Biomedical subjects
Publications and source records attributed to P Coll.
Five adult patients with bacterial meningitis and normal cerebrospinal fluid (CSF) findings are described. All were patients in whom the lumbar puncture was performed very early in the course of the disease, or who had a low white blood cell count in peripheral blood. In such cases the diagnosis of bacterial meningitis may be overlooked.
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The sensitivity in the diagnosis of spontaneous bacterial peritonitis of ascitic fluid inoculation in blood culture bottles has been compared with the conventional method. We have analyzed 74 positive ascitic fluid cultures from 64 patients, the samples being processed by both techniques simultaneously. While all the ascitic fluid cultures performed by inoculation in blood culture bottles were positive, in only 42 from the 74 conventional cultures (56, 75%) bacterial growth was detected (p less than 0.001). Nineteen bacterascites were diagnosed by inoculation in blood culture bottles and 10 by the conventional method (p = NS). Gram stain was only positive in 3 spontaneous bacterial peritonitis (6%). We conclude that ascitic fluid inoculation in blood culture bottles improves significantly the sensitivity of the microbiological diagnosis of spontaneous bacterial peritonitis, without increasing the diagnosis of bacterascites.
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The ability of the Extractor system (Molecular Biosystems, Inc., San Diego, Calif.) to isolate nucleic acid (NA) from stool samples for use in hybridization assays was investigated. Crude NA was recovered from 45 of 50 stool samples by using this system. The amount of NA recovered varied considerably depending on the microbial flora present in the sample (mean +/- standard deviation, 50.2 +/- 46.7 micrograms; range, 2 to 228 micrograms) but did not correlate with the consistency of the sample. Samples containing primarily gram-positive organisms or yeast cells gave lower yields of NA (less than 10 micrograms) than those containing gram-negative bacilli. The five samples which did not yield NA were sterile when cultured aerobically on blood agar plates. Samples of the 45 stools yielding NA were inoculated into broth and grown overnight, and a 10-microliters sample of broth was spotted onto nitrocellulose filters. The NA samples recovered from the Extractor column were applied to nylon membranes by using the Centri-dot system. The NA on the broth blots and the NA on the Centri-dot filters were hybridized with a 310-base-pair probe specific for the 2"-O-aminoglycoside adenylyltransferase [ANT(2")] resistance gene. The Extractor-Centri-dot system demonstrated 61.9% sensitivity and 95.8% specificity in detecting the ANT(2") gene in stool samples containing colonies demonstrating the ANT(2") phenotype. The positive and negative predictive values of the NA blot were 92.8 and 74.2%, respectively.
The serological response to Echinococcus granulosus was evaluated by immunoblotting in 20 patients with hydatid disease. In non-reducing conditions, the highest reactivity corresponded to 80, 66 and 56 kd proteins, while in reducing conditions only one 36 kd protein was detected. A low molecular weight component which moved with the migration front of gels was also detected. In reducing conditions the activity was less marked. Immunoblotting permits the identification of specific immunogenic proteins and the improvement of the serologic diagnosis of hydatid disease, as it eliminates the problem of low titer nonspecific reactions with serological tests using complex antigens.
The cause of primary pneumonia was diagnosed in 157 of 198 children and 165 of 207 adults seen as inpatients or outpatients in a 12-month period. In children Mycoplasma pneumoniae and pneumococcus were identified in 79 and 29 cases respectively. Twenty-nine of 53 cases of viral infection in children were caused by respiratory syncytial virus, two-thirds of the cases occurring in children under three years of age. No children died of pneumonia. In adults pneumococcus was the most common pathogen, accounting for 81 cases. The overall mortality in adults was 7.7%. A high mortality was found in patients with Haemophilus influenzae and other gram-negative bacilli infections, and in elderly patients with pneumococcal pneumonia. Coagglutination was more sensitive than counterimmunoelectrophoresis for the detection of pneumococcal antigen in respiratory samples (p less than 0.001). Counterimmunoelectrophoresis was the only useful technique for detection of pneumococcal antigen in urine specimens, concentration, overnight storage at 4 degrees C and specific staining significantly increasing positivity (p less than 0.001).
Between April 1980 to December 1984 we undertook a study on the epidemiology of pathogenic Yersinia. Stool specimens from 5.199 patients with acute gastroenteritis were studied and Y. enterocolitica biotype 4 serotype 3 was isolated in 42 cases (0.8%). The serological response was studied in 21 of these patients. Faecal specimens from 784 non-laboratory animals were also studied. The only pathogenic isolates from these animals were seven strains of Y. enterocolitica biotype 4 serotype 3 from six pigs and one dog and one strain of Y. pseudotuberculosis from a pig. The search of pathogenic Yersinia in 424 samples form row foods allowed the isolation of eight strains of Y. enterocolitica serotype 3 and one strain of Y. pseudotuberculosis from pig's tongue.
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This paper reports the results of a microbiological study of the patients seen with diarrhea at the Hospital de la Santa Creu i Sant Pau (Barcelona) through 1983. Two thousand seven hundred sixty three specimens were studied in search of an enteropathogenic bacteria, 1341 were submitted to parasitologic study and 684 to rotavirus search. Two hundred fifty one Salmonella spp., 233 C. jejuni, 152 Shigella spp., 47 Yersinia spp., 96 G. intestinalis and 181 positive Rotavirus specimens were detected. Data about efficacy of the methods employed, seasonal and age incidence and sensitivity to the antimicrobials of the bacterial isolated strains are reported.
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The in vitro activity of clofazimine against 80 isolates of rapidly growing nonchromogenic mycobacteria was studied by an agar dilution method. The drug inhibited 96% of strains tested at concentrations less than or equal to 1 microgram/ml, and it appears to be an agent of potential efficacy against Mycobacterium fortuitum and M. chelonae.
In order to evaluate the clinical aspects of gram-negative bacillary meningitis (GNBM) we reviewed the charts of 20 adult patients with the discharge diagnosis of meningitis caused by gram-negative bacilli (bacteriologically proved) seen between 1973 and 1984. Nine patients had post-neurosurgical (post-NS) GNBM and 11 patients spontaneous (S) GNBM; the mean age of the former was 42 +/- 16 years and of the latter 56 +/- 14 years (p less than 0.05). The overall mortality rate was 50% (33% in the post-NS group and 64% in the S group). The glucose levels in CSF were significantly lower in the patients who died. Patients treated with combined aminoglycoside therapy presented a lower mortality rate than those treated with intravenous aminoglycoside only (25% versus 70%). We suggest that if aminoglycoside therapy is employed, these antibiotics must be administered both intravenously and directly into CNS.
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