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PubMed2005

[The new concept and diagnostic method of sepsis--not SARS, yes SIRS].

Sepsis is one of the most complicated and common conditions clinicians encounter. The presence of causal bacteria has not been an essential element for sepsis, after the American College of Chest Physicians and the Society of Critical Care Medicine proposed SIRS as the new consensus and concept in 1991. The test kit "Hybrisep", detects pathogens in the blood directly. Effective use of it may be helpful in the further study of sepsis.

Humans↗

PubMed1992

Norfloxacin compared to trimethoprim/sulfamethoxazole for the treatment of travelers' diarrhea among U.S. military personnel deployed to South America and West Africa.

A randomized treatment trial of travelers' diarrhea was carried out among U.S. military personnel participating in routine exercises in several port cities in South America and West Africa. A 5-day, twice daily course of either norfloxacin (400 mg) or trimethoprim/sulfamethoxazole (TMP/SMX, 160/800 mg) was given to 142 volunteers. At the end of 5 days of treatment, diarrhea had resolved in 100% of 73 patients receiving norfloxacin and 97.1% (67/69) receiving TMP/SMX. A probable bacterial pathogen was determined in 44% of 142 subjects: 49% of the norfloxacin group and 39% of the TMP/SMX group. The most common pathogens detected were enterotoxigenic Escherichia coli in 20% of cases and rotavirus in 15%. Resistance to TMP/SMX was present in 20 (27%) bacterial isolates, while no resistance to norfloxacin was found. Eight of 10 patients in the TMP/SMX treatment group who had TMP/SMX-resistant bacterial enteropathogens improved clinically. Both norfloxacin and TMP/SMX were clinically effective in the treatment of travelers' diarrhea in this military population.

Acute Disease↗

PubMed2005

[Clinical and virological studies of nosocomial conjunctivitis infection caused by adenovirus type 37 variant].

PURPOSE: To study the clinical features and virological analysis of the nosocomial adenoviral conjunctivitis cases occurring in the ophthalmology ward of Fukushima Medical University Hospital. MATERIALS AND METHODS: We studied the symptoms and clinical course of 61 patients who had adenoviral conjunctivitis caused by nosocomial infections in our hospital. We attempted to detect the adenovirus antigen, analyze the viral DNA, and isolate the virus from conjunctival swabs. RESULTS: The clinical symptoms of adenoviral conjunctivitis were mainly conjunctival hyperemia, discharge and conjunctival follicles. Adenoviral conjunctivitis patients who had undergone ophthalmic surgery had conjunctivitis in the operated eye. The sensitivity of Adeno-check was 78.9% in the in-patients. Adenovirus type 37 variant was detected by molecular analysis and viral isolation. CONCLUSIONS: Adenoviral conjunctivitis can often lead to outbreaks of nosocomial infection in the ophthalmic ward and sometimes requires makes necessary restriction of hospitalization and closing of the ward. Therefore, patients need to be observed carefully. The virological analysis of specimens from conjunctival swabs detected pathogens and provided useful information concerning adenoviral conjunctivitis.

Adenoviruses, Human↗

PubMed2006

[The clinical features of postoperative ventilator-associated pneumonia after lung surgery].

OBJECTIVE: To investigate the clinical features of postoperative ventilator-associated pneumonia (VAP) after lung surgery. METHODS: Of 104 patients who had undergone lung surgery and been treated with ventilator in our surgical intensive care unit between January 2003 and March 2005, 35 patients met with the criteria of both VAP and postoperative pneumonia (POP), and 41 cases had no evidences of pneumonia. The clinical and laboratory data of all 76 cases were recorded and analyzed by a statistical software package (SPSS). RESULTS: The diagnosis of postoperative VAP was established clinically in 35 patients (46.1%), and etiologically in 33 cases. Compared to the patients without postoperative VAP, the patients with postoperative VAP had a significantly longer mean interval between intubation and operation [(2.7 +/- 2.9) days vs. (1.6 +/- 1.7) days, P = 0.039], a longer duration of mechanical ventilation [(32.2 +/- 37.7) days vs. (4.2 +/- 2.9) days, P < 0.001], and higher morbidity (20.0% vs. 2.4%, P = 0.013). There was a significant difference in mean duration of mechanical ventilation between the 15 cases of early-onset VAP and 20 cases of late-onset VAP (17 +/- 15 days vs. 43 +/- 46 days, P = 0.042). Among the initially detected pathogen, Staphylococcus aureus remains the most common Gram-positive coccus whereas Acinetobacter Baumannii took the place of Pseudomonas aeruginosa as the top Gram-negative rod. CONCLUSION: Postoperative VAP after lung surgery has different clinical features from VAP in medical ICU.

Adult↗

PubMed2006

Microarray technology in biomedical research.

Microarrays have dozens to millions of probes attached to an inert surface allowing high-throughput analyses of many biologic processes to be performed simultaneously on the same sample. Microarrays with nucleic acid probes are now widely used for gene expression analysis, DNA re-sequencing, single nucleotide polymorphism genotyping, and comparative genomic hybridization. This technology is accelerating research in many fields and now microarrays are moving into clinical application. This review discusses how the microarray facility at the new Kaka'ako campus of the John A. Burns School of Medicine will impact molecular diagnostics, pathogen detection, oncology, and pharmacogenomics.

Biomedical Research↗

PubMed1988

[A method of bacterial count by epifluorescence with acridine orange. Application to skin biopsies performed in burnt patients].

Acridine orange was used for staining and counting micro-organisms obtained from 136 skin biopsies performed in burned patients. The number of organisms per gram of tissue was compared to the number of colony-forming-units (CFU) calculated from cultures of the same biopsies. The staining method was positive in 97 per cent of septic samples, and in 25 per cent of these it proved more sensitive than bacterial cultures, with a 100 to 1000-fold greater number of pathogens detected. Acridine orange also demonstrated bacteria in 69 biopsies which remained sterile after culture. In some cases, the same bacterial species was found in other samples taken a few days later.

Acridine Orange↗

PubMed1989

Differentiation of Gardnerella vaginalis, Candida albicans, and Trichomonas vaginalis infections of the vagina.

This study evaluated the positive predictive values of factors associated with Gardnerella vaginalis, Candida albicans, and Trichomonas vaginalis for diagnosing vaginitis in a community-based population. One hundred ninety-six women with and without vaginal complaints were evaluated for historical factors, physical examination findings, and office laboratory results that were potentially associated with each of the three vaginal organisms. Extensive microbiological tests were performed to detect pathogenic organisms in the vagina and cervix. Gardnerella vaginalis was associated with findings of clue cells, gray or creamy vaginal discharge, amine ordor on application of potassium hydroxide solution to the discharge, pH greater than 5, and a history of more than six sexual partners. Candida albicans was associated with the presence of pseudohyphae or budding yeast on microscopic examination and the lack of clue cells. Current use of oral contraceptives and the recent use of antibiotics were not predictive of a Candida albicans infection. Trichomonas vaginalis was more common in patients presenting with symptoms, but otherwise was not predicted by the factors tested.

Adolescent↗

PubMed1980

[Reproduction of Brucella titers in swine using experimental infection with Yersinia enterocolitica, serotypes 0:9 and 0:6].

Measurable Brucella titres were produced by slow agglutination, slow agglutination at 57 degrees C (heat test), and complement fixation reaction with Brucella antigen in infection experiments with gilts in which Yersinia enterocolitica Serotypes 0:9 and 0:6 were used. Slow agglutination gave brucellosis titres up to 1:1280 and titres against Yersinia enterocolitica, Serotype 0:9, up to 1:20480. The antibody titres stayed persistent throughout the 80 days of the experiment. Yersinia enterocolitica infection was found to be transmissible between the animals. Aspects relating to the development and course of the infection as well as to pathogen detection are discussed.

Animals↗

PubMed1995

Outbreaks of infectious intestinal disease associated with person to person spread in hotels and restaurants.

Twenty-eight outbreaks of infectious intestinal disease, reported as being transmitted mainly by the person to person route, were identified in association with retail catering premises, such as hotels, restaurants, and public houses, in England and Wales between 1992 and 1994. Five thousand and forty-eight people were at risk in these outbreaks and 1234 were affected. Most of the outbreaks (over 90%) occurred in hotels. Small round structured viruses were the most commonly detected pathogens. Diarrhoea and vomiting were common symptoms and most of the outbreaks occurred in the summer months. Control measures to contain infectious individuals and improved hygiene measures are necessary to contain such outbreaks.

Communicable Diseases↗

PubMed1995

Isolation of Escherichia coli in foods.

This study was carried out to assess contamination of foods and drinks with Escherichia coli as well as to detect pathogenic strains of the organism associated with diarrhoea in a rural community. Cooked or prepared food and drink samples were collected from homes of families with children less than five years old. The samples were cultured for E. coli and the E. coli isolates were tested for enteropathogenic, enterotoxigenic and enterohaemorrhagic E. coli. The commonest cooked or prepared foods and drinks found in the homes were sadza (thick maize meal porridge), vegetables, mahewu (a non-alcoholic fermented cereal gruel), tea and home baked bread. Thirty seven pc of all the foods and drinks examined had E. coli, indicating faecal contamination. The foods with high percentages of faecal contamination were sadza (48 pc), mahewu (39 pc), home baked bread (27 pc) and vegetables (26 pc). Pathogenic strains of E. coli were rarely isolated despite the high isolation rate of E. coli in the foods and drinks. Sadza had the highest isolation rate of enterotoxigenic E. coli (7 pc). The community studied need to be educated on thorough reheating of stored food before it is consumed in order to reduce the transmission of bacterial enteric pathogens through contaminated food.

Child, Preschool↗

PubMed1994

Endoscopic study of African AIDS patients with upper gastrointestinal symptoms.

This study was carried out to investigate the endoscopic and histopathological findings in AIDS patients in Mulago Hospital, in Uganda who present with upper gastrointestinal symptoms. Any observed morphological changes were biopsied. Duodenal contents were aspirated in each case for microscopic examination. Vomiting was reported in 100% of the patients, dysphagia and epigastric pain were reported in 89%. Other symptoms reported in decreasing frequency were odynophagia 46%, retrosternal chest pain 40%, haematemesis 10%, and hiccough 3%. Up to 74% of the patients had morphological changes in the oesophagus, while 28% showed changes in the stomach. Only 15% demonstrated changes in the duodenum. Duodenal aspirate revealed giardia lamblia 22%, Acid fast bacilli 7% and cryptosporidium 5%. Endoscopic findings were mostly observed in the oesophagus. Candida was the main pathogen detected. Also atrophic gastritis is a recognizable finding in these patients.

AIDS-Related Opportunistic Infections↗

PubMed1994

Microbiological patterns in vaginitis.

OBJECTIVES: To determine the incidence and microbial aetiology of vaginitis, and the usefulness of Gram staining of vaginal fluid in detecting the aetiology of vaginitis in Sri Lankan women. DESIGN: Prospective study with microbiological investigation of high vaginal specimens from symptomatic and healthy groups of women. SETTING: A gynaecological clinic of the De Soysa Hospital for Women, and a family planning clinic of the Family Health Bureau, Colombo. PATIENTS: 114 untreated patients with symptoms suggestive of vaginitis and 109 healthy controls. RESULTS: Candida species were isolated from 36% patients and 9% of controls. Gardnerella vaginalis was recovered from 8.8% of patients and 7.3% of controls. The bacterial vaginitis group consisted of several distinct subgroups, viz Gardnerella vaginalis vaginitis, anaerobic vaginitis, non-anaerobic vaginitis and polymicrobial vaginitis. The incidence of trichomoniasis was lower (4.4%) compared to other studies. Other bacteria (anaerobes, enterococci, coliforms, Group B Streptococci) were isolated in significantly higher numbers in the symptomatic group compared to the control group. Microscopy showed that the majority (73%) of the Candida vaginitis patients retained the normal Lactobacillus morphotype. In bacterial vaginitis Lactobacillus morphotype was replaced by other bacterial morphotypes. CONCLUSIONS: In our study 36% had candidiasis, 4.4% had trichomoniasis and 47% had bacterial vaginitis. In 12% there was no detectable pathogen. Microscopy of vaginal fluid is useful in determining the aetiology of vaginitis.

Adolescent↗

PubMed1993

Histopathology of human immunodeficiency virus-associated esophageal disease.

We evaluated the histopathologic features of the esophageal mucosa in 88 patients seropositive for human immunodeficiency virus (HIV). All patients had an upper endoscopy because of esophageal symptoms. Forceps biopsies and brushings of the esophagus were examined histologically and cytologically for evidence of viral, fungal, and mycobacterial infections: in addition, biopsies and brushings were cultured for cytomegalovirus and herpes simplex. Esophageal inflammation (acute or chronic) was graded 0 through 3. Twenty-one patients (24%) had a normal endoscopy; none displayed high grade (grade 2 and 3) acute inflammation and only two (9.5%) had high grade chronic inflammation in the esophagus. Moreover, no fungi or viral inclusions were seen in samples from these patients. Eleven patients (12%) had an abnormal esophageal mucosa but no pathogen detected and were categorized as "idiopathic esophagitis." The percent with high-grade inflammation (27%) was not significantly different from the normal group. Fifty-six patients (64%) had an infectious diagnosis. Forty-six percent had Candida, 16% had viral esophagitis alone, and one patient had Kaposi's sarcoma. Infections were associated with high-grade acute and chronic inflammation in 53% and 47% of patients, respectively. The location of the infiltrate did not predict the type of infection. In conclusion, if esophagoscopy is normal in patients with HIV infection and esophageal symptoms, a biopsy is not necessary.

Esophageal Diseases↗

PubMed1993

The spectrum of Aeromonas-associated diarrhea in tropical Queensland, Australia.

During a twelve-month period (1 July 91-30 June 92), feces from 912 persons from the Townsville region in the dry tropics of Queensland, Australia were evaluated by culture and 45 (4.9%) immunocompetent patients were found to be carrying Aeromonas in their stools. All patients were index cases and no secondary cases from household or close contact of index cases were identified. Eight patients (9.3%) were from Palm Island, an Aboriginal community, and 37 (4.5%) were from the essentially Caucasian population of Townsville. This is a significant difference in incidence of cases between the two population groups. Infection occurred mainly in two age groups: the under five-year-old (27 cases) and the over 25-year-old age group (17 cases). Except for one patient, all cases of Palm Island Aborigines were children less than five years of age, and 13 of these infants (48%) were less than 1 year old, but none were neonates. Of the 37 Townsville patients, 20 cases (54%) were in the under five-year-old group. Signs and symptoms of Aeromonas-associated diarrhea in patients where Aeromonas was the sole pathogen isolated were diarrhea sometimes with vomiting, absence of fever and of fecal leukocytes and blood in the stools. No cases of Aeromonas-associated diarrhea with dysentery were encountered. After rotavirus (12.3%), Aeromonas was the second most common enteric pathogen detected, but was only marginally more common than Giardia and Salmonella. Of the aeromonad isolations, 50% were Aeromonas hydrophila, 22% were A. sobria, and 28% were A. caviae.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1995

Use of Multiscreen plates for the preparation of bacterial DNA suitable for PCR.

A rapid and inexpensive method for isolating bacterial DNA for use in PCR is described. The method is based on the guanidinium thiocyanate (GuSCN)-lysis method of Boom et al. (J. Clin. Microbiol. 28:495-503, 1990) and enables a multiple of 96 samples to be prepared in only one hour. We use Multiscreen plates and a vacuum manifold from Millipore. Clinical samples are lysed and washed in the wells of a Multiscreen plate, and DNA is eluted in a standard microplate. Purified DNA was recovered with high yields (over 25%). The method allows multichannel or robotic pipetting for both the sample preparation as well as for the PCR step. The method has been applied successfully to detect pathogenic Streptococcus suis type 2 in nasal and tonsil swab specimens of pigs.

Animals↗

PubMed1996

Infectious intestinal disease in elderly people.

This paper analyses routinely available data on infectious intestinal diseases occurring in people aged 65 years and over in England and Wales from 1990 to 1994. These data include annual reports of consultations with general practitioners in spotter practices collated by the Royal College of General Practitioners, notifications of food poisoning collated by the Office of Population Censuses and Surveys, hospital admissions extracted from Hospital Episode Statistics data, reports of general outbreaks and laboratory reports of faecal isolates both collated by the PHLS Communicable Disease Surveillance Centre, and death registrations held at the Office of Population Censuses and Surveys. From 1 January 1990 to 31 December 1994 a total of 8,910 episodes of infectious intestinal disease in people aged 65 years and over were seen in the 93 spotter practices that care for a population of all ages of about 700,000. This extrapolates to about 925,000 cases in elderly people in England and Wales, if consultation rates in spotter practices are representative. Twenty-seven thousand two hundred and thirty-three cases of food poisoning were notified and 46,216 faecal isolates were reported in people of the same age group. The commonest pathogens detected were campylobacter, Clostridium difficile and salmonellas. Thirteen thousand five hundred and eighty-five people aged 65 years and over were admitted to hospital with infectious intestinal disease between 1 April 1991 and 31 March 1994. The PHLS Communicable Disease Surveillance Centre learnt of 360 outbreaks in residential institutions and hospital wards for elderly people between 1 January 1992 and 31 December 1994, 52% of which were caused by small round structured viruses. Seven hundred and seventy-seven deaths attributable to infectious intestinal disease in elderly people were registered from 1990 to 1994. Infectious intestinal disease is a largely preventable group of conditions that cause substantial morbidity and mortality in elderly people. Appropriate food hygiene and infection control measures, particularly in institutions, will help to reduce the incidence of infectious intestinal disease in elderly people.

Aged↗

PubMed1995

Hepatocellular carcinoma and infections with multiple hepatitis viruses.

Hepatitis B virus (HBV) plays a major role in liver carcinogenesis. HBV-DNA integration into cellular DNA provides some molecular basis for understanding the mechanisms of neoplastic transformation of the liver cell. Persistence of HBV-DNA episomic forms, necro-inflammation in the liver, and cirrhosis appear to be additional promoting factors. We studied the possible association between hepatocellular carcinoma (HCC) and the defective hepatitis D virus (HDV), a virus that requires the helper function of HBV. Patients infected with HDV and HBV develop HCC about 10 years earlier than those infected with HBV alone. Persistence of active HDV disease and low levels of "wild-type" HBV (i.e., secreting the hepatitis B surface antigen [HBsAg]) are associated with progressive liver disease and HCC. Therefore, HBV replication, in spite of being inhibited by HDV, appears to play a major role sustaining HDV pathogenicity. Detection of antibody to the hepatitis C virus (HCV) in many HCC patients raises the important question whether HCV has oncogenic potential. Clinico-epidemiological data show that the most severe forms of liver disease in patients with multifactorial liver damage occur in those infected with HCV. The prevalence of HBV markers in patients with cirrhosis, HCC, and HCV infection is higher than in individuals with comparable age and other diseases. HBV-DNA integration occurring early during HBV infection can persist in those with and without detectable HBsAg in their serum. Therefore, one can speculate that in patients with integrated HBV-DNA and concurrent HCV infection, cirrhosis and HCC may develop more easily than in patients without HBV-DNA integration. HCV hampering the immune system also might play a role in the genesis of HCC. The evidence that multiple hepatitis viruses are more frequently associated with HCC than infections of one virus alone has important practical consequences. It warrants the identification of high risk patients so that they can be monitored frequently for early diagnosis and treatment.

Adolescent↗

PubMed1996

Application of polymerase chain reaction for diagnosing amebic liver abscess.

Polymerase chain reaction (PCR) has been applied in diagnosing amebic liver infection by detecting pathogenic Entamoeba histolytica DNA in liver aspirates. Oligonucleotide primers found to be specific for the gene encoding the 30 kDa molecule of this pathogenic ameba were used in the test. Liver aspirates obtained from 23 patients with amebic liver abscess substantiated by typical clinical manifastation or with very high titres of anti-E histolytica antibodies by ELISA were found to be positive by PCR. Fourteen control samples (3 cases of bacterial liver abscess, 1 of liver cancer and 10 of other abscess) were all found to be negative to this reaction. The results suggested PCR to be a specific and sensitive tool for diagnosing amebic liver abscess infections.

Animals↗