[Gastroenteritis due to Plesiomonas shigelloides--rare cases in the Western world]. / Plesiomonas-shigelloides-induzierte Gastroenteritiden--seltene Fälle in der westlichen Welt.

BACKGROUND: Plesiomonas shigelloides is a common pathogen in tropical regions, whereas it is rarely isolated in temperate climates. It is most often found in surface water and fish. During the last 10 years it was found to cause gastroenteritis 6 times in Ludwigshafen. Not all of these patients reported a trip to foreign countries. CASE REPORT: A 54-year-old male patient was hospitalized after a trip to Malaysia with strong greenish watery diarrhea and chills. On physical examination we saw a dehydrated patient in severely reduced general condition. The stool frequency was 30/d. The laboratory examinations only showed elevated parameters of inflammation. Plesiomonas shigelloides was cultivated in the stool cultures. With appropriate substitution of fluid and electrolytes, and antidiarrheal therapy the patient resumed a normal diet without any complications. Three days later his bowel movements were normal and his general condition was greatly improved. We withheld antibiotic therapy because of the noncomplicated course of illness. CONCLUSION: In Germany infections with Plesiomonas shigelloides are rare, an increase is observed because of increasing tourism to tropical regions. The course of infection is sometimes asymptomatic, but usually patients develop an acute gastroenteritis. Especially immunocompromised patients can show serious courses of infection. Plesiomonas shigelloides should be included in the differential diagnosis of acute gastroenteritis after journeys to tropical regions. Some of our patients, however, denied traveling to tropical regions. They also denied consuming seafood, which indicates a risk of infection in Germany. Still an infection with Plesiomonas shigelloides seems to be rare in northern European countries.

Low seroprevalence of Helicobacter pylori infection in patients with stress ulcer bleeding--a prospective evaluation of patients on a cardiosurgical intensive care unit.

OBJECTIVE: The pathogenesis of stress ulceration in seriously ill patients is uncertain and the pathogenic role of Helicobacter pylori infection is unknown. We therefore assessed the seroprevalence of patients of a cardiosurgical intensive care unit (ICU) with clinically important stress ulcer bleeding. We compared this prevalence with a control group matched for this kind of surgical intervention, missing history of peptic ulcer disease, age and gender. DESIGN: Prospective survey. SETTING: Cardiosurgical ICU in a university teaching hospital. PATIENTS AND PARTICIPANTS: Two thousand five hundred seventy cardiosurgical patients with intravenous ranitidine stress ulcer prophylaxis were screened for clinically important stress ulcer bleeding. Helicobacter pylori seropositivity was measured in all patients with a clinically important bleeding and in a control group of 245 consecutive cardiosurgical patients, matched for the kind of cardiosurgical intervention, age and gender. RESULTS: In 56 of 2,570 (2.1%) patients signs of clinically important bleeding were seen. Endoscopical examination revealed stress ulcer bleeding in 42 cases. The incidence of stress ulcer bleeding was 1.6%. The seropositivity of the group with ulcer bleeding was 45.2 % whereas 62.4 % of the patients in the control group were Helicobacter pylori positive (p = 0.08). CONCLUSIONS: Our results suggest that the Helicobacter pylori infection does not play a pathogenic role in stress ulcer bleeding. Prophylactic cure of Helicobacter pylori can not be recommended in this setting.

Eradication of MRSA from carriers by means of whole-body washing with an antiseptic in combination with mupirocin nasal ointment.

Patients who are infected or colonised by MRSA should be isolated. However, isolation is very costly in terms of time and work. In order to shorten the period of isolation, attempts are being made to eradicate this organism from patients by means of whole-body washing in addition to nasal mupirocin treatment. The effectiveness of such washes has not yet been adequately confirmed by studies. From September 1997 to August 1998, therefore, in a clinical trial of MRSA eradication, 28 patients were washed for a period of five days with a 1:1 diluted preparation based on octenidine dihydrochloride. At the same time, the nose was treated with mupirocin. Before washing was begun, on day 4 during washing and on days 1, 4 and 7 after washing was completed, smears were taken from each patient from the nose, pharynx, forehead hairline, groin, axilla and wounds, and in the case of women from the sub-mammary area. Elimination of the MRSA was achieved in 21 out of 28 cases; in four cases the washing was discontinued on account of skin redness, in three cases no elimination could be achieved during the control period. In order to ensure the success of eradication and to minimise skin reactions due to the washing, the wash procedure must be standardised, and decontamination controlled microbiologically. The study confirms that MRSA can be eradicated by means of washing with an antiseptic combined with mupirocin treatment.

[Brucellosis with fatal endotoxic shock]. / Bruzellose mit tödlichem Endotoxinschock.

BACKGROUND: Brucellosis is a zoonosis with good prognosis in cases of early diagnosis. To make the diagnosis is still a problem today. CASE REPORT: A 60-year-old butcher was admitted with undulating fever, sweats, arthralgia and weight loss. Further examination revealed hepatosplenomegaly with laboratory findings of a hepatitis and multiple focal liver lesions shown by abdominal ultrasound and CT. Histologically, these lesions corresponded to caseous granulomas. Diagnosis of brucellosis was confirmed by detection of brucella species in prolonged incubation in blood culture. After the beginning of antibiotic resistance-tested therapy with tetracycline and quinolones, an endotoxic shock occurred during the first 24 hours of treatment and the patient died after multiorgan failure with disseminated intravascular coagulation. CONCLUSION: In cases of undulating fever with liver involvement, a brucellosis should be considered. Good teamwork of the internal, pathological and microbiological departments is necessary for early and correct diagnosis. This is the first report of human brucellosis in association with lethal endotoxic shock.

Detection of Mycoplasma sp. in bronchoalveolar lavage of AIDS patients with pulmonary infiltrates.

We examined 486 bronchoalveolar lavages (BAL) including 32 from AIDS patients with pulmonary infiltrates and 20 from patients with leukemia or after transplantation. Mycoplasmas were found in 4/32 (12.5%) HIV-positive patients compared to 4/454 (< 0.9%) HIV-negative patients (p < 0.001). All of these four HIV-positive patients suffered from advanced infection (CD4 counts < 100/microL) and developed complications (Pcp, n = 2, recurrent bacterial pneumonia, n = 1, pulmonary Kaposi sarcoma, n = 1). No mycoplasmas were detected in 20 immunosuppressed patients with leukemia or after transplantation. Our data indicate that AIDS patients may be more often colonised or infected by mycoplasmas than HIV-negative patients or other immunocompromised persons. Although the etiological role of mycoplasmas for pulmonary infections in these patients remains unclear, the finding of mycoplasmas was associated with rapid progress and development of severe complications in our study.

Characterization of the hemagglutinin of Staphylococcus epidermidis.

Adherence to biomaterials and production of biofilm is thought to be pivotal in the pathogenesis of prosthetic device infection by Staphylococcus epidermidis. In this study a strong association (P < .001) of hemagglutination with adherence and biofilm production was observed. Hemagglutination was not associated with cell surface hydrophobicity (P = .906). Hemagglutination inhibition studies revealed that hemagglutination was not affected by heat, pH, cation concentration, proteolytic enzymes, biologic detergent, serum proteins, or subinhibitory antibiotics. Hemagglutination was abolished by periodate oxidation and digestion with glycosidases. It was markedly inhibited by beta-lactose and its monosaccharide constituents in a concentration-dependent fashion. Hemagglutinin expression depended on the presence of glucose. Chemical analysis of a partially purified hemagglutinin preparation and cell-free hemagglutinating supernatants revealed little or no protein and small quantities of reducing sugars, pentose, ketose, hexosamine, uronic acid, and phosphate. Hemagglutinin of S. epidermidis appears to be a polysaccharide distinct from other known adhesins of S. epidermidis.

Purification and characterisation of elastase from Staphylococcus epidermidis.

An elastase of Staphylococcus epidermidis was purified by ion exchange chromatography on CM-Sepharose and characterised. Its M(r) is c. 21 kDa, its optimal temperature for activity is 42 degrees C and the pH optimum is 6.8. The enzyme is activated by cysteine and other SH-donators and inhibited by L-trans-epoxy-succinylleucylamido-(4-guanidino)butane (E64), an inhibitor of cysteine proteases, but not by 3,4-dichloroisocoumarin (3,4-DCI), an inhibitor of serine proteases. This finding suggests that the elastase of S. epidermidis is a cysteine protease. Because S. epidermidis elastase degrades human sIgA, IgM, serum albumin, fibrinogen, and fibronectin, this enzyme may be regarded as a virulence factor.