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[Role of Pseudomonas aeruginosa in the etiology of infectious complications in cancer patients].

The occurrence of Pseudomonas aeruginosa in various pathologic materials and feces from patients with different cancer was compared. The rate of Pseudomonas aeruginosa-associated postoperative complications versus the frequency of intraoperative detection of the organism was studied. The sensitivity of Pseudomonas aeruginosa to antibacterial drugs was assessed. Serotypes of 480 strains isolated from patients and environment were identified. It was inferred that exogenous contamination from the external environment accounts for the majority of cases of Pseudomonas aeruginosa-associated complications.

Anti-Bacterial Agents↗

Kawasaki's disease and infantile polyarteritis nodosa: is Pseudomonas infection responsible? Report of a case.

A nineteen-month-old child presented with a febrile illness, skin rash, painful swelling of the joints, lymphadenopathy and hepatosplenomegaly. Pseudomonas was cultured from the blood during life and, subsequently, at autopsy. Autopsy revealed a generalized panarteritis involving the coronary, retroperitoneal and pulmonary arteries with thickening of arterial walls and narrowing of the lumina. Thrombi and foci of necrosis and infarcts were found in many organs. Numerous bacilli were present in fresh lesions, but not in the organizing lesions. Periodic acid-Schiff-positive deposits were found in occasional macrophages, in walls of affected vessels, in the marginal sinuses of lymph nodes and diffusely in epicardial and retroperitoneal adipose tissue. The findings suggest that some or even all cases of Kawasaki's disease and infantile polyarteritis nodosa may be caused by Pseudomonas sepsis. It is also suggested that the vasculitis and paucity of inflammatory reaction in many cases of Pseudomonas sepsis might be related to the fact that many strains of Pseudomonas produce high-molecular-weight levan (or another polysaccharide). This compound is known to inhibit the inflammatory reaction and to increase bacterial pathogenicity.

Arteries↗

Immunization of mice and chinchillas against Pseudomonas aeruginosa.

The possibility of production of an effective vaccine against Pseudomonas aeruginosa infections in fur-bearing animals was investigated. Twenty-three strains of Pseudomonas aeruginosa isolated from diseased chinchillas and mink were tested in mice for their immunogenic properties. Nineteen of these strains produced good immunity against homologous strains, and three of these produced also good immunity against heterologous strains. Of the remaining four strains two produced moderate immunity and two no immunity. It was found that 0.05% or 0.5% formalin added to suspensions of Pseudomonas aeruginosa or ultrasonification of the suspension produced better results than 0.5% phenol, 0.3% alcohol or heat at 100 degrees C for half an hour. Chinchillas vaccinated with two doses of formolized Pseudomonas aeruginosa bacterins were immune for 36 weeks after the second dose, while all controls died within 48 hours after being challenged. It was found that the protection afforded by the polyvalent bacterin extended beyond the strains included in the vaccine.A field survey on 34 ranches which included over 7,700 chinchillas showed very promising and encouraging results.

Animals↗

Whirlpool-associated Pseudomonas aeruginosa urinary tract infections.

Three previously healthy outpatients had urinary tract infection caused by Pseudomonas aeruginosa. Investigation disclosed that all three patients had been exposed to whirlpool baths within 48 hours before the onset of symptoms. Pseudomonas aeruginosa was isolated from the whirlpool bath associated with each case. Whirlpool baths and spas are commonly contaminated with Pseudomonas and have in the past been associated with rash illness and folliculitis. In addition to these skin infections, our results indicate that whirlpool bath or spa exposure may be an emerging risk factor associated with Pseudomonas urinary tract infections among outpatients.

Acute Disease↗

Chemotherapy against Pseudomonas aeruginosa in cystic fibrosis. A study of carbenicillin, azlocillin or piperacillin in combination with tobramycin.

A comparative study was made on tobramycin combined with either carbenicillin (500 mg/kg/day) or one of the new penicillins: azlocillin or piperacillin (both 300 mg/kg/day) in 50 cystic fibrosis patients with chronic Pseudomonas aeruginosa infection. Average 2-h levels of penicillins in serum were 46 micrograms/ml (piperacillin), 88 micrograms/ml (azlocillin) and 66 micrograms/ml (carbenicillin). The Pseudomonas strains were significantly more sensitive to piperacillin and azlocillin than to carbenicillin (minimal inhibitory concentrations 1.9, 2.3 and 4.2 micrograms/ml). In 21 of 54 treatment course temporary eradication of Pseudomonas was achieved. Improved ventilatory capacity and diminished proteolytic activity in sputum were seen in most patients with or without bacteriological treatment success. Resistant strains - often belonging to other types - appeared in the patients with treatment failure. With increased number of precipitating antibodies against Pseudomonas and with increased minimal inhibitory concentrations, the chance of eradication was smaller. Seven out of 20 treated with azlocillin and 14 out of 30 treated with piperacillin developed fever and exanthema by the end of treatment. Our experience suggests caution in the use of the new penicillins.

Anti-Bacterial Agents↗

Effect of Pseudomonas aeruginosa lipopolysaccharide on phytohaemagglutinin induced lymphocyte transformation.

Examination of the mitogenic response of lymphocytes in 50 blood samples from 17 patients suffering from Pseudomonas aeruginosa infection and on 5 occasions from 5 healthy persons revealed that a Pseudomonas lipopolysaccharide unfamiliar to the lymphocytes decreased, whereas the purified O-antigen of the infection causing Pseudomonas serogroup increased the effect of phytohaemagglutinin on parallel lymphocyte cultures prepared from the same blood samples during the whole infectious process. After complete recovery, however, the lipopolysaccharide of the infection causing P. aeruginosa strain inhibited again the phytohaemagglutinin response as if the lymphocytes had never met it. The model seems to offer a possibility to follow up in vivo the signs of the changes in the cellular background during the reaction given on Pseudomonas lipopolysaccharides.

Antigens, Bacterial↗

DNA hybridization studies of the association of Pseudomonas maltophilia with inflammatory bowel diseases.

An infectious etiology has been suggested for the inflammatory bowel diseases, Crohn's disease and ulcerative colitis, and an association of cell wall-defective variants of Pseudomonas maltophilia and Pseudomonas-like group Va bacteria with Crohn's disease has been reported by Parent and Mitchell. Seven of the Parent-Mitchell isolates were compared by using DNA hybridization and six were identical and similar, but not identical, to a type strain of P. maltophilia. The seventh isolate showed extensive homology with VARC, a reference strain of group Va organism, but not with P. maltophilia. Pseudomonas DNAs were radiolabeled by nick translation and used as probes for homologous DNA in hybridization experiments involving 48 different tissues. The presence of DNA with sequences homologous to those of P. maltophilia was detected in three of 23 Crohn's disease samples, two of 10 ulcerative colitis samples, and none of 15 control samples. There was no hybridization with VARC or Pseudomonas aeruginosa probes. We were unable to culture cell wall-defective organisms from patients' tissues but have detected pleomorphic organisms in hypertonic cultures of 14 of 53 Crohn's disease specimens, none of six ulcerative colitis specimens, and none of 11 control specimens. None reverted to normal bacteria. These results do not support an exclusive association of P. maltophilia with Crohn's disease but rather suggest a possible association of P. maltophilia with IBD. Technical limitations currently preclude definitive conclusions regarding the significance of this association. Although we demonstrated the presence of DNA sequences with homology to P. maltophilia DNA in tissues of some patients with IBD, the role, if any, of these bacteria in the pathogenesis of IBD has yet to be established.

Base Sequence↗

Pseudomonas septicaemia in a general hospital--seven years experience.

Pseudomonas aeruginosa is an opportunist pathogen of low invasiveness which can cause serious disease in patients with abnormal defence mechanisms against infection. Advances in medicine and surgery have resulted in an increase in such patients and Ps. aeruginosa has therefore assumed greater importance in hospital practice. During the years 1974-1980 Pseudomonas organisms were cultured from the blood of 69 patients at East Birmingham Hospital. The records of these patients have been reviewed with the intention of identifying those at risk and suggesting a rational approach to the management and prevention of pseudomonas infections. The importance of differentiating pseudomonas septicaemia from transient bacteraemia or contaminated blood cultures is stressed.

Adolescent↗

[A study of nosocomial infections by the comparison of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa].

The objective of this study was to investigate nosocomial infections by the comparison of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. We made a serological classification of 262 strains of Pseudomonas aeruginosa between 1983 and 1991. Group E strains were prevalent in 1987 and group F strains after 1990. Both these groups strains were resistant to several antibiotics, and were scarcely detected from the appendix contents in appendicitis that originated outside the hospital. Therefore we presumed these were nosocomial pathogens. With the countermeasures to nosocomial infections from 1987 on the isolation rate of enterotoxin type B and C MRSA strains decreased. Following this MRSA change, almost group E strains disappeared in Pseudomonas aeruginosa. Whereas type AC MRSA began to isolated abruptly from 1990, and the isolation of group F strains increased simultaneously. Type B and C strains still remained high sensitivity to minocycline. Type AC which have already gotten resistance to minocycline took the place of type B and C and prevalented. Similarly group F in Pseudomonas aeruginosa took the place of group E as soon as the former acquired resistance to carbapenem.

Cross Infection↗

Effect of Pseudomonas aeruginosa elastase, alkaline protease, and exotoxin A on corneal proteinases and proteins.

PURPOSE: To determine the effects of exoproducts from the corneal pathogen Pseudomonas aeruginosa on corneal proteinases and proteins. METHODS: Whole rabbit corneas were cultured in the presence or absence of broths conditioned with Pseudomonas aeruginosa, elastase, alkaline protease, and exotoxin A. Protein synthesis was assayed by adding 35S-methionine during the last 6 hours of culture. Caseinolytic assays and zymography on sodium dodecyl sulfate polyacrylamide gels containing casein and gelatin were used in the presence and absence of inhibitors to quantify and identify corneal proteinases. RESULTS: The major proteinases released by the corneas were 92/89 kD (MMP9) and 65 kD (72 kD gelatinase, MMP2) gelatinases and a 97 kD caseinase. Minor proteinases observed included 184, 166, 156, 153, 126, 111, 102, 60, 57, and 43 kD gelatinases and 170, 136, 85, and 54 kD caseinases. P. aeruginosa elastase at 1 microgram/ml cleaved the 92 kD gelatinase to yield a 77 kD active form and cleaved the 65 kD gelatinase to yield a 57 kD active form. At 25 micrograms/ml elastase, the gelatinases were degraded. P. aeruginosa alkaline protease had no effect on the 92 or 65 kD gelatinases. Both elastase and alkaline protease degraded the 97 kD caseinase. Proteinases other than elastase and alkaline protease in P. aeruginosa103- and P. aeruginosa01-conditioned broths also activated and/or degraded corneal proteinases. Exotoxin A inhibited the synthesis of the 92 kD gelatinase and most other proteins. The 72 kD gelatinase and the 97 kD caseinase were released in the presence of exotoxin A. CONCLUSIONS: Pseudomonas aeruginosa exoproducts can contribute directly to keratitis caused by Pseudomonas organisms through toxic effects on corneal cells and degradation of corneal proteins and indirectly through the activation of corneal proteinases.

ADP Ribose Transferases↗

[Immunomodulation in Pseudomonas urinary infection].

The urological department is as a rule of department with the highest incidence of nosocomial infections. They are often caused by Pseudomonas aeruginosa. In 1992 the authors started to use prophylactic immunization with antipseudomonas vaccine PSAEVA in 58 patients indicated for surgery on account of an prostate adenoma. During and after operation the incidence of Pseudomonas infection in immunized and control patients was compared. In the immunized group the incidence after operation was 1.72%, in the control group 12%. The drop of Pseudomonas infections in operated patients immunized with the anti-pseudomonas vaccine as compared with non-immunized ones was by 10.28% lower which is statistically significant--p.0.05.

Bacterial Vaccines↗

Cryotherapy of Pseudomonas keratitis and scleritis.

Three cases of perforated Pseudomonas corneal ulcers with scleral extension were treated with keratoplasty and cryotherapy to the remaining cornea and sclera. All three cases showed dramatic improvement. Cryotherapy of Pseudomonas keratitis in guinea pigs has been shown to be effective. Pseudomonas organisms seem to be susceptible to cryotherapy in vivo; there is no effect in vitro. Cryotherapy may prove to be a new tool in the treatment of Pseudomonas keratitis.

Adult↗

Adherence of Pseudomonas aeruginosa to the mouse cornea. Epithelial v stromal adherence.

Adherence of Pseudomonas aeruginosa to the cornea is the first step in the pathogenesis of Pseudomonas corneal ulceration. To determine the roles of epithelial and stromal adherence, a quantitative in vivo model of adherence was developed in the mouse. More than twice as many organisms were recovered from mouse corneas in which two linear abrasions were created compared with corneas totally denuded of epithelium. Scanning electron microscopy demonstrated poor adherence of Pseudomonas to bare stroma, but large numbers of organisms were seen adhering to the injured edge of epithelium. This study supports the concept that corneal trauma predisposes to Pseudomonas corneal ulceration by creating an injured epithelial edge as a site for adherence of the organisms, rather than by exposing areas of bare stroma susceptible to penetration by the organisms.

Adhesiveness↗

Edetate sodium aerosol in Pseudomonas lung infection in cystic fibrosis.

In vitro and animal experimental data suggest the combination of edetate sodium (EDTA) by aerosol plus oral antimicrobials might be effective in the treatment of chronic Pseudomonas infection in patients with cystic fibrosis (CF). For six months we studied the effects of edetate sodium administered by ultrasonic nebulizer to ten children with CF and chronic Pseudomonas aeruginosa infection in a double-blind, placebo-controlled, crossover study. The children had evidence of mild to moderate disease at entry in the study, with a mean (+/- SD) forced expiratory volume in the first second of 85% (+/- 18%) of the predicted value and a mean (+/- SD) Shwachman-Kulczycki score of 83 (+/- 7)/100. Each child was on a three-month regimen of aerosolized edetate sodium plus oral tetracycline twice daily followed by three months of placebo aerosol plus tetracycline or vice versa. Progress was assessed by measurement of pulmonary function, physical examination, and sputum cultures at four weekly intervals, plus chest roentgenograms on entry and after each of the three-month treatment periods. Daily symptoms were assessed using a diary card system. Two patients could not complete the study, one because of severe respiratory relapse, the other because of antibiotic side effects. Of the remaining eight patients, none showed any improvement in pulmonary function, weight gain, or growth acceleration, and none was rendered free of Pseudomonas lung infection. Daily symptom scores and chest roentgenograms were unaltered by edetate sodium. We conclude that the combination of aerosol edetate sodium plus oral tetracycline over a three-month period does not modify the clinical course nor the pulmonary flora in patients with CF with chronic Pseudomonas lung infection.

Administration, Oral↗

Combined antiestrogen and cytotoxic therapy with pseudomonas vaccine immunotherapy for metastatic breast cancer. A prospective, randomized trial.

One hundred thirty-three consecutive, previously untreated patients who had metastatic breast cancer were treated with a combination of 5-fluorouracil, doxorubicin (Adriamycin), and cyclophosphamide (FAC). They were randomly assigned to receive nonspecific immunotherapy with a heptavalent pseudomonas vaccine. Sixty-five patients were treated with pseudomonas vaccine, whereas 68 did not receive immunotherapy. In addition, all patients with estrogen receptor-positive tumors or tumors with an estrogen receptor status were also treated with tamoxifen. To allow clinical assessment of hormone sensitivity in vivo, tamoxifen was started 6 weeks before chemotherapy except in patients who had life-threatening disease. After the initial 6 weeks of tamoxifen, 3% of patients had achieved a complete remission, 9% a partial remission, while 16% achieved a minor response. The maximum response after tamoxifen and chemotherapy included complete remissions in 20% of patients and partial remissions in 61% of patients for an overall remission rate of 81%. The median response duration was 15 months, and the median survival time, 27 months. There were no differences in remission rate, remission duration, or survival time between the groups treated with or without pseudomonas vaccine. Eleven patients with limited metastatic disease received radiotherapy consolidation to initially involved sites. In these patients the median time from radiotherapy to progression of disease was 33 months, and the median survival time was 46 months. We conclude that nonspecific immunotherapy with pseudomonas vaccine failed to increase remission rate or survival time. Furthermore, the addition of tamoxifen to FAC chemotherapy did not improve the remission rate or duration compared to a recent, historical control group of patients treated with only FAC chemotherapy.

Adult↗

Characterization of the cryptic plasmids of the Pseudomonas alcaligenes type strain.

The species type strain of Pseudomonas alcaligenes contains three small cryptic plasmids (designated pECB1, 2, and 3) of 7740, 4480, and 2700 bp, respectively. Partial restriction enzyme maps have been constructed for pECB1 and 2 which on this basis do not appear to be related. pECB3 proved refractile to cutting with commonly used restriction enzymes, though it was completely rendered by those enzymes which recognize 4-bp sequences containing only G + C. This suggested that pECB3 is especially rich in these bases. Hybridization studies using labeled pECB2 as probe revealed homology with pECB3 and with regions of the bacterial chromosome, but not with pECB1. A 1214-bp region of pECB2 showed great sequence similarity to the basic replicon of pPS10, a 10-kb Pseudomonas-specific plasmid isolated from Pseudomonas syringae pv. savastonoi. The putative replicon (including the gene for a replication protein) was subcloned and both DNA strands were sequenced. Introduction of the putative replicon into the Escherichia coli plasmid pUC19 created a recombinant vector able to replicate in both E. coli and Pseudomonas spp. Minicell analyses did not reveal any peptides which could be attributed to the remaining region of pECB2 or to pECB1--a finding supported by sequencing studies. Attempts at plasmid curing were unsuccessful. A phenotypic comparison with a non-plasmid-harboring strain of P. alcaligenes, based on nutritional versatility and antibiotic susceptibility, revealed a single difference of note: the type strain alone was able to utilize benzoate for growth. Transformation of the non-harboring strain with pECB1-3, followed by selection on a minimal medium containing benzoate, gave no colonies. The advantages gained by possession of pECB1-3, if any, are at present unknown.

Amino Acid Sequence↗

Conservation of xcp genes, involved in the two-step protein secretion process, in different Pseudomonas species and other gram-negative bacteria.

The two-step protein secretion pathway in Pseudomonas aeruginosa is dependent on the xcp genes. We investigated whether a similar secretion mechanism is present in non-pathogenic Pseudomonas spp. and in other gram-negative bacteria. The plant growth stimulating Pseudomonas strains P. putida WCS358, P. fluorescens WCS374 and Pseudomonas B10 appeared to secrete proteins into the extracellular medium. Southern hybridization experiments showed the presence of xcp genes in these strains and also in other gram-negative bacteria, including Xanthomonas campestris. Complementation experiments showed that the xcp gene cluster of P. aeruginosa restored protein secretion in an X. campestris secretion mutant. The secretion gene cluster of X. campestris however, restored secretion capacity in P. aeruginosa mutants only to a low degree. Two heterologous proteins were not secreted by P. fluorescens and P. aeruginosa. The results suggest the presence of a similar two-step protein secretion mechanism in different gram-negative bacteria, which however, is not always functional for heterologous proteins.

Bacterial Proteins↗

Localization of functional domains in the Escherichia coli coprogen receptor FhuE and the Pseudomonas putida ferric-pseudobactin 358 receptor PupA.

Transport of ferric-siderophores across the outer membrane of gram-negative bacteria is mediated by specific outer membrane receptors. To localize the substrate-binding domain of the ferric-pseudobactin 358 receptor, PupA, of Pseudomonas putida WCS358, we constructed chimeric receptors in which different domains of PupA were replaced by the corresponding domains of the related ferric-pseudobactin receptors PupB and PupX, or the coprogen receptor FhuE of Escherichia coli. None of the chimeric proteins composed of pseudobactin receptor domains facilitated growth on any of the original substrates, or they showed only an extremely low efficiency. However, these receptors enabled cells of Pseudomonas BN8 to grow on media supplemented with uncharacterized siderophore preparations. These siderophore preparations were isolated from the culture supernatant of WCS358 cells carrying plasmids that contain genes of Pseudomonas B10 required for the biosynthesis of pseudobactin B10. Hybrid proteins that contained at least the amino-terminal 516 amino acids of mature FhuE were active as a receptor for coprogen and interacted with the E. coli TonB protein. A chimeric PupA-FhuE protein, containing the amino-terminal 94 amino acids of mature PupA, was also active as a coprogen receptor, but only in the presence of Pseudomonas TonB. It is concluded that the carboxy-terminal domain of ferric-pseudobactin receptors is important, but not sufficient, for ligand interaction, whereas binding of coprogen by the FhuE receptor is not dependent on this domain. Apparently, the ligand-binding sites of different receptors are located in different regions of the proteins. Furthermore, species-specific TonB binding by the PupA receptor is dependent on the amino-terminal domain of the receptor.

Bacterial Outer Membrane Proteins↗