Christoph Wenisch

Role of Candida in Antibiotic-Associated Diarrhea

To quantitatively assess the role of Candida species in antibiotic-associated diarrhea (AAD), stool samples from a total of 395 patients and control subjects were cultured in differential isolation medium: 98 patients had AAD, 93 patients were taking antibiotics but did not have diarrhea (A(+)D(-)), 97 patients were not taking antibiotics but had diarrhea (A(-)D(+)), and 107 patients were control subjects (A(-)D(-)). In addition, secreted aspartyl proteinase (Sap) production was tested. In AAD patients, Candida positivity (77/98) and Candida overgrowth (62/98) were not different from that among A(+)D(-) patients (75/93 [P= .860] and 52/93 [P= .375], respectively). Candida overgrowth among A(-)D(+) patients (40/97, P= .003) was less frequent than among AAD patients, but Candida positivity was not different (80/97, P= .612). In control subjects, Candida positivity and overgrowth were less common than in all other groups. Production of Sap did not differ between patients with AAD and control subjects (P= .568 and P= .590, respectively). Data indicate that elevated Candida counts are a result of antibiotic treatment or diarrhea rather than a cause of AAD.

Effect of vitamin C on neutrophil function after high-intensity exercise.

High‐intensity exercise leads to an increased risk of upper respiratory tract infections in athletes, which had been related to an exercise‐induced impairment of neutrophil function. In this study, several indices of neutrophil function were analysed before and after a biathlon and the effect of oral vitamin C on neutrophil function was determined.

Thrombopoietin in Plasmodium falciparum malaria.

Thrombopoietin (TPO) is the key growth factor for platelet production and is elevated in states of platelet depletion. As thrombocytopenia is a common finding in malaria, we analysed TPO regulation before, during and after antimalarial treatment. Before treatment, TPO serum levels were significantly higher in patients with severe malaria (nu2003=u200335) than in patients with uncomplicated malaria (nu2003=u200344; Pu2003=u20030·024), normalizing within 14–21u2003d of therapy. The rapid normalization of TPO levels and increase in low peripheral platelet counts after treatment indicate that the biosynthesis of TPO and its regulation in malaria patients are normal.

Osteomyelitis of the Hip Joint Associated with Systemic Cat-Scratch Disease in an Adult

Abstractu2002Reported here is the case of a 29-year-old male with cervical lymphadenopathy, fever and weight loss, followed by acute painful osteomyelitis of the left hip joint due to cat-scratch disease. The diagnosis was established by detection of IgG antibodies to Bartonella henselae in serum and histologic examination of a lymph node including a positive polymerase chain reaction test. Treatment consisted of clarithromycin and cefotiam for 2 weeks. Four weeks after discharge, all of the patients symptoms had completely resolved. Magnetic resonance imaging of the left hip joint showed marked regression of bone inflammation 4 months later and normalization after 8 months. Cat-scratch disease should be considered in the differential diagnosis of osteomyelitis in an adult, especially when lymphadenitis is present.

A Case of Lung Transplantation Following Mycoplasma pneumoniae Infection

Abstract.Reported here is a case of severe necrotizing pneumonia following Mycoplasma pneumoniae infection that occurred in a 55-year-old man. The histological changes of lung parenchyma included granulomas and bronchiolitis obliterans. Mycoplasma infection was diagnosed by repeated antibody determination (complement fixation test) and confirmed using the polymerase chain reaction to detect the pathogen from a tracheal aspirate. Prior to this episode of pneumonia, the patient had been healthy, except for Reiters disease that had been diagnosed 18 years previously. In addition to severe pulmonary involvement, the patient developed rhabdomyolysis with subsequent acute renal failure, Stevens-Johnson syndrome, biochemical pancreatitis, severe anemia, and an effusion of the right knee. Contrary to the symptoms of pulmonary disease, all of the extrapulmonary manifestations except anemia were transient. Due to persistent respiratory insufficiency and long-term failure to wean the patient from a respirator, a lung transplantation was performed. Five weeks after transplantation the patient died as a result of intrapulmonary hemorrhage. To the best of our knowledge, this is the first report of pneumonia due to Mycoplasma pneumoniae leading to lung transplantation. Furthermore, the multiple extrapulmonary manifestations in this case make it exceptional.

Effect of hospitalization and antimicrobial therapy on antimicrobial resistance of colonizingStaphylococcus epidermidis

SummaryEndogenous infections with multi-resistantS. epidermidis are among the leading causes of nosocomial infections. The effect of hospitalization and antimicrobial therapy on antimicrobial resistance of colonizing staphylococci was determined from swabs of the nose, hand, axilla and groin from 157 patients on one day. Hospitalization for > 72 hours, compared with < 72 hours, was associated with a higher percentage of isolates resistant to oxacillin (56% versus 19%), gentamicin (40% versus 15%), trimethoprim (36% versus 17%), clindamycin (56% versus 17%), and fusidic acid (20% versus 4%; p<0.01 for all), but not to rifampicin (6% versus 1%) or fosfomycin (43% versus 34%, p>0.05 for both). Concurrent antimicrobial therapy resulted in increased resistance to oxacillin (61% versus 28%), gentamicin (43% versus 20%), and clindamycin (60% versus 26%; p<0.01 for all), but not to trimethoprim (39% versus 23%), fusidic acid (19% versus 9%), rifampicin (6% versus 3%), or fosfomycin (46% versus 38%, p>0.05 for all). The increase in resistant isolates was not independent, since hospitalization and antimicrobial therapy were correlated (p<0.001). After adjustment for potential risk factors such as diabetes mellitus, central venous catheters, and hemodialysis, the odds ratio for oxacillin resistance was 2.8–3.6. None of the risk factors showed statistically significant results, except for the presence of neoplastic disease, which had a significant interaction (P=0.035). The within-subgroup odds ratios for patients with and without neoplasm were 4.2 (95% CI, 2.3–5.7) and 2.1 (95% CI, 0.78–3.12), respectively. These results show that hospitalization for more than three days, with or without antimicrobial therapy, and the presence of neoplastic disease are associated with increased antimicrobial resistance in colonizingS. epidermidis.

Bacteremia with Mycoplasma hominis and Ureaplasma urealyticum in Patients Undergoing Hysterectomy

In the study presented here, the aim was to investigate the frequency and clinical significance of bacteremia with urogenital mycoplasmas in immunocompetent patients following gynecological surgery. Among 56 patients undergoing elective hysterectomy (mean age, 55 years; range, 32–82 years), Mycoplasma hominis and Ureaplasma urealyticum were detected in urine by PCR in 2 and 11 patients, respectively. Pre- and postoperative blood samples of the colonized patients were investigated for the colonizing species by PCR. In 4 of the 11 patients colonized by Ureaplasma urealyticum the pathogen was also detected from one of the postoperative blood samples, while no case of bacteremia with Mycoplasma hominis was detected. The postoperative course was uncomplicated in all patients.

Elevated fecal Candida counts in patients with antibiotic-associated diarrhea: role of soluble fecal substances.

ABSTRACT To assess the role of soluble fecal substances in the elevation of fecal Candida counts in patients with antibiotic-associated diarrhea (AAD), we investigated the growth of Candida albicans in vitro in serially diluted stool fluids from patients with AAD and healthy subjects. There were significantly higher Candida albicans counts in stool fluids diluted 1:10 from AAD patients than in healthy subjects and the phosphate-buffered saline growth control, which may be due to reduced soluble Candida inhibitors and increased availability of growth factors and nutrients.

Assessment of Neutrophil Function in Patients with Septic Shock: Comparison of Methods

ABSTRACT Patients with septic shock are shown to have decreased neutrophil phagocytic function by multiple assays, and their assessment by whole-blood assays (fluorescence-activated cell sorter analysis) correlates with assays requiring isolated neutrophils (microscopic and spectrophotometric assays). For patients with similar underlying conditions but without septic shock, this correlation does not occur.

Vom pneumonischen Infiltrat zum parapneumonischen Erguss – vom Erguss zum Pleuraempyem: Internistische Aspekte parapneumonischer Ergussbildung und des Pleuraempyems

SummaryInfectious processes cause the majority part of all clinically relevant pleural effusions which frequently complicate the course of pneumonia. The assessment of an inflammatory effusion requires a careful history, physical examination, imaging techniques and clinical workup. The presence of polymorphonuclear leukocytes, high LDH-activity (>xa0200 U/L) and protein level (>xa03 g/dL) in a pleural effusion indicates acute inflammation. An effusion is usually called empyema, when large numbers of neutrophils form thick, turbid exudates within preexisting body cavities. A thoracic empyema may occur as a result of primary or secondary pleural pathologies and in most cases involves infection with bacteria, frequently provided by progressing pneumonia. There are several therapeutic options for treatment of parapneumonic effusions and of thoracic empyemata, respectively. Optimal therapeutic management and antimicrobial medication to the infected pleural space depend in part on the stage of the empyema at presentation. Treatment can vary from a conservative medical approach in uncomplicated or small parapneumonic effusions to invasive surgical interventions in fibropurulent or organizational stages of empyema. Empyemata usually progress from a parapneumonic exudative stage (stage I), when the fluid is still sterile, with low leukocyte counts, low LDH, physiological pH, and normal glucose, to the fibropurulent stage (stage II) with high leukocyte counts, high LDH activity, low pH, and low glucose, and finally to the organizational stage (stage III), in which fibroblasts convert fibrin strands into inelastic membranes. Pleural peels and pockets may compartmentalize the viscous empyematous fluid and can cause serious restrictive ventilatory impairment. Each patient must be individually evaluated to determine the nature of the exudate and the stage of the pleural space infection. Due to its high mortality rate (~xa05xa0%) a thoracic empyema requires prompt treatment. Diagnostic thoracentesis and withdrawal of liquid for the microbiological, cytological and biochemical analysis is urgently recommended in all cases to assess severity of the disease and the likelihood of a complicated or uncomplicated course, and to select the most appropriate treatment optionZusammenfassungEntzündlich-infektiöse Prozesse sind für den Großteil aller klinisch relevanten Ergussbildungen verantwortlich und finden sich häufig als Komplikation eines pneumonischen Prozesses. Zur Charakterisierung eines entzündlichen Pleuraergusses bedarf es neben einer sorgfältigen Anamnese und physikalischen Untersuchung des Einsatzes bildgebender Verfahren sowie chemischer und bakteriologischer Analysen. Eine neutrophile Leukozytose, hohe LDH-Aktivität (> 200 U/L) und ein Eiweißgehalt ≥ 3 g/dL in der Ergussflüssigkeit gelten als Indikatoren eines akut entzündlichen pleuralen Geschehens. Die Ergussflüssigkeit wird in der Regel dann als Empyem bezeichnet, wenn auf Grund eines hohen Anteiles an neutrophilen Granulozyten eine trüb-viskose Flüssigkeitsansammlung innerhalb einer präexistenten Körperhöhle entsteht. Ein Empyem der Pleurahöhle kann im Rahmen eines primären oder sekundären Pleuraprozesses entstehen und ist in den meisten Fällen durch das Fortschreiten einer pneumonischen Infiltration bakteriell bedingt. Therapieoptionen zur Behandlung parapneumonischer Ergüsse sowie von Empyemen richten sich im wesentlichen nach dem Stadium zum Zeitpunkt der Erstpräsentation. Der therapeutische Rahmen reicht von konservativ-medikamentösen Massnahmen bei unkomplizierten parapneumonischen Ergüssen bis zu invasiv-chirurgischen Interventionen. Empyeme entwickeln sich gewöhnlich aus einem parapneumonischen, exsudativen Stadium (Stadium I) mit steriler Exsudation, niedriger Granulozytenzahl, niedriger Laktatdehydrogenaseaktivität, physiologischem pH-Wert und normaler Glukosekonzentration über ein fibro-purulentes Stadium (Stadium II) mit hoher Neutrophilenzahl, hoher LDH-Konzentration, erniedrigtem pH-Wert (7.21–7.29) und niederer Glukosekonzentration (< 40 mg/dL) letztlich zum Stadium der bindegewebigen Organisation (Stadium III), in dem sich Fibrinstränge infolge Fibroblastenmigration zu rigiden Bindegewebsmembranen umwandeln können. Diese stellen eine häufige Ursache für abgekapselte Flüssigkeitskompartimente einerseits sowie eine oft beträchtliche restriktive Lungenfunktionseinschränkung andererseits dar. Jeder Patient mit pleuraler Ergussbildung sollte individuell beurteilt werden. Die mit einem Pleuraempyem verbundene hohe Mortalität (~xa05xa0%) rechtfertigt geeignete Sofortmassnahmen, um einen Zeitverzug bei der Einleitung adäquater Therapiemassnahmen zu verhindern.Um den Schweregrad und das individuelle Risiko abzuschätzen, mit welcher Wahrscheinlichkeit ein Pleuraerguss unkompliziert oder kompliziert verlaufen wird, ist eine diagnostische Thorakozentese zur Gewinnung von Pleuraflüssigkeit zusammen mit weiteren mikrobiologischen, zytologischen und biochemischen Untersuchungen in allen Fällen entzündlicher sowie unklarer Ergussbildung dringlich zu empfehlen, damit auf dieser Basis die beste Therapieoption unverzüglich eingeleitet werden kann.