Unusual non-toxigenic Corynebacterium diphtheriae in homosexual men.
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Biomedical subjects
Publications and source records attributed to G L Ridgway.
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A 41-year-old man who habitually slept in a car park presented with a culture-negative endocarditis. Serological tests indicated infection with both Coxiella burneti and Chlamydia psittaci. He was treated with doxycycline and clindamycin and required aortic valve replacement. Culture of the excised value for both agents was negative but electron microscopy was suggestive of coxiella endocarditis.
A patient with systemic lupus erythematosus (SLE)/erosive arthritis overlap is described who was also shown to have late latent treponemal infection. The possibility of serological reactivation is discussed. Since antiphospholipid antibodies are the basis of the reagin tests for syphilis as well as being present in patients with SLE, difficulties with diagnosis may ensue.
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The activity of oxytetracycline and seven macrolide antibiotics was investigated against a prototype strain of Chlamydia pneumoniae in cell culture. Following incubation, inoculated cell monolayers were fixed in methanol and stained with a genus specific immunofluorescent monoclonal antibody before examination for inhibition of inclusion formation. The most active agent was clarithromycin (MIC 0.007 mg/l), followed by erythromycin (0.06 mg/l). Other macrolides were less active; josamycin and roxithromycin (0.25 mg/l), midecamycin acetate and azithromycin (0.5 mg/l) and spiramycin (4.0 mg/l). The MIC of oxytetracycline was 0.25 mg/l. Clinical evaluation of clarithromycin for C. pneumoniae lower respiratory infection is indicated.
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A 54 year old Bangladeshi man presented with a history and chest X-ray appearances suggestive of pulmonary tuberculosis. Following deterioration 4 weeks later, he required ventilation. Although a blood culture isolate was subsequently found to be Pseudomonas pseudomallei, it was initially misidentified and dismissed as a contaminant. Further cultures demonstrated the organism, but the patient died, despite treatment with ceftazidime. The case illustrates the importance of taking a detailed travel history and having a high index of suspicion in patients from South East Asia and the Indian sub-continent, including Bangladesh, where the disease has not previously been considered endemic.
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Erythromycin is a macrolide antimicrobial chemically comprised of a 14-membered lactone ring substituted with a neutral (cladinose) and an amino (desosamine) sugar. Recently, a number of new macrolide molecules have been identified containing either 14-, 15- or 16-membered substituted lactone rings. In this study the authors have determined the in vitro activity of roxithromycin and clarithromycin (both 14-membered macrolides), azithromycin (a 15-membered macrolide or azalide) and midecamycin acetate (a 16-membered macrolide) against clinical isolates of Staphylococcus spp., (including methicillin-susceptible and -resistant isolates), Legionella spp., Mycoplasma spp. and Ureaplasma urealyticum. Minimum inhibitory concentrations of the macrolides for the clinical isolates of Staphylococcus spp. examined were widely distributed. However, midecamycin acetate retained activity against those isolates of Staphylococcus spp. exhibiting inducible resistance to erythromycin and the other macrolides tested. Isolates characterised by constitutive resistance to erythromycin were also resistant to midecamycin acetate. All of the macrolides were very active against Legionella spp., with clarithromycin demonstrating the greatest potency (MIC range: less than or equal to 0.03-0.06 mg/l). Isolates of Mycoplasma pneumoniae and Ureaplasma urealyticum were susceptible to all of the macrolides tested. However, erythromycin, roxithromycin, clarithromycin and azithromycin were poorly active against isolates of Mycoplasma hominis. By contrast, the same isolates were susceptible (MIC range: 0.008-0.12 mg/l) to midecamycin acetate.
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We report our experiences of microbiological testing of operating theatres over a 10-year period. Major faults within the theatres can be detected by microbiological monitoring of air flow direction and the bioload in theatre air. We advocate that there should be a close cooperation between the microbiologist and the hospital engineering department for effective monitoring of theatre commissioning and upgrading. Also we recommend that contract work should be closely supervised particularly with respect to theatre ventilation systems.
A cell culture technique was used to test the in-vitro susceptibility of the type strain of Chlamydia pneumoniae to 23 antibiotics including macrolides, tetracyclines and quinolones. The activity of the antibiotics tested was similar to previous findings with C. trachomatis. Clarythromycin had the lowest MIC overall (0.007 mg/l). Other macrolides were found to have similar MICs to erythromycin (0.06 mg/l). Both the macrolides and the tetracyclines were more active than the quinolones. It is proposed that the tetracyclines and erythromycin should be the drugs of choice for treating infections with C. pneumoniae; however several other antibiotics need to be evaluated.