Immunoglobulin A response against Gardnerella vaginalis hemolysin and sialidase activity in bacterial vaginosis.

OBJECTIVE: The aim of this study was to investigate the correlation between the immunoglobulin A immune response to Gardnerella vaginalis hemolysin and sialidase activity in vaginal fluids from patients with bacterial vaginosis. STUDY DESIGN: Nonpregnant women who were examined at a gynecologic clinic, in an age range of 18 to 62 years, were enrolled. The study population comprised 131 healthy volunteers, 32 women with bacterial vaginosis that was positive for immunoglobulin A to Gardnerella vaginalis hemolysin, 40 women with bacterial vaginosis that was negative for immunoglobulin A to Gardnerella vaginalis hemolysin, and 19 women with Candida vaginitis. Bacterial vaginosis was diagnosed by clinical criteria and Gram stain. RESULTS: Sialidase activity was present in 75% (54/72) of patients with bacterial vaginosis. Women having bacterial vaginosis and lacking a specific immunoglobulin A response had a significantly higher level of sialidase activity than patients who had an immune response against Gardnerella vaginalis hemolysin. Sialidase activity was detected in 87% (35/40) of the former subgroup of patients with bacterial vaginosis and in 59% (19/32) of women of the latter subgroup. No sialidase activity was measured in patients with candidiasis. Specificity of the assay for healthy controls was 95% (124/131 women without sialidase activity). CONCLUSIONS: Sialidases produced by Prevotella bivia and other microorganisms present in the microflora of patients with bacterial vaginosis are very likely a virulence factor not only by destroying the mucins and enhancing adherence of bacteria but also by impairing a specific immunoglobulin A immune response against other virulence factors such as cytotoxin from Gardnerella vaginalis.

Antituberculosis drug-resistance surveillance as a tool for tuberculosis control programmes: a retrospective study.

The aim of this study was to verify the suitability of antituberculosis (antiTB) drug-resistance surveillance as a tool for tuberculosis (TB) control programmes at local level. A retrospective study reviewing laboratory records and medical records of TB patients referred to Udine Hospital between 1981 and 1995 was analysed. The initial susceptibility pattern for each Mycobacterium tuberculosis isolate was recorded. It was found that between 1981 and 1995, 899 M. tuberculosis strains underwent susceptibility testing for four first-line drugs. Over a period of 15 yrs the annual number of M. tuberculosis strains initially decreased and then stabilized. Overall, 15.3% of the 899 strains showed initial resistance to at least one first-line drug, and 2.8% to two or more first-line drugs. Streptomycin-resistant strains were the most commonly observed (10.8%), with resistance to isoniazid, rifampicin and ethambutal shown to be 6.4, 1.0 and 0.4%, respectively. Multidrug resistant (MDR)-TB was observed in only five cases. An additional four cases eventually developed secondary MDR-TB during the follow-up. The proportion of resistant strains did not vary significantly over time. Recurrent TB disease was significantly associated with resistant strains (odds ratio = 3.59, p < 0.01). Only one patient had a documented human immunodeficiency virus (HIV)-positive serology. All six patients who developed MDR-TB during or after treatment, were suffering either from chronic alcoholism or from a psychotic disorder. In the study it was shown that recurrent tuberculosis cases, tuberculosis patients with behavioural problems (i.e. alcoholism, psychiatric disorder) and patients presenting with primary resistant Mycobacterium tuberculosis strains are at risk of multidrug-resistant tuberculosis and may thus benefit from the directly observed treatment approach, which has been proposed as a mainstay in tuberculosis control programme strategy.

Fatal human pulmonary infection caused by an Angiostrongylus-like nematode.

An immunocompetent man developed malaise, fever, progressive weight loss, eosinophilia, and transient pulmonary infiltrates that responded to steroid treatment but recurred after its discontinuation. Examinations of feces, bronchoalveolar lavage fluid, and pulmonary tissue obtained during a 50-day period of hospitalization yielded negative results. When a new bronchoalveolar lavage sample and a new pulmonary biopsy specimen showed nematode larvae and adult worms, treatment with thiabendazole was started. However, therapy with this agent and then with mebendazole had no impact on the patient's downhill course, which ended in respiratory distress and death. Autopsy documented an overwhelming pulmonary infection with a metastrongylid nematode resembling a species of Angiostrongylus. Histologic study revealed features of necrotizing angiitis closely mimicking those of Wegener's granulomatosis. To our knowledge, this is the first reported instance of patent metastrongylid parasitism of the human pulmonary arteries with necrotizing angiitis caused by a reaction to the parasite and/or its metabolic products.

A multicentre study: Staphylococcus and Enterococcus susceptibility to antibiotics.

A multicentre study to evaluate the susceptibility of Gram-positive cocci isolated from clinical samples, was performed by six centres working in different areas of Italy. We examined 4,544 strains of Staphylococcus aureus, 4,381 strains of coagulase-negative staphylococci and 2,478 strains of enterococci. The following antibiotics were tested: penicillin G, ampicillin, amoxicillin, piperacillin, imipenem, oxacillin, ofloxacin, pefloxacin, ciprofloxacin, gentamicin, tobramycin, amikacin, netilmicin, rifampicin, clindamycin, tetracycline, cotrimoxazole, erythromycin, chloramphenicol, vancomycin and teicoplanin. Oxacillin-susceptible staphylococci confirmed their susceptibility to many other antimicrobial agents while oxacillin-resistant strains confirmed their multiple and frequent resistance to antibiotics. Resistance to oxacillin, cotrimoxazole and chloramphenicol was more frequent in coagulase-negative staphylococci than in Staphylococcus aureus. Aminoglycosides, rifampicin and quinolones were more active against coagulase-negative staphylococci than against Staphylococcus aureus. Enterococci were susceptible to penicillins and imipenem, and moderately susceptible to ciprofloxacin. Susceptibility of 70-79% was observed with high levels of aminoglycosides. Excellent results against staphylococci and enterococci were observed with vancomycin and teicoplanin.

Infections in an Alpine environment: antibodies to hantaviruses, leptospira, rickettsiae, and Borrelia burgdorferi in defined Italian populations.

From 1987 to 1991, a seroepidemiologic survey for antibodies to hantaviruses, leptospira, rickettsiae, and Borrelia was conducted in selected Italian population groups. In the mountainous areas of northeastern Italy, the prevalence of antibody to hantaviruses, as detected by indirect immunofluorescent antibody (IFA) assay, was 7.1%, 4.8%, 4.3%, and 4% in 265 forestry workers, 82 rangers, 395 farmers, and 75 hunters, respectively. Among 299 Alpine soldiers, the prevalence was lower (0.7%). Of those with Hantaan antibody, the reactivity pattern using Hantaan, Puumala, and Fojnica viruses suggested a prevalence of antibody to Hantaan virus, with titers reaching levels of 128. The presence of leptospiral antibodies (by microagglutination test), which included the prevalence of antibodies to Leptospira icterohaemorrhagiae, L. bratislava, and L. saxkoening serotypes, was observed in 10-12% of the farmers and forestry workers in these Alpine mountain regions. Only a few sporadic clinical cases of leptospirosis have been reported from these regions. Antibodies to Borrelia burgdorferi (by IFA) were observed in 19% of the rangers and forestry workers, with lower values in farmers (10%) and hunters (8%). These data suggest the presence of a large number of asymptomatic infections with B. burgdorferi and the leptospires in the densely wooded areas of the Alpine Italian regions. Furthermore, the recent identification of a case of Hantaan acute nephropathy in a man living in the mountainous northeastern area of Italy confirms the presence of hantavirus in the Italian Alpine zones, especially those near the Slovenian border.

[Bacteriologic monitoring in a surgical department with emergency services. Epidemiologic analysis and study of sensitivity to antibiotic therapy]. / Monitoraggio batteriologico in una divisione chirurgica con servizio d'urgenza. Analisi epidemiologica e verifica di sensibilità alla antibioticoterapia.

The two year experience with 2091 biological cultures and the related antibiograms has been reported on the basis of a prospective, computerized study. The incidence of germs coming from each fluid collected has been analyzed as well as the sensibility to various antibacterial drugs. The gram negative such as Escherichia Coli, Enterococcus, Pseudomonas, Proteus, Klebsiella, Serratia and Enterobacter resulted more frequently isolated; in addition a revival of gram positive strains (Staphylococcus, Streptococcus) was noted too.

[Antibioticotherapy based on statistics in intensive therapy]. / Antibioticoterapia su base statistica in terapia intensiva.

The authors present the epidemiological data concerning nosocomial infections in their Intensive Care Unit, and discuss an antibiotic strategy statistically oriented by these data. In their experience, treatment based on statistical criteria, brought to a reduction in antibiotic consumption with particular regard to broad-spectrum antibiotics, and to a decrease in individual budget.

A quality assurance program for the evaluation of antimicrobic treatment of urinary tract infections.

In the course of a quality assurance (QA) activity on the use of antimicrobics the authors set out to assess the management of urinary tract infection (UTI) in 76 patients. From culture data they noted an excellent or correct use in 78% of the patients, but a misuse in 22%. A committee was organized, with representatives of all departments, which set out criteria for the correct treatment of UTI. Using these criteria, the medical records were retrospectively assessed and the results are described. The protocol will be communicated to all involved, and then a reassessment will be made, to evaluate change in behaviour.

[In vitro evaluation of the activity and interactions of cefotaxime and its metabolite desacetylcefotaxime against strains of enterobacteria, staphylococci and Bacteroides fragilis isolated from hospital infections]. / Valutazione in vitro dell'attività e dell'interazione tra cefotaxime ed il suo metabolita desacetilcefotaxime su ceppi di enterobatteri, stafilococchi e Bacteroides fragilis d'isolamento ospedaliero.

The paper reports a study of the activity of cefotaxime and its metabolite, desacetylcefotaxime, and the association of the two compounds, against 699 strains of enterobacteria, staphylococci and Bacteroides fragilis of hospital origin. The results of the study confirm the good activity of the drug and the less satisfactory activity of its metabolite, which is nevertheless comparable to second generation cephalosporins. The 1:1 association of the two compounds showed synergism in percentages ranging from 3.7% to 15% of strains, and partial synergies of indifference to the remaining strains. Antagonisms were only observed against some M. morgani and H. alvei strains.

Monoclonal-oligoclonal immunoglobulins in HTLV III infected subjects: HTLV III-induced or HTLV III-associated?

Sera from 55 patients with positivity for anti-HTLV III antibodies, including 24 "healthy" subjects, 29 LAS and 2 AIDS, were examined by means of high resolution agarose gel electrophoresis and immunofixation, in order to evaluate the occurrence of monoclonal-oligoclonal immunoglobulin patterns. Monoclonal-oligoclonal immunoglobulins were found in 20.8% of "healthy" subjects and in 72.4% of LAS patients. Furthermore, a lower but significant prevalence of monoclonal-oligoclonal immunoglobulins was found in a control group including patients with high-titre positivity for anti-CMV and anti-EBV antibodies. Considering the consistent association between EBV-CMV and HTLV III infection, it is concluded that at least a part of monoclonal-oligoclonal immunoglobulins found in LAS-AIDS patients are likely to be induced by these associated viral infections. On the other hand, the finding of monoclonal-oligoclonal immunoglobulins in "healthy" HTLV III-positive subjects points out a possible direct stimulatory effect of HTLV III on B-cell lineage.

[Recovery from from Listeria monocytogenes meningitis in an adult]. / Meningite da Listeria monocytogenes ad esito in guarigione in adulto.

The authors describe a case of meningitis by Listeria monocytogenes from which the patient, an adult suffering from a chronic lymphatic leukosis, recovered completely. Both the immune-suppressor treatment and the basic lymphoproliferative disease may have given rise to this infective disease. The diagnosis has been obtained by isolating the germ in liquor-cultures. We want to point out the importance of a specific and early antibiotic treatment.

A comparison of the antibiotic activities of sisomicin, gentamicin and aminosidine sulphate against pseudomonas aeruginosa.

Sisomicin, gentamicin and aminosidine sulphate were compared for their antibiotic activity against Pseudomonas strains freshly isolated from clinical material. The activity of the three agents, expressed as a minimum inhibitory concentration, was determined using the same automatized system.

A comparison of the minimum inhibitory concentrations of sisomicin and of fourteen other antibiotics.

The activities of sisomicin and of fourteen other antibiotics have been compared for their inhibitory activity on all the different strains of bacteria isolated from a 3,000 bed hospital. The antibiotic sensitivity tests were performed in liquid medium and expressed as minimum inhibitory concentrations. The tests were performed over a period of four months. The results are discussed.

[Clinical problems about microbiological findings in pneumology (author's transl)]. / Problematica clinica dei reperti microbiologici in pneumologia

Identification for clinical purposes of the etiological germs in individual cases of bronchopulmonary not tuberculous infections is usually very hard. Sometimes, particularly in acute cases, microbiological counts in sputum as in tracheobronchial secretions and exudates may be useful. In some chronic cases an amount of particular bacteria in tracheal (transcutaneous) secretion larger than in sputum is to consider an etiological sign.

[Microbiological drawings in pneumology (author's transl)]. / I prelievi microbiologici in pneumologia

Microbiological examinations of the sputum for clinical purposes is often not satisfactory or useless. Suitability, chances of oropharyngeal contamination, hazards for the patients and clinical indications of the various drawing methods for tracheobronchial secretions and exudates are different. Transcutaneous tracheal aspiration is easy, reliable and safe.

[Considerations on the antibiotic activity (M.I.C.) revealed in 247 serotypes of Salmonella]. / Considerazioni sull'attivita' antibiotic (CMI) rilevata su 247 sierotipi di Salmonella

247 strains of Salmonella, isolated in Brescia province duriing 1973-1974 have been typed by serological methods. The MIC has been determined, using the following antibiotics: chloramphenicol, tetracycline HCL, ampicillin, doxycycline, rifampicin, cephazolin, carbenicillin, nifuratel, gentamicin, aminosidine, trimetho-prim-sulphamethoazole, nalidixic acid. The pattern of resistence of the various serotypes is quite constant. The relationship between diffusion and epidermiological factors are discussed.