Biomedical subjects
Publications and source records attributed to Z Samra.
A patient with endocarditis caused by Corynebacterium CDC Group A-4 is described. This is the first case in the literature of endocarditis caused by this bacteria, and is unique in that the patient was immune competent and the infection occurred on a native valve. This case illustrates that corynebacteria cannot be considered a contaminant and that the exact pathogen should be identified.
The genital mycoplasmas: Ureaplasma urealyticum and Mycoplasma hominis have recently assumed an increasing importance as neonatal pathogens. The aim of the present survey was to determine the prevalence of infections with these organisms in preterm infants in two neonatal intensive care units in Israel. Among 99 preterm infants, 24 (24%) harboured mycoplasmas in their throats shortly after birth. U. urealyticum was the most common organism. M. hominis was isolated only from 3 infants. Six out of 27 (22%) mechanically ventilated infants secreted U. urealyticum in their lower airways. The rate of colonization was inversely correlated with gestational age; 80% of infants younger than 28 weeks gestation were found to be colonized as opposed to 17.9% at 28-36 weeks of gestation. No mycoplasmas were isolated in blood cultures drawn from 146 infants and CSF cultures obtained from 47 preterm infants. Neonatal mortality, respiratory complications and intraventricular haemorrhage grade 3-4 were significantly increased in colonized infants. However, above gestational age of 27 weeks, colonization with mycoplasmas was not associated with a worse prognosis. We conclude that colonization with U. urealyticum is common in Israeli preterm infants, correlates inversely with gestational age and has no detrimental effect on neonatal morbidity and mortality of infants older than 27 wks of gestation.
In a survey of 296 episodes of gram-negative bacteremia in 286 patients (aged 13-99 years), four clinical variables were found to predict both significantly and independently the subsequent isolation of a multiresistant strain; hospital acquisition of the infection, antibiotic treatment before the bacteremic episode, endotracheal intubation, and thermal trauma as the cause of hospitalization. These variables were combined in an index that served to classify the patients into four groups with an increasing prevalence of multiresistant strains, Pseudomonas isolates, and isolates resistant to each of the antibiotic drugs in common use. For example, the percentage of isolates susceptible to cefuroxime in the four groups were 79%, 56%, 34% and 25%, and to gentamicin, 89%, 79%, 46%, and 33% (P less than .001 for both comparisons). The performance of the index was validated in a second group of 144 episodes of gram-negative bacteremia. The index kept its discriminative power. Compared with the prescriptions of the attending physicians, the index could probably have improved empiric antibiotic treatment in 24% of patients.
To define the uropathogens of various childhood populations and their antibiotic susceptibility, 646 episodes of urinary tract infections (UTI) were studied. Of the community-acquired UTI 78% were caused by Escherichia coli and 12% by Klebsiella whereas only 65% of hospital-acquired UTI were caused by E. coli (P less than 0.01), and other pathogens, including Pseudomonas, were more common. In children with UTI who did not have an underlying disorder, most infections were caused by E. coli and Klebsiella species. Children with urinary malformations or urinary catheters or those who developed UTI while receiving antibiotic prophylaxis had fewer E. coli infections and more infections caused by other pathogens, including Pseudomonas (P less than 0.01). Children receiving antibiotic prophylaxis had also significantly more Enterococcus and Acinetobacter infections (P less than 0.001), and children with urinary catheters had more Enterobacter infections (P less than 0.05). Isolates of these risk groups showed increased resistance to antibiotics. Only 30-53% were susceptible to trimethoprim-sulfamethoxazole, which is usually recommended for UTI; 19 to 25% and 27 to 66% were susceptible to ampicillin and cephalothin, respectively. In contrast uropathogens of immunocompromised children did not differ significantly from those of children with no underlying disturbances, nor did they show distinct antibiotic susceptibility patterns.
OBJECTIVE: To assess the prevalence of sexually transmitted pathogens in drug-addicted women in Tel Aviv, Israel. DESIGN: A prospective study conducted between March and July 1987. SETTING: A methadone clinic in Tel Aviv, Israel. SUBJECTS: Sixty four asymptomatic female drug addicts were studied; 38 of them were declared practising prostitutes. METHODS: Cervical specimens were obtained for cultures, and blood samples were drawn for serological tests. Demographic data and sexual histories were obtained using a standard questionnaire. RESULTS: Chlamydia trachomatis was detected in the cervix of 25% of women; 98% had antibody titres (greater than 1:64). Mycoplasma hominis and Ureaplasma urealyticum were isolated in 57% and 65% respectively. Gardnerella vaginalis was detected in 17% of women, and herpes simplex virus was cultured from two prostitutes. Five per cent of women were carriers of HBsAg, while 57% had HBSs and/or HBc antibodies. Only one prostitute had specific treponemal antibodies. In no case were gonococci or group B streptococci isolated, and HIV serology was invariably negative. CONCLUSION: Chlamydia and genital mycoplasmas appear to be the prevailing pathogens in Israeli drug-addicted women, while gonococci and Treponema pallidum occur only rarely.
Hepatic involvement is considered a rare complication of psittacosis. Occurrence of icteric hepatitis as the cardinal manifestation of the disease has been rarely reported. We describe two members of a family infected by psittacosis, in whom icteric hepatitis was the prominent expression of the disease. The diagnosis of psittacosis was confirmed by isolation of the pathogen and by detection of serum antibodies to Chlamydia species. No serological evidence for acute TWAR infection was found. Chlamydia psittaci was also isolated from the family's parrot.
OBJECTIVE: To compare the microbiology, sources, complications, and outcome of bacteremia in diabetic and nondiabetic patients. RESEARCH DESIGN AND METHODS: A prospective study was conducted of all episodes of bacteremia in hospitalized diabetic and nondiabetic patients. The study consisted of patients greater than or equal to 18 yr of age with bacteremia detected within a 19-mo interval. RESULTS: We compared 124 episodes of bacteremia in 119 diabetic patients to 508 episodes in 480 nondiabetic patients. Diabetic patients were older than nondiabetic patients (median age 74 vs. 68 yr, P = 0.0001). In patients with an indwelling urinary catheter and bacteremic urinary tract infection, the percentage of Klebsiella in diabetic patients was 60% (6 of 10) and in nondiabetic patients was 17% (4 of 23, P = 0.04). In patients without an obvious source of bacteremia, the percentage of staphylococcal isolates in diabetic patients was 29% (10 of 35) and in nondiabetic patients was 14% (24 of 176, P = 0.04). Staphylococci were a common cause of bacteremic infections of the extremities in diabetic patients (12 of 19, 63%) and nondiabetic patients (20 of 50, 40%). Septic shock was the only complication that was more common in diabetic patients. The mortality in diabetic and nondiabetic patients was 28 and 29%, respectively. CONCLUSIONS: Our results represent elderly patients with non-insulin-dependent diabetes mellitus. In this group, empirical treatment for suspected bacteremic urinary tract infection in patients with a urinary catheter should include coverage for Klebsiella. Empiric treatment for suspected bacteremia of unknown origin or caused by infection of the extremities should include an antistaphylococcal drug. The prognosis of bacteremia in diabetic and nondiabetic patients was similar.
To study the effect of mycoplasmas and Chlamydia trachomatis infection on semen quality, these microorganisms were cultured from the semen and anterior urethra respectively, in a group of 175 infertile men suspected of a silent genital infection with a poor postcoital test. Chlamydia infection, but not mycoplasmas, was parodoxically more frequent in the apparently normal than oligotetratoasthenozoospermia patients. Mycoplasmas male infection, but not chlamydia, was more frequent in cases with female, mechanical, and/or organic infertility factors. Infection was unrelated to the accessory gland evaluation or sperm variables. However, seminal antisperm antibody activity was significantly increased in cases with any positive culture. By this local antibody increase, chlamydia and mycoplasmas may significantly reduce sperm egg penetration ability.
Serological tests of 35 patients suffering from inflammatory bowel disease were compared to those of 35 healthy controls. The tests were performed using the indirect immunoperoxidase assay. Ninety-three per cent of 15 patients with Crohn's disease had IgG antibodies against Chlamydia, compared to 26% in the control group. In the 20 patients with ulcerative colitis, 45% had IgG antibodies against Chlamydia, compared to 10% in the control group. High serum titres of IgG antibodies were found in most of the patients with inflammatory bowel disease, mainly with Crohn's disease, while weak reactions appeared in most of the controls in which antibodies were detected. These results suggest a high incidence of Chlamydia infection in the studied patients with inflammatory bowel disease, especially in those with Crohn's disease. The possible association between Chlamydia trachomatis and inflammatory bowel disease is discussed.
A complete microbiologic analysis of nine infectious agents causing low genital tract infection (LGTI) was obtained in 240 young women, of whom 193 were symptomatic for LGTI and 47 were asymptomatic (control group). The polymicrobial nature of LGTI was demonstrated by both the increased frequency of different microorganisms (1.77 +/- 1.09 SD in symptomatic vs. 1.08 +/- 0.98 in asymptomatic patients) and the increased total number of agents (0 agents 8.3 and 36.2%, 1-2 agents 67.4 and 55.3%, greater than or equal to 3 agents 24.3 and 8.5%, in symptomatic and asymptomatic patients respectively). There was a mutual association between Ureaplasma urealyticum and Mycoplasma hominis, where the presence of one nearly doubled the frequency of the other. Of 74 symptomatic patients with a single infectious agent, Chlamydia trachomatis was isolated most frequently, suggesting an important role of this agent in infections of the female low genital tract.
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A high level of immunoglobulin E (IgE) in cord blood (CB) is well known to be predictive of the development of clinical allergy during early childhood. We have tried to ascertain the source of IgE in cord blood by carrying out a series of measurements of IgE concentrations in arterial and venous CB of newborns and comparing them to IgE concentrations in blood samples from both parents. We found that the concentrations of IgE in arterial and venous CB were almost completely identical in the 131 newborns examined whereas IgD concentrations were significantly higher in arterial than in venous CB. Moderate but significant positive correlations were found between IgE concentrations in maternal blood and CB; paternal blood and CB; and maternal and paternal blood. Our data suggest that CB-IgE is essentially a product of fetal lymphocytes. The positive correlations found between the IgE blood concentrations in the newborns, the mothers and the fathers, is most likely an effect of the amount and nature of the allergenic constituents in the family environment.
We describe an ELISA technique for human transferrin. The test has a lowest detection limit of 2 micrograms/l and a wide range. It is specific for human transferrin and its reproducibility proved acceptable in both intra-run and between-day examinations. Results obtained by radial immunodiffusion and by ELISA were strongly correlated (n = 51; y = 0.92x + 16.1; r = 0.90). The cost in Israel for disposables and chemicals for triplicate examination is $0.55 per sample. This is 7-8 times less than the cost of a determination, using commercial immunodiffusion plates. This assay is of particular value where the sample size is limited, e.g. samples of 1-4 microliters are sufficient for the determination of transferrin in tears. The transferrin concentrations in arterial and venous cord blood were shown to be essentially identical and similar to that in adult blood.
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Eight family outbreaks of clinical or subclinical psittacosis in Israel after exposure to infected birds were studied. Throat cultures for Chlamydia psittaci and serological tests for Chlamydia species, including strain TWAR, were obtained from 37 people. Cloacal smears and cultures of internal organs for C psittaci were taken from 9 dead birds. 62% of the people studied had symptoms, and 67% of the birds that died had previously been sick. Evidence for acute C psittaci infection was found in 81% of patients (30/37). Diagnosis was established in 22 by isolation of the causal organism from throat cultures and in 8 by positive IgM serology (reciprocal titre greater than or equal to 8) with evidence of acute seroconversion or clinical findings compatible with the disease, or both. No serological evidence for acute TWAR infection was found. All birds studied had microbiological evidence of C psittaci infection, and most had abnormal findings on necropsy.
Five hundred and thirteen clinical specimens, mainly from patients with urogenital inflammations, were examined for Ureaplasma urealyticum and mycoplasmas, including cultures for Mycoplasma genitalium. The study yielded 95 isolates of Ureaplasma urealyticum, 37 isolates of Mycoplasma hominis and two isolates of Mycoplasma fermentans, but no growth of Mycoplasma genitalium was obtained. It was concluded that Mycoplasma genitalium is a relatively rare inhabitant of the human urogenital tract in Israel.
Twenty-five male patients with nongonococcal urethritis including 15 chlamydial infections, were treated with spiramycin for ten days. All but four patients had been treated previously, mostly with tetracyclines. Chlamydia trachomatis was cultured in seven patients and was detected in three additional men by immunofluorescent smear. Five other patients had antibodies to chlamydia, and one patient yielded a positive culture for Ureaplasma urealyticum and Mycoplasma hominis. A successful clinical response was observed in 64% of the patients; C. trachomatis was eradicated from six of seven patients with positive cultures and the three positive direct smears were negative after treatment. It is concluded that spiramycin can be used effectively for the therapy of acute nongonococcal urethritis, as well as in patients who have failed to respond to previous treatment with tetracyclines and erythromycin.
The possible causative relationship between exposure to house dust mite allergen (HDMA) and symptoms of vernal keratoconjunctivitis (VKC) was investigated. VKC patients were evaluated for an average of 18 months using patient reports of symptoms, physicians' observations and assays of sera and tears for total and specific IgE to 10 inhalant allergens common in Israel, including HDMA. Tear and serum samples from a group of 8 patients reacted only with HDMA, and were compared with the tear and serum samples of a group of 11 patients not reacting to any of the above allergens. House dust samples from the homes of two VKC patients in the HDMA-reactive group were examined monthly for a year. While mites were detected throughout the year, they were approximately 3 times more abundant from June through September than at other times. 96.6% of the mites collected belonged to the family Pyroglyphidae; 91.0% were Dermatophagoides pteronyssinus and 5.5% Dermatophagoides farinae. Both the severity of VKC symptoms in HDMA-reactive patients and mite population levels peaked simultaneously in the summer. This relationship was not seen among the non-HDMA-reactive patients. Our results suggest that exposure to HDMA plays an important role in the aggravation of VKC symptoms in HDMA-reactive patients.