Probable early-onset group B streptococcal neonatal sepsis: a serious clinical condition related to intrauterine infection.

BACKGROUND: The estimated incidence of true early-onset group B streptococcal (GBS) neonatal infection is based on positive GBS blood or cerebrospinal fluid (CSF) culture results, but the real burden of disease is underestimated owing to the high incidence of culture-negative sepsis possibly because of antibiotic administration to the mother. OBJECTIVE: To examine the rate of probable early-onset GBS neonatal sepsis and to assess its impact on total GBS neonatal disease. DESIGN: A multicentre longitudinal prospective surveillance of 107,021 deliveries. RESULTS: The rates of culture-proven and probable early-onset GBS sepsis were 0.39 and 0.47 per 1000 live births, respectively. Of great concern was the finding of three deaths related to the infection in the group with probable early-onset GBS sepsis. CONCLUSIONS: The use of chemoprophylaxis in GBS-colonised pregnant women, especially when it is incomplete, may not be sufficient to prevent clinical neonatal infection, but may inhibit the growth of GBS in blood and CSF cultures. In assessing the effectiveness of GBS prophylaxis, it is advisable to consider the incidence of culture-positive and probable culture-negative GBS neonatal infection.

[Liver abscess caused by Klebsiella pneumoniae in diabetic patients]. / Absceso hepático por Klebsiella pneumoniae en pacientes diabéticos.

Pyogenic liver abscess are macroscopic collections of pus within the hepatic parenchyma after a bacterial infection. These infections are usually polymicrobial in nature, and in most occasions due to biliary tract diseases or cryptogenetic in origin. Monomicrobial hepatic abscess caused by Klebsiella pneumoniae are uncommon lesions in western countries. These lesions are associated with underlying diseases, particularly diabetes mellitus, and are frequently complicated with septic metastasis. We report here three cases of monomicrobial liver abscess caused by Klebsiella pneumoniae in diabetic patients, without septic metastasis and a favourable outcome.

Rapid detection of respiratory viruses by shell vial assay using simultaneous culture of HEp-2, LLC-MK2, and MDCK cells in a single vial.

A shell vial assay with simultaneous culture of HEp-2, LLC-MK2, and MDCK cell lines in a single tube (CoHLM SV assay) was compared with traditional tube culture (TC) for the detection of the main respiratory viruses in 358 nasal wash specimens. A total of 170 strains were isolated from 168 virus-positive samples. A total of 94. 1% of the strains (160 strains; 128 respiratory syncytial viruses and 32 other viruses) were detected by the CoHLM SV assay in 48 h, whereas 98.2% of the strains (167 strains; 132 respiratory syncytial viruses and 35 other viruses) were detected by TC in a mean time of 6 days. The CoHLM SV assay may be useful for the rapid detection of respiratory viruses.

Infections due to sandfly fever virus serotype Toscana in Spain.

Of the sandfly fever viruses known to be human pathogens (serotypes Toscana [TOS], Sicilian [SFS], and Naples [SFN]), only TOS has demonstrated neurotropic activity. Infections by TOS have been reported in Mediterranean countries, but the virus was previously isolated only in Italy and Portugal. We isolated 15 strains of TOS between 1988 and 1996 from the cerebrospinal fluid of patients with acute aseptic meningitis in Granada, Spain. This finding led us to study the presence of antibodies to TOS, SFS, and SFN in 1,181 adults and 87 children from different regions of Spain. We found that the prevalence of antibodies to these viruses was 26.2%, 2.2, and 11.9%, respectively; these rates imply that TOS infections are common in Spain.

Efficacy of a universal screening program for the prevention of neonatal group B streptococcal disease.

Universal antepartum vaginal cultures for group B streptococcus (GBS) were initiated in a Spanish hospital in 1994 using Granada medium. Infants born to carriers were monitored closely, and blood, urine and mucocutaneous areas were cultured for GBS. Group B streptococcus was detected in 543 of 4,525 women (12%). Of these, 454 gave birth vaginally, of whom 201 (44%) received intrapartum ampicillin. Prophylaxis was not administered to 253 women (56%). In this group, infants of 120 women were colonized and 1 case of neonatal GBS disease occurred. Using this protocol, most GBS carriers with risk factors received intrapartum prophylaxis. This protocol also led to early identification of colonized newborns.

[Comparison of immunofluorescence reagents for the detection of the early antigen of cytomegaloviruses in the Shell-vial]. / Comparación de reactivos de inmunofluorescencia para la detección de antígeno precoz de citomegalovirus en Shell-vial.

Detection of cytomegalovirus has been carried out in 178 clinical samples in order to compare the effectiveness of two distinct commercial immunofluorescence reagents: anti-CMV early nuclear protein (Du Pont) and CMV culture identification (Syva Micro-Trak). In 61 of the samples we observed positive reaction to either of the two procedures (Shell-vial and, or, cellular conventional culture). Sensitivity was 0.92 for Du Pont reagent, 0.79 for Syva reagent, and 0.93 for the conventional cellular culture. In the overall samples we observed a higher incidence of fluorescent focus using Du Pont reagent that using that of Syva.