Biomedical subjects
Publications and source records attributed to A Andreu.
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BACKGROUND: Maternal-fetal transmission of Haemophilus influenzae (HI) and Haemophilus parainfluenzae (HPI) as well as characteristics of the infection in the neonate have been poorly described. METHODS AND RESULTS: From 1982 to 1994 18 HI and 12 HPI from vaginal secretion of 30 women obtained intrapartum or immediately post partum were isolated. The following was observed in the 18 patients in whom HI was isolated: 1 abortion, 2 antepartum death, 1 post partum death, and 14 live neonates from whom 10 were suspect a infection with 5 cases being confirmed with isolation of HI in blood culture. Mortality was 40%. The rate of vertical transmission of HI was 80% (8/10) and neonatal sepsis 50% (5/10) (71.4% of the infants whose mothers did not receive intrapartum antibiotics and 0% in those who did). Twenty-seven point seven percent of the strains of HI were beta-lactamase producers with II and III being the most frequent biotypes observed. Of the 12 patients from whom HPI was isolated the following was reported: 1 antepartum death, and 12 live neonates of whom 10 were suspect a infection, but no case was confirmed because HPI was not isolated from blood culture. The vertical transmission of HPI was 20% (2/10). CONCLUSIONS: The isolation of HI in the vagina of pregnant women should be considered as being potentially very virulent since despite a low prevalence, the rate of vertical transmission and, overall, neonatal sepsis, is high.
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Seventy-five pregnant women (mean gestational age 32.26 weeks, range 20-36 weeks) with premature rupture of the membranes (PROM) were admitted in our department during 1989 and the first 6 months of 1990. Amoxicillin and clavulanic acid was initially administered at a dose of 1.2 g i.v. every 8 hours for 3-4 days and was followed by oral administration of 625 mg every 8 hours until labor. Sixty-one patients (mean gestational age 32.6 +/- 2.3 weeks, range 26-36 weeks) achieved an uncomplicated course of their pregnancies with a mean time of 11.4 +/- 5.7 days (range 3-27 days), from rupture to delivery. Fourteen women (mean gestational age 30.8 +/- 5 weeks, range 20-36 weeks) developed chorioamnionitis 3.5 +/- 0.9 days (range 1.4-5.6 days) after the rupture with several degrees of leukocyte infiltration of the membranes, placenta and the umbilical cord. Five women (mean gestational age 23.8 +/- 2.3 weeks, range 20-26 weeks) had complications resulting in fetal/infant death, three of them because of fetal sepsis (Escherichia coli, Pseudomonas aeroginosa, Staphylococcus aureus). The newborns were followed up 6 months from delivery and had no signs of drug influence. Few side effects were observed with the chief complaints involving the gastrointestinal tract (4%). No one discontinued the drug. It seems therefore, that the prophylactic administration of amoxicillin and cluvalanic acid in women with PROM is associated with a significant prolongation of pregnancy and with a reduction in the incidence of fetal/maternal infections.
To address the poorly understood mechanisms through which lactobacilli adhere to vaginal epithelial cells (VECs), 65 wild type lactobacilli isolated from the vaginal flora of young women and 3 American Type Culture Collection Lactobacillus strains were studied. Group I isolates (n = 56) hemagglutinated sheep, rabbit, and human red blood cells (RBCs) and adhered poorly to VECs. In contrast, all 4 group II strains hemagglutinated sheep and human but not rabbit RBCs, adhered in large numbers to VECs, and were identical in five phenotypic tests and DNA-DNA hybridization. Eight other strains (group III) hemagglutinated all RBC types studied, adhered avidly to VECs, and had identical protein and hybridization patterns but showed heterogeneous enzyme activities. Although most wild type lactobacilli from the vaginal flora of young women adhered poorly to VECs, selected isolates (groups II and III) adhered in large numbers, demonstrated specific and reproducible hemagglutination patterns, and may have specific mechanisms of attachment to VECs.
BACKGROUND: The hypothesis that fractional protein synthesis rates (Ks) are tissue-specific and bidirectional during sepsis was tested in an animal model. MATERIAL AND METHODS: Ks in liver, triceps muscle, and diaphragm were measured in septic (n = 27) and control rats (n = 26). Sepsis was induced by a reproducible model established in our laboratory (intraperitoneal injection of sterile NaOH 0.75 N at 0.075 ml/100 g of body weight). Ks were measured using the flooding-dose method in tissue obtained from the diaphragm, liver, and from the triceps muscle. RESULTS: In hepatic and diaphragmatic tissue, Ks were significantly higher in the septic animals (Ks: 112.2 +/- 8 and 5.4 +/- 1.9, respectively) than in control animals (Ks: 78.5 +/- 13 and 2.9 +/- 1.7, respectively). In the triceps, Ks were significantly lower in septic animals (Ks: 2.9 +/- 1.4) than in control animals (Ks: 5 +/- 1.8). CONCLUSION: The results suggest that in septic animals the rate of protein synthesis is enhanced in tissues of priority, such as the liver, and varies in response to differences in muscle activity.
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During a period of 28 months, 114 isolates of Acinetobacter baumannii obtained from urine samples of 57 patients, were recovered in a Spinal Cord Unit; an unusual increase in the number of A. baumannii isolates was observed between February 1991 and January 1992. Six different typing methods [biotyping, antimicrobial susceptibility, whole cell and cell-envelope protein analysis, plasmid analysis and chromosomal DNA analysis by pulsed-field gel electrophoresis (PFGE)] were used to study the isolates to establish any potential relationships among them. Chromosomal DNA analysis by digestion with ApaI and separation of the fragments by PFGE was the most powerful tool to determine the relatedness of isolates. The results suggest that the isolates from 1991 and 1992 may have originated from strains present in 1990 that subsequently acquired resistance to amikacin and tobramycin during the epidemic.
The in vitro activity of fluconazole, itraconazole and ketoconazole against 625 Candida yeast strains from patients treated at the University Hospital of the Canaries, by means of a micromethod of dilution in broth enriched with Yeast Nitrogen Base (YNB), and buffered to pH7, has been assessed. Species distribution was as follows: Candida albicans (388), Candida tropicalis (84), Candida glabrata (84), Candida parapsilosis (69). Our results show 10.0% and 8.8% of C. albicans resistant to itraconazole and fluconazole, respectively, and 1.8% resistant to ketoconazole; 39.5% of C. tropicalis were resistant to itraconazole, 34.5% to fluconazole and 2.4% to ketaconazole. 19.1% of C. glabrata were resistant to fluconazole and 13.1% to itraconazole; 4.4% of C. parapsilosis were resistant to fluconazole and 1.5% to itraconazole. In general C. tropicalis was the most resistant strain and C. parapsilosis the most sensitive. The greatest percentages of resistance in vitro were seen with the two triazols.
A study was made of the possible influence of sepsis on liver protein synthesis in septic and control rats, fed either parenterally (TPN) or with water and feed available "ad libitum". Liver protein synthesis was determined using the single massive dose method. In experiment I, the septic and control animals received TPN for twenty-four hours: in experiment II water and food was available to them "ad libitum". Twenty-four hours after the sepsis occurred, the animals were injected with a massive dose of 14C-labelled leucine, and slaughtered by decapitation. The septic animals with water and feed available "ad libitum" were fasted voluntarily without any intake. This group of fasted septic animals was the only one which lost weight. Liver protein synthesis increased in septic animals in comparison with the control animals, whether receiving TPN (112.2 +/- 8/78.5 +/- 13) or with "ad libitum" nutrition (97.2 +/- 15/60.8 +/- 8). The increased liver protein synthesis in the septic animals was modified (although with reduced significance) by parenteral nutrition (112.2 +/- 8/97.2 +/- 15). Our results suggest that sepsis increases liver protein synthesis, and that this protein synthesis may be enhanced by parenteral nutrition.
From January 1990 to April 1992, 114 urinary strains of Acinetobacter baumanii were isolated in 57 patients with traumatic spinal cord [correction of medular] injury. The strains were characterized by having all of them the same biochemical identification, except for citrate, maltose and tryptophan-desaminase. Until December 1990, (5 strains) were resistant to all antibiotics, except to tobramicine, amikacine, cotrimoxazol and imipenem (6.3%, 33.9%, 26.7% and 0% of resistances, respectively); since January 1991, (99 strains) became resistant to all of them, except to imipenem. 39.5% of AB were isolated in pure cultures, 46% of them with pyuria. Between February 1991 and January 1992, we observed the highest number of affected patients, although without seasonal predominance. We observed as well a higher incidence among males (46 males, 11 females). 80% of them carried a permanent probe. Only 6 patients presented clinical signs directly related to AB. The environmental study could not demonstrate any source of contagion or transmission mechanism.
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A new method of urine screening based on the enzymatic study of catalase (Uriscreen) was evaluated. Catalase is produced by the majority of microorganisms that cause urinary infections as well as by red cells, uroepithelial cells and PMN. In 553 consecutive urine samples we studied the sediment, the conventional culture, and the Uriscreen test. Comparative study between culture and Uriscreen revealed a sensitivity of 92.3%, specificity of 83.3%, negative predictive value of 96.2%, and positive predictive value of 69.9%. In 86% of the samples the results obtained with both techniques were similar, whereas in 14% of the cases they failed to coincide. Among the 74 cases of disagreement, 12 were false negative (culture positive, Uriscreen negative) and 62 were false positive (culture negative, Uriscreen positive). The high sensitivity and negative predictive values obtained with the screening method indicate that this is an useful procedure for the study of negative urines since it allows to rapidly classify 60.2% of the samples.
Amongst 1.202 genital samples studied, the microscopic exam revealed in 179 (14.8%) cases flora compatible with bacterial vaginitis. Of these 179 samples, Mobiluncus SP was observed in 35 (19.6%) using Gram staining and in 18 (10.1%) this microorganism was isolated in agar RLK and anaerobic atmosphere. Using biochemical characterization M. curtisii species was found more frequently (15 isolations) than M. mulieris (3 isolations). Chromatographic characterization permitted the diagnosis of the genus but not the differentiation of the species. Out of the 35 cases of Mobiluncus observed microscopically, 11 (31.4%) were afterwards isolated while in 7 occasions Mobiluncus growth was obtained without having been previously visualized using Gram staining. The percentage of Mobiluncus observed was different according to the species since 2 of the 3 M. mulieris while only 9 out of the 15 M. mulieris were visualized.
The presence of type 1 fimbriae, P fimbriae and X adhesins in 30 strains of Escherichia coli producing pyelonephritis, 30 strains producing cystitis, and 30 strains producing recurrent urinary infections are compared. All the strains were collected from adult women without risk factors for infections of the urinary tract. The presence of P fimbriae was 73% in strains producing pyelonephritis, 40% in strains producing cystitis and 20% in strains producing recurrent urinary infections; the presence of X adhesins was 3%, 0, and 17% respectively. There were, in consequence, significant differences between the groups studied; however, such differences were not observed with respect to the presence of type 1 fimbriae, which was 97%, 97% and 90%, respectively. We conclude that P fimbriae act as a factor of greater virulence in the strains of E. coli producing pyelonephritis and X adhesins are found almost exclusively in the strains producing recurrent urinary infections.
In 573 urethral swabs, 3 Haemophilus influenzae (HI) and 7 Haemophilus parainfluenzae (HPI) were isolated; 7 of the patients had clinical features of urethritis and in 3 another genital pathogen was associated. Biotype IV was the predominant one in HI, and II in HPI. In 6.259 endocervical and/or vaginal swabs 15 HI and 5 HPI were isolated. Three out of the 15 females infected by HI, had clinical features of salpingitis and 8 of vaginitis; 5 of them were carriers of an IUD. In four out of the 5 females with HPI another genital pathogen coexisted, and in the fifth there was an additional non analysable isolate. Biotype I predominated in HI and biotype II in HPI.
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