A comparison between amylase levels from peritonsillar, dental and neck abscesses.

OBJECTIVES: Pus of peritonsillar abscess (PTA) contains very high amylase levels in some patients. The objective of this study was to further test this finding and to check whether high amylase levels in peritonsillar abscess originate from contamination by saliva during aspiration. STUDY DESIGN: Prospective study. SETTING: Tertiary care university hospital. PARTICIPANTS: The study includes 64 patients with PTA, 8 patients with a neck abscess and 12 patients with a dental abscess. MAIN OUTCOME MEASURE: Amylase levels of pus and serum were compared between the groups. Clinical data regarding hospitalisation length, recurrence rate and previous antibiotic treatment were also collected. RESULTS: Mean amylase levels in the pus of the PTA group were 3045 U/L (median 59 U/L), 13 U/L in the neck abscess group (P = 0.001) and 22 U/L in the dental abscess group (P = 0.001). Mean serum amylase was higher in the PTA group; PTA - 50 U/L, neck abscess - 37 U/L (P = 0.002) and dental abscess - 26 U/L (P < 0.002). All of the patients with amylase levels above 65 U/L had a first episode of PTA. In contrast, 40% of patients with amylase lower than 65 U/L had recurrent PTA (P = 0.003). CONCLUSION: A clear association is seen between minor salivary glands and peritonsillar abscess. The high amylase level in peritonsillar pus is not from contamination with saliva.

Isolation of Staphylococcus aureus and black-pigmented bacteroides indicate a high risk for the development of Ludwig's angina.

OBJECTIVE: The aim of this study was to compare clinical, microbiological, enzymatic, and host immune response variables between subjects hospitalized with facial cellulitis, with Ludwig's angina (LA) and without Ludwig's angina (WOLA). STUDY DESIGN: Microbiological and enzymatic tests on pus, and hematological and immunological assessments on blood samples of 15 patients with LA and 42 patients with WOLA were performed. Laboratory findings of both groups were compared using the Student t test. Multiple logistic regression analysis was performed and significant differences identified by univariate analysis. RESULTS: Patients with LA demonstrated increased levels of white blood cell counts, urea, and CRP levels, and decreased levels of CIC compared with patients WOLA. However, only CRP and urea were found to be significantly raised in the LA group. A greater population of Staphylococcus aureus and black-pigmented bacteroides were isolated from patients with LA. CONCLUSION: Elevated levels of CRP and urea could indicate the severity of infection in patients with LA. This could be because of the highly virulent and fast-spreading organisms, S. aureus and black-pigmented bacteroides, which may be a factor indicative of LA.

Neutrophil elastase levels in periapical exudates of symptomatic and asymptomatic teeth.

The aim of this study was to determine neutrophil elastase levels (NE) in periapical exudates and to evaluate its relationship with clinical signs and symptoms of endodontically involved teeth. A total of 42 teeth with periapical periodontitis of 37 patients were clinically examined and spontaneous pain, swelling, pain on palpation or percussion, sinus tract formation and pus discharge were recorded. Additionally, periapical lesion size was measured on periapical radiographs. Periapical exudate samples were obtained during routine root canal treatment by using paper points. Enzyme levels were determined by spectrophotometric assays using the NE specific substrate N-methoxysuccinil-Ala-Ala-Pro-Val-p-nitroanilide. The teeth with signs and symptoms showed higher NE levels than the teeth without symptoms (p<0.05). The differences were significant when NE levels were presented as total amounts instead of concentration. This study demonstrated that NE in periapical lesions related with clinical symptoms and total enzyme amount may be more reliable mode of data presentation.

Reactive nitrogen species contribute to blood-labyrinth barrier disruption in suppurative labyrinthitis complicating experimental pneumococcal meningitis in the rat.

Sensorineural hearing damage is a frequent complication of bacterial meningitis, affecting as many as 30% of survivors of pneumococcal meningitis. There is a substantial body of evidence that oxidants, such as reactive nitrogen species (RNS), are central mediators of brain damage in experimental bacterial meningitis. In the present study, we investigated whether RNS also contribute to the pathophysiology of suppurative labyrinthitis in our well-established rat model of pneumococcal meningitis. In all infected rats, but not in uninfected controls, we observed suppurative labyrinthitis. Cochlear inflammation was accompanied by severe blood-labyrinth barrier (BLB) disruption as evidenced by increased Evans Blue extravasation. Furthermore, increased cochlear expression of endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) was detected by immunohistochemistry. Colocalization of iNOS and tyrosine nitration (a marker of RNS attack) indicated that nitric oxide (NO) produced by iNOS contributes to oxidative cochlear damage through the action of RNS. To determine the pathophysiological role of RNS in BLB disruption, rats were treated with peroxynitrite scavengers (MnTBAP and uric acid, UA). Six h after adjunctive treatment with 300 mg/kg i.p. UA or 15 mg/kg i.p. MnTBAP+100 mg/kg i.p. ceftriaxone, BLB disruption was significantly reduced compared with that in infected animals treated only with ceftriaxone. Therefore, we conclude that RNS are involved in the breaching of the BLB during meningogenic pneumococcal labyrinthitis.

Hyaluronidase activity in human pus from which Streptococcus intermedius was isolated.

Hyaluronidase (HAase) activity was detected in both a human pus sample and the culture supernatant of the only bacterial isolate from the pus, Streptococcus intermedius, using a zymographic technique. The optimum pH range for HAase activity was similar for both samples. Although the bands showing the strongest HAase activity of these samples differed from each other with respect to molecular size, both samples were equally inhibited by an antiserum raised against HAase of S. intermedius. These results suggest that S. intermedius may produce HAase in vivo as well as in vitro, and that this enzyme and/or its fragments may play an important role in host tissue degradation.

[Effect of pyrimidine derivatives on the regulation of active transport of calcium in the immunocompetent cells]. / Vliianie pirimidinovykh proizvodnykh na sistemu reguliatsii aktivnogo transporta kal'tsiia v immunokompetentnykh kletkakh.

Experiments with guinea pig immunocompetent cells and nonadherent and adherent mononuclear fractions of the peripheral blood of healthy donors, and patients with rheumatoid arthritis and purulent surgical infection disclosed different levels of Ca(2+)-ATPase activity. Thymectomy in adult guinea pigs led to diminution of activity of the enzyme in all lymphoid organs. The effect of ximedon (30 mg/kg) on Ca(2+)-ATPase activity depended on the thymus and duration of treatment with the drug, and was of a two-phase character.

[Rapid screening for beta lactamase of Neisseria gonorrhoeae in pus from blennorrhagia]. / Dépistage rapide dans le pus de blennorragie de la Bétalactamase de Neisseria gonorrhoeae.

The authors have evaluated in an isolated post, a method for rapid detection of penicillinase-producing Neisseria gonorrhoeae in urethral exudates. This method, easy to use and not very expensive, offers a good sensitivity, and could help in making for the therapeutic decision and in the epidemiological surveillance of Neisseria gonorrhoeae's resistance to penicillin.

Antileukoprotease in patients with maxillary sinusitis.

Antileukoprotease, an inhibitor of leukocyte elastase, was studied in paired sera from 12 patients with maxillary sinusitis. The serum concentration of antileukoprotease was increased at the day of admission to hospital, compared with the serum concentration in convalescence sera. In purulent maxillary sinus secretions antileukoprotease was found in complex with leukocyte elastase, as shown by gel filtration. The findings suggest a local protective function of antileukoprotease in maxillary sinus.

Oxidation of Escherichia coli iron centers by the myeloperoxidase-mediated microbicidal system.

Myeloperoxidase, HeO2, and a halide (chloride, bromide, iodide) constitute a powerful microbicidal system which is active against a wide variety of microorganisms and is believed to contribute to the antimicrobial activity of neutrophils. The precise mechanism by which this system exerts its toxicity is unknown. We report here that the microbicidal activity of the myeloperoxidase-H2O-chloride system on Escherichia coli is associated with the loss of iron into the medium as measured by the release of 59Fe from prelabeled organisms. Iron loss (but not bactericidal activity) was considerably increased by the addition of EDTA or other iron chelators; it was not associated with a corresponding release of protein with 14C-amino-acids. Iron loss was observed with chloride or bromide as the halide, but not when iodide was employed in microbicidal concentrations. Microbicidal activity was detected at an earlier time period and at a lower halide concentration than was iron loss. Analogous changes were observed when cytochrome c was oxidized by the myeloperoxidase H2O2-halide system. The initial response was a shift in the Soret maximum, followed by a fall in absorbance accompanied by the loss of iron. As with the intact organism, iron loss was evident with chloride and bromide, but not with iodide as the halide. These findings suggest that microbial iron centers are a target for the myeloperoxidase-mediated antimicrobial system and that their oxidation may contribute to microbicidal activity.

beta-Lactamase activity in human pus.

Pus was obtained from patients with polymicrobial intraabdominal abscesses or polymicrobial empyema. Physical and chemical characteristics of 12 specimens were examined, and bacterial isolates were enumerated. Pus supernatant of six specimens rapidly inactivated penicillin, cephalothin, and cefazolin. Carbenicillin and ticarcillin were similarly degraded by supernatant of certain pus specimens. Cefoxitin, chloramphenicol, and clindamycin were not appreciably inactivated by pus supernatant. Degradation of penicillin and cephalosporin congeners in pus was due to the presence of beta-lactamase, as shown by chemical interaction with nitrocefin, chromatography, and inhibition by the beta-lactamase inhibitor clavulanic acid. Pus supernatant containing beta-lactamase activity reduced the bactericidal activity of carbenicillin against Bacteroides fragilis in whole pus in an abscess model in vitro. Bactericidal activity of clindamycin or cefoxitin was not impaired in pus containing beta-lactamase.

Granulocyte collagenase and elastase and the plasma protease inhibitors in human pus.

Granulocyte collagenase and elastase was demonstrated in human pus using specific antisera. The enzymes were complexed by alpha1-antitrypsin and alpha2-macroglobulin but also were present as free proteases. All purulent exudates showed free elastolytic and collagenolytic activity.

Inactivation of penicillin by purulent exudates.

Four of 22 specimens of human pus inactivated up to 90% of added penicillin within one hour in vitro. Ampicillin and cephaloridine were also inactivated, but streptomycin and fusidic acid were not. The effect was not related to the protein content of the pus, nor to its pH value. Microbes that may produce beta-lactamase in small quantities were isolated from three of the four specimens, but the enzyme was not detected in the pus by physical methods nor by microbiological inhibition assay. The inactivating effect was shown to be a property of the solid portion of the pus, and was absent from the filtrate. We suggest that the effect may be an intrinsic property of the host, which should be investigated further as it has important implications for clinical practice.

New cause of penicillin treatment failure.

A large empyema infected with a penicillin-sensitive haemolytic group B streptococcus failed to respond to high doses of penicillin. After two weeks' treatment the pus aspirated was found not only to contain no penicillin, but also to inactivate penicillin added to it. We believe that the inactivating agent is an enzyme that may destroy various penicillins and cephalosporins but has no effect on other common antibiotics. When treatment was changed to doxycycline the patient made a rapid recovery.