PubMed · 14306843
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J GUNDERSEN. 1965-05-19. [ASYMPTOMATIC BACTERIURIA].. https://pubmed.ncbi.nlm.nih.gov/14306843/
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We have vaccines for nearly thirty of the more than seventy infectious diseases which are pathogenic for humans. Most of the vaccines, especially those to prevent childhood diseases, are highly effective with a high safety profile. Vaccines are being developed against many of the other bacteria and viruses, and some parasites. Occasionally, a new vaccine has to be withdrawn because of unexpected side effects. Smallpox remains the only infectious disease to have been eradicated. The Global Program to eradicate poliomyelitis initiated in 1988, has unfortunately run into difficulties. A few children immunised with the Sabin oral vaccine fail to clear the virus which can mutate over some years into a pathogenic form and spread rapidly unless large vaccination programs are re-introduced. Of major concern are emerging and re-emerging infectious diseases, especially HIV, for which there is currently no vaccine. Fortunately, new techniques are becoming available making it possible to consider developing vaccines based on inducing strong cell-mediated immune responses to control the agent's replication when antigenic variation in surface antigens (e.g. HIV, influenza) makes classical techniques based on induction of antibody responses less attractive.
In this era of coexistence of high-throughput sequencing technologies and serious difficulties in the management of both common and novel infectious syndromes, new techniques which improve the study of micro-organisms is timely. In bacteriology, the most important subjects are bacterial pathogenicity, discovery of the genomic complexity of bacteria, and the epidemiology of antimicrobial resistance traits. From the clinical point of view, genetic testing is flanking phenotypic testing for the assessment of new, difficult to test antibiotic resistance traits, and for correlations with the microbial behaviour in vivo. The demand for faster, comprehensive and highly parallel microbial diagnostics is also cogent even at the basic laboratory level, where the ultimate objective is saving lives. In this setting, DNA microarrays offer a pivotal contribution by allowing performance of hybridization experiments in highly parallel formats, with an increasing reliability. Not only they are useful in deciphering host and microbial pathophysiology, they can also make the difference in the management of prognostic and therapeutic aspects of many diseases. Here, we provide an overview of the current use and the potential of DNA microarrays in clinical bacteriology, and several applications and technical solutions are discussed.
The 'Y' set introduced in the clinical practice in the early 80s with the aim of reducing the peritonitis rate in patients on continuous ambulatory peritoneal dialysis, successfully revolutioned the philosophy of the connection system catheter-container of dialysate, which was the main way of bacterial contamination of the peritoneal cavity. In fact, while the previous connection systems had focused the attention on the reduction of the possible contaminating acts, the 'Y' system, taking into account the fact that soon or later a failure could occur even with the most skilled and compliant patient, introduced the possibility to kill the bacteria with a disinfectant and to remove it and the killed bacteria together with the bacteria eventually still surviving, by flushing the contaminated area. This goal was achieved thanks to a 'Y' shaped connector, having a third way connected to the discharge bag/container, besides the two connected to the new bag and to the catheter. From the 'Y' set have originated all the currently used continuous ambulatory peritoneal dialysis connection systems, where the 'Y' is mounted on the bag side (double-bag systems). However in these systems the disinfectant is no longer used, due to the fear of possible untoward effects on the peritoneal membrane. The groundlessness of this position and the possible further advantages of the use of a disinfectant in combination with the 'Y' are discussed and new 'Y' systems preventing every possibility of accidental entry of disinfectant into the peritoneal cavity are presented.