Isolation of Clostridium botulinum type G from Swiss soil specimens by using sequential steps in an identification scheme.

After Clostridium botulinum type G organisms and toxin were identified in necropsy specimens in cases of unexplained death in adults and infants (O. Sonnabend, W. Sonnabend, R. Heinzle, T. Sigrist, R Dirnhofer, and U. Krech, J. Infect. Dis. 143:22-27, 1981), extensive research to detect C. botulinum type G in soil samples from Switzerland was done. A total of 41 specimens from virgin soil and from cultivated land were examined for the presence of C. botulinum type G and other toxin types. Because of the lack of the lipase marker in type G, the detection of C. botulinum type G was based on the demonstration of type G organisms in enrichment cultures by a type G-specific enzyme-linked immunosorbent assay to detect both the type G toxin and antigen; enrichment cultures in which type G toxin or antigen was identified by enzyme-linked immunosorbent assay were then tested by a type G-specific gel immunodiffusion agar procedure. This method not only isolated strains of type G but also strains of Clostridium subterminale, a nontoxigenic variant of C. botulinum type G. As a consequence of the observed cross-reactions caused by strains of C. subterminale within this test system, all isolates of type G had to be definitively confirmed by mouse bioassay. The sequential steps of these methods seem to be very useful for detecting C. botulinum type G organisms. C. botulinum type G strains were isolated in five soil samples from different locations in close association with cultivated land.(ABSTRACT TRUNCATED AT 250 WORDS)

Intestinal toxicoinfection by Clostridium botulinum type F in an adult. Case associated with Guillain-Barré syndrome.

A 27-year-old man with type F botulism (classification undetermined) had two episodes of botulinum toxaemia with identification of botulinum toxin and Clostridium botulinum organisms in faecal specimens during a three-month stay in hospital. Between these clinical episodes neither toxin nor Cl botulinum could be demonstrated. The illness was severe with quadriplegia, respiratory insufficiency, and bowel paralysis. In addition the patient had sensory abnormalities and a raised protein in the cerebrospinal fluid. The results demonstrate for the first time in detail an intestinal colonisation with and multiplication of C botulinum organisms and in-vivo production of toxin in an adult. The clinical findings at first pointed to Guillain-Barré syndrome, and it is suggested that patients with this syndrome should be examined for botulinum toxin in serum and for toxin and organisms in stool.

[Etiology of atypical pneumonias. A serological study on 1494 patients]. / Die Atiologie atypischer Pneumonien. Eine serologische Studie an 1494 Patienten.

In a retrospective study the serological results from 1494 patients with community-acquired pneumonia were evaluated. An infectious etiology was found in about 40% of the cases. The majority of pneumonias was caused by Mycoplasma pneumoniae and by influenza virus type A, whereas Legionella pneumophila was the fifth most frequent pathogen. In the second part of the study, 13 hospitalized patients with community-acquired pneumonia were investigated by the whole panel of routinely used microbial methods. The etiological agent was found serologically in 3 cases and in one case by cultivation. These results suggest that the determination of serum antibodies against pathogens is frequently more useful than is generally assumed, although the yield of positive results is dependent on the epidemiological situation. The detection of elevated complement-fixing titers or specific IgM antibodies often leads to diagnosis from the first serum examined.

Continuous microbiological and pathological study of 70 sudden and unexpected infant deaths: toxigenic intestinal clostridium botulinum infection in 9 cases of sudden infant death syndrome.

As part of a programme to exclude infection as the cause of death in infants who died suddenly and unexpectedly necropsies were carried out on 70 such infants. In 11 cases (15%), a pathological diagnosis could be made at necropsy; in 9 of these, causative bacteria or viruses were found. The 59 cases in which the cause of death could not be found had histological features characteristic of sudden infant death syndrome (SIDS). Botulinum toxin was found in 9 SIDS cases (15%). 8 of these infants had botulinum toxin and organisms of different types (A, B, C, F, G) in the contents of the ileojejunum or colon. 4 of them also had toxin in the serum. No botulinum toxin or organisms were found in the 11 infants who died of identified causes or 18 other infants who died in hospital of known causes.

Staphylococcus aureus skin colonization in atopic dermatitis patients.

A study was conducted to compare the Staphylococcus aureus skin colonization of 21 patients with atopic dermatitis (AD) and 22 healthy controls. It was found that the total aerobe count (total CFU/cm2), the S. aureus fraction thereof and the S. aureus carrier frequency were significantly higher in apparently normal skin of AD patients than in healthy individuals. In addition, compared to normal skin of patients S. aureus density was 100 to 1,000 times higher in the 3 different kinds of lesional skin (dermatitic, lichenified and impetiginized sites). 190 S. aureus strains isolated from the skin of AD patients were tested for sensitivity to 5 topically used antibiotics and the results reported. Besides the biological consequences for the person affected by AD this severe colonization with S. aureus is of epidemiological importance. Several outbreaks of S. aureus infections by dispersal from dermatitic skin have been described. Therefore some preventive and therapeutic aspects are discussed.

Aminoglycoside monitoring: timing of peak levels is critical.

Recommendations for optimal therapeutic peak concentrations of aminoglycosides are often not differentiated with respect to duration of infusion and timing of peak sample thereafter. To document the relevance of the timing, 139 dose intervals were analyzed in 58 patients during administration of gentamicin, amikacin, and netilmicin. Serum concentrations measured immediately after 30-min infusions were compared with concentrations obtained 90 min later (2 h values). The ratio of 30 min/2 h concentrations showed considerable variability. This ratio was less than 1.5 in 15% of the dose intervals analyzed and greater than 3 in 8% of the intervals. The poor correlation between concentrations measured at 30 min and at 2 h was documented by the coefficients of variation of 0.82, 0.30, and 0.67 for gentamicin, amikacin, and netilmicin, respectively. This variability was not explained by interindividual differences, renal function, or drug half-life. However, the initial decrease in concentrations was significantly lower in patients with impaired renal function (p less than 0.001). These data suggest that timing is critical for the sampling of serum to determine peak levels in patients and the definition of optimal therapeutic concentrations.

[Mezlocillin in the antibiotic therapy of severe bacterial infections in visceral surgery]. / Mezlocillin in der antibiotischen Therapie schwerer bakterieller Infektionen in der Viszeralchirurgie.

Fifty-six patients suffering from severe and very severe bacterial infections received additional antibacterial treatment with mezlocillin following abdominal or chest surgery. There were 18 intestinal-peritoneal infections, 15 pleuropulmonary infections, seven patients with sepsis, six localized abscesses and ten patients receiving perioperative application. In 36 patients treatment had to be initiated before the pathogens had been identified. Twenty patients received mezlocillin alone and 37 in combination with an aminoglycoside. The clinical course and laboratory data were recorded while the patients were receiving antibiotic therapy. In 43 of the 56 patients, most of whom were suffering from mixed infections caused by anaerobes and aerobes or from fecal infections, a cure without complications could be achieved. In six patients a generalized infection was reduced to a local one which could be cured. Eight patients died, six of their surgical primary disease and two of septic complications. Apart from four instances of phlebitis at the site of the infusion, no side-effects resulted from our antibiotic therapy.

Focal necrotizing brain stem encephalopathy and cranial radiculopathy in a kidney transplant recipient.

A 48-year-old female patient developed sensory and motor palsy of the V-Xth cranial nerves immediately after kidney transplantation due to terminal uremia. A second exacerbation followed about 4 weeks later. After 46 days post transplantation she died from bronchopneumonia. Autopsy showed multiple acute and subacute necrotic foci in proximal portions of the cranial nerves as well as a discontinuous necrotizing encephalopathy localized mainly in the subpial zone of the brain stem. The mechanism by which lesions of the nervous system were produced remains speculative. A possible neurotoxic role was attributed to the drugs administered after transplantation. Herpes virus hominis antigen could be demonstrated in the cells of the pons and of the trigeminal ganglion, but its presence was thought to be coincidental and probably not causally related to the described lesions.

[Moxalactam - a beta-lactam antibiotic in the monotherapy of severe infections in surgery. Clinico-bacteriological study of 35 patients]. / Moxalactam - ein beta-Lactam-Antibiotikum in Monotherapie bei schweren Infektionskrankheiten in der Chirurgie. Klinisch-bakteriologische Studie an 35 Patienten.

Moxalactam, a new beta-lactam antibiotic, was given to 35 patients at the Department of Surgery, Cantonal Hospital, St. Gall. The trial period started in April 1980 and ended in October. Moxalactam was not combined with any other antibiotic. The clinical course was observed closely and extensive bacteriological, mycological, and pharmacokinetic studies were carried out to evaluate the new antibiotic. Most of the patients had an intra-abdominal infectious disease and primary treatment was surgery. The antibiotic therapy was started at surgery. A total of 290 different bacteria could be isolated from the 35 patients. 220 isolates were aerobic and 7 0 anaerobic. The minimal inhibitory concentration was calculated for every isolate. In addition, the serum levels of moxalactam was determined in almost every patient. In 31 patients (88.6%) the therapy was successful, in 2 patients no evaluation was possible and in 2 patients the therapy was unsuccessful, including one patient with a primarily moxalactam-resistant Bacteroides fragilis responsible for sepsis. In some patients a massive increase in Candida was noted in the urine, stool, or wound drainage. Primarily moxalactam-resistant organisms, such as Streptococcus faecalis, were often found alone in the samples taken later in the course of therapy. An extraordinary change in the fecal flora could be observed during therapy, but no clinical complications resulted. No specific antifungal therapy nor any additional antibiotic against Streptococcus faecalis was necessary. Moxalactam was well tolerated and side effects were minimal. No impairment of renal function was noticed.

Spontaneous generalized Herpesvirus hominis infection of a lowland gorilla (Gorilla gorilla gorilla).

A 13-day-old lowland gorilla died from a generalized herpesvirus infection shortly after the onset of clinical signs. The pathologic-anatomical findings were compatible with those described for generalized herpes simplex infection in the human neonate. Electron microscopic examination of lung tissue revealed the presence of herpesvirus which was identified with the fluorescent antibody technique as Herpes simplex virus type I. Tests with related sera of the herpes group (varicella, herpesvirus-B) revealed no specific immunoflourescence.

Isolation of Clostridium botulinum type G and identification of type G botulinal toxin in humans: report of five sudden unexpected deaths.

Clostridium botulinum type G has not been identified until now from humans or animals; it has been isolated only twice, from soil samples in Argentina. Type G organisms were isolated from necropsy specimens in four adults and an 18-week-old infant. Type G botulinal toxin was demonstrated in the serum of three of these individuals. The toxic dose in mice ranged from 2 to 7 50% lethal doses/ml. These persons died suddenly and unexpectedly at home, without any pathologic evidence to account for the cause of death in four cases. Symptoms in two individuals were similar to those observed in food-borne botulism. Thus, a prompt postmortem search for toxin and organisms of C. Botulinum in blood and feces may be worthwhile in determining the etiology of unexplained deaths. More microbiologic, physiologic, and toxicologic data are needed to clarify the role of C. botulinum in the pathogenesis of sudden unexpected death in infants and adults.

[Legionnaires' disease in the Lake Zurich area. Report on 6 sporadic cases]. / Die Legionärskrankheit am Zürichsee. Bericht über 6 sporadische Fälle.

Six sporadic cases of Legionnaires' disease seen over 13 months in the region of Lake Zurich (Switzerland) are reported. The disease was severe in all cases; 2 patients died while on artificial respiration; 5 patients were heavy smokers; 3 had probably acquired the infection in France. These 6 patients showed the following typical symptoms and signs: fever above 39 degrees C (6 patients), nonproductive cough (4), gastrointestinal symptoms (4), encephalopathy (4), renal insufficiency (5), hepatic involvement (4), bilateral pneumonia (4), and pO2 below 60 mm Hg (4). The disease was diagnosed serologically in all cases and by staining and culturing Legionella pneumophila from lung tissue in one case. The authors propose to treat unusual cases of pneumonia with erythromycin from the outset.

[Microbiological aspects of Legionnaires' disease]. / Mikrobiologische Aspekte der Legionärskrankheit.

Legionella pneumophila was isolated in 1947 but its etiological role was only recognized after the Philadelphia outbreak in 1976. Since then, infections with Legionella pneumophila in patients with so-called atypical pneumonia have been found in different parts of the world in sporadic cases and outbreaks affecting up to several hundred patients. The etiological agent is a bacterium which can be found in dust, mud and water. Transmission to the human most likely occurs through water-cooled air condition units or showers. Air conditioning in hotels, hospitals and offices may transmit the organism and lead to infection which, moreover, is more frequent during the warm season. The diagnosis is based on clinical data and the demonstration of specific antibodies. Isolation of the agent is technically difficult and up to now only approximately 3% of the cases have been confirmed by isolation of the agent. Evidence of Legionella pneumophila infection in Switzerland was obtained by testing stored blood samples from transplanted patients in 1970. Sporadic cases were observed in the period 1977 to 1980. Acute infection was considered in 141 patients on the basis of serological results. Approximately 3% of all pneumonias in 1979 were caused by Legionella pneumophila. Isolation of the etiological agent has been achieved in 3 patients only.

[The cerebral abscess (author's transl)]. / Der Hirnabszess.

The incidence of cerebral abscess is assessed at 1 in 500,000 per annum, the relative frequency among neurosurgical operations at 2 per thousand. The most common mode of development is metastatic from chronic cranial or pulmonary infections. The abscess develops from the initial stage of the focal encephalitis, often with few symptoms, after a latent stage of weeks or months to the third stage of the manifest encapsulated cerebral abscess, a macroscopicsketch of which is drawn. In metastatic and advanced abscesses resulting from chronic infection, anaerobic organisms predominate, in primary cerebral infections due to trauma or operation, aerophilic colonization. Among the clinical diagnostic procedures computer tomography is dominant. The results of combined antibiotic and surgical therapy are good with early computer tomography: mortality less than 2%. postoperative morbidity is, however, more than 15%.

[Effect of aerobic and anaerobic germs on the healing of decubitus ulcers]. / Einfluss aerober und anaerober Keime auf den Heilungsverlauf von Dekubitalulzera.

Bacteriological examinations of decubitus ulcers were performed in 34 geriatric patients. A total of 179 wound swabs were analyzed for aerobic and anaerobic bacteria. The decubitus ulcers were divided into three groups according to wound healing: group A with progressive worsening, group B, stationary, and group C with healing within 10 weeks. The aerobic bacteria isolated from the three groups were significantly different (p less than 0.0001). In group A Pseudomonas aeruginosa was isolated in 88%, enterococci in 73% and Providentia in 34%, whereas in group B staphylococci were found in 69%, enterococci in 62% and E. coli in 32%. In group C staphylococci dominated with 91%, followed by enterococci (51%) and E. coli (25%). Anaerobic microorganisms were significantly (p less than 0.01) more frequent in decubitus ulcers with poor healing tendency (group A and B) than in healing ulcers (group C). These results suggest that bacterial growth on decubital ulcers significantly influences decubital ulcer healing. Furthermore, bacteriological examinations are of prognostic value and the results should be considered in treatment.

[Transitory bacteremia in rectoscopy]. / Transitorische Bakteriämie bei Rektoskopie.

A prospective study was undertaken to determine the frequency of transient bacteremia on recto-sigmoidoscopy. Blood specimens were drawn for aerobic and anaerobic bacterial culture immediately before, and 1, 5, 10, 15, 20, 25 and 30 min after the beginning of recto-sigmoidoscopy. 19 blood cultures were supposed to be contaminated. In 3 patients (6%) a positive blood culture was found with the following types of organisms: enterococci, Escherichia coli and nonhemolytic streptococci. The need for antibiotic prophylaxis in patients with valvular heart diseases or prosthetic valves is discussed. In such cases the authors propose prophylaxis with 1 g streptomycin i.m. and 3 g ampicillin by mouth 30 min before recto-sigmoidoscopy.

[The enlarged diagnosis of the fatal penicillin accident. Immunehistologic demonstration of antigen-antibody complexes and of antibodies against the tubular basement membrane after administraiton of depot penicillin]. / Zur erweiterten Diagnostik des tödlichen Pencillin-Zwischenfalles.

In a case of fatal penicillin allergy it proved possible at autopsy to demonstrate (by immunohistological examination of basal membranes of proximal renal tubuli) antigen-antibody complexes belonging to the penicillin (BPO) group and to an anti-penicilloyl antibody of the IgG type. In addition, complement C3 was detected. Antibodies against the basal membranes or renal tubuli were also demonstrated in material eluted from the kidney, although an inflammatory reaction ot the immunoligical changes had not yet been observed in light microscopy. It is undecided whether this discrepancy is due to the low dose of penicillin administered or the relatively short time lag between first injection and time of fatality. It is assumed that, pathogenetically, a reaction of the serum sickness type is probably involved. For etiological clarification the use of immunohistological methods in addition to serological procedures provides further indices for an antecedent sensitization to penicillin, because assay effectiveness does not decrease even after a lengthy postmortal time-lapse. On the other hand, tissues and serum for examination should be frozen at low temperatures immediately after autopsy.