as the sole infecting organism. Serial computerized tomographic scans showed resolution after aspiration and antibiotic therapy.

Recurrent urinary tract infections in men: a role for aberrant bacterial forms?

We studied 11 infected, asymptomatic elderly men who had experienced recurrent urinary tract infections classified as bacterial relapse. These men did not have ileal loop bladders, urethral catheters, suprapubic catheters, or condom drainage. We had to process more than 1,000 urines from men attending the urology clinic to identify the 11 study patients. A positive antibody-coated bacteria immunofluorescence test was detected on the urinary sediments of each of these men. This selective study group was subjected to excretory urography and a 2-week course of antibiotics, in accordance with the results of in vaitro susceptibility tests. Two patients experienced a "cure." Recurrences developed in eight patients (six relapses, two reinfections), and in one patient a superinfection emerged. No pathogenetic role could be attributed to aberrant bacterial forms in this elderly population of asymptomatic men with recurrent, invasive urinary tract infections.

Isolation of Mycoplasma bovis from a patient with systemic illness.

Mycoplasma bovis was cultured from the sputum of a patient with lobar pneumonia, psychosis, and probable myocarditis, nephritis, and hemolytic anemia. Although we cannot be certain that this species of mycoplasma was the etiological agent of the patient's acute illness, this case report is of interest because, to the best of our knowledge, it represents the first isolation of M. bovis from a human source.

Infection of a traumatic pelvic hematoma with Mycoplasma hominis.

Fever developed in a previously healthy young man who had sustained extensive pelvic trauma. Mycoplasma hominis was isolated in pure culture from six of seven specimens taken from a retroperitoneal hematoma over a one-week period, and mycoplasmacidal antibodies were present in high titer in the convalescent-phase serum. The fever abated after thorough surgical drainage of the infected hematoma.

Fever of unknown origin: attempts to isolate L-forms and other aberrant bacterial forms.

An investigation was conducted with 65 selected febrile patients, 33 of whom fulfilled in all respects the classic criteria of "fever of unknown origin." Clinical evaluation included extensive radiological and immunological testing. Multiple blood cultures were examined by conventional methods in control studies. In addition, venous blood was cultured in a variety of hyperosmolar media using the special techniques used to detect L-forms and other cell wall-defective bacterial forms. By the extensive methods used, no bacterial forms were isolated. The use of media containing osmotic stabilizers did not detect L-forms or other aberrant bacterial forms, nor did it contribute to the determination of the etiology of fever of unknown origin in these patients.