David Sompolinsky

Mycobacterium haemophilum sp.nov., a new pathogen of humans.

A patient under immunosuppressive treatment of Hodgkins disease developed generalized skin granulomata and subcutaneous abscesses. Several aspirated pus samples yielded acid-fast rods with the following properties: Temperature optimum, about 30°C with no growth at 37°C; slow growth (2 to 4 weeks); nonchromogenic; hemoglobin or hemin requirement for growth; catalase negative; pyrazinamidase and nicotinamidase positive; and urease negative. The guanine-plus-cytosine content of the deoxyribonucleic acid was calculated from the melting temperature to be 66.0 mol%. It is concluded that these isolates belong to a new species, for which the name Mycobacterium haemophilum is proposed. The type strain of this species is strain 1 (= ATCC 29548). The new species is related to M. marinum and M. ulcerans.

Arrival of Klebsiella pneumoniae producing KPC carbapenemase in the United Kingdom

BACKGROUNDnKPC-type carbapenemases are increasingly prevalent in parts of the USA and Israel and are an emerging concern in South America, Europe and China. We investigated the UKs first two KPC-producing Klebsiella pneumoniae isolates.nnnMETHODSnThe isolates were referred to the UKs national reference laboratory for confirmation of carbapenem resistance. Susceptibilities were determined by agar dilution, and bla(KPC) and Tn4401-like elements were sought by PCR and sequencing. Isolates were compared by PFGE of XbaI- and SpeI-digested genomic DNA.nnnRESULTSnThe isolates were from patients in different UK hospitals, with no epidemiological connection. Both were resistant to carbapenems (MICs > 16 mg/L), with imipenem MICs unchanged by EDTA, and also to all other beta-lactams (including inhibitor combinations), tobramycin, amikacin and ciprofloxacin. They were susceptible to gentamicin (MICs </= 1 mg/L) and colistin (MICs </= 0.5 mg/L), with intermediate susceptibility to tigecycline (MICs 1-2 mg/L). The isolates belonged to the same PFGE-defined strain, highly related to a disseminated KPC-producing strain characterized previously in Tel Aviv, Israel. Like this Israeli strain, the UK isolates produced KPC-3 carbapenemase, with the bla(KPC-3) gene located within a Tn4401-like element.nnnCONCLUSIONSnThe first KPC-3-producing K. pneumoniae isolates detected in the UK were highly genetically related to a KPC-3-producing Israeli K. pneumoniae strain. This relatedness was consistent with the history of one UK patient, who had been hospitalized previously in Israel. However, this strain may be circulating more widely since the second UK patient had no identifiable links with Israel or other overseas countries.

Efficacy of the placental barrier for immunoglobulins : correlations between maternal, paternal and fetal immunoglobulin levels

The relationship of immunoglobulin levels in fetal and parental blood for those classes showing a high degree of placental impermeability was investigated in 430 mothers, their newborn infants (cord blood) and their husbands. Levels of IgA, IgD and IgM in maternal serum were unrelated to the sex of the offspring. IgE levels were significantly higher in mothers of male infants than in mothers of female infants (53 versus 40 IU/ml, p < 0.02). Significant correlations between maternal-fetal (r = 0.37; p < 0.01), paternal-fetal (r = 0.12; p < 0.02) and maternal-paternal IgE levels were found (r = 0.17; p < 0.02). For the levels of other immunoglobulins studied, the maternal-fetal correlations were not significant. The results support the effectiveness of the placental barrier for IgA, IgD, IgE and IgM. The significant correlation between IgE levels in mothers-newborns, fathers-newborns and mothers-fathers may be explained by the influence of the home milieu on the entire family, including the fetus.

Amnionitis and T strain mycoplasmemia

Abstract A 32-year-old woman was admitted during the seventh month of her first pregnancy which was achieved by insemination with donor semen. A twin pregnancy was diagnosed, and the water bag of one of the fetuses had ruptured spontaneously. The woman was afebrile during 7 days with penicillin-ampicillin treatment. Thereafter she developed symptoms of a generalized infection. Two successive blood cultures were positive for T strain Mycoplasma. After delivery the same organism was isolated from the blood of one of the infants and from throat and vulva smears from the other one, as well as from the urine of the sperm donor, while a urethral smear from the patients husband was negative. Histologic examination showed focal purulent amnionitis of the water bag that was intact until delivery. This is the second reported case of T strain mycoplasmemia which demonstrates the potential virulence of this organism.

Infections with mycoplasma and bacteria in induced midtrimester abortion and fetal loss.

Placentas and fetuses from cases of induced midtrimester abortion and fetal loss (13 weeks of pregnancy or more) were examined microbiologically. In the series of midtrimester fetal loss, bacteria were isolated in 14 per cent and genital Mycoplasma in 37 per cent of the placentas. In induced abortion, 18 per cent of the placentas grew bacteria and in only one case out of 27 was a Mycoplasma strain isolated. Fetal organs yielded cultures positive for bacteria in 16 per cent and for genital Mycoplasma in 23 per cent of the spontaneous fetal loss material, whereas pyogenic cocci were isolated from fetal organs in 18 per cent and Mycoplasma in no case of induced abortion. In the positive cases, the fetal lungs were most often infected (in 34 out of 37 positive cases of spontaneous and 4 out of 5 positive cases of induced abortion). On the other hand, microorganisms could be isolated from the brain in only 5 out of 28 cases of spontaneous and none of induced abortion. In the series of fetal loss, positive microbiologic findings from the fetal organs seemed correlated to prolonged bleeding before abortion or labor and to premature rupture of membranes.

Proteins in tears from healthy and diseased eyes

The levels of total protein in tears from healthy donors, conjunctivitis vernalis patients, and conjunctivitis follicularis patients, were 625, 1370 and 1160 mg% respectively. Serum albumin accounted for 3.3%, 43% and 67% of the total protein of tears from these groups, and the level of proteins probably synthesized by the lacrimal gland, was in tears from conjunctivitis follicularis patients only half the level in normal tears. By crossed immunoelectrophoresis with intermediate gel, 10 antigenic species could be recognized in normal tears, and of these the following were identified: Lysozyme, IgA, lactoferrin and serum abumin. In tears from patients with conjuntivitis vernalis three more immunoprecipitates were observed, of which one was due to IgG. No lysozyme could be demonstrated in tears from a case of conjunctivitis sicca by immunoelectrophoresis.In tears from healthy donors the mean level of IgA was 20 mg%, of IgG 3 mg%, and IgM could not be demonstrated. Rabbit anti-tear immunoglobulin did not precipitate a standard of human IgM in double immunodiffusion. In cases of conjunctivitis vernalis and follicularis the mean levels were increased to 80 and 114 mg% IgG, and 11 and 14 mg% IgM, but IgA was increased only to 32 and 41 mg%. It is assumed that the level of IgA in normal tears is almost entirely due to local synthesis, while serum albumin and other immunoglobulins may have escaped from the circulation by molecular sieving. The increased levels of immunoglobulins in inflammatory diseases is probably due to transudation. However, in blepharoconjunctivitis patients several tear samples with a high IgM and a low or zero level of IgG could be demonstrated. Possible explanations for this phenomenon are discussed.

An antigen common to a wide range of bacteria. 2. A biochemical study of a "common antigen" from Pseudomonas aeruginosa.

Common Antigen (CA) of Pseudomonas aeruginosa has been shown to be a protein composed of polypeptide subunits of a molecular weight (MW) of about 62 000. The MW of this protein was estimated to 665 000 by gel filtration on sepharose CL-6B, to 800 000 by electrophoresis on polyacrylamide gradient gels and to about 900 000 by ultracentrifugation, on a sucrose gradient. By analytical ultracentrifugation with Schlieren optics a sedimentation coefficient (S20 degrees, W) of 22.65 was calculated. The isoelectrical point was determined to pH 4.4. The antigen was decomposed on exposure to proteolytic enzymes. Polysaccharide, lipid, deoxyribonucleic acid or ribonucleic acid were not demonstrated in CA. The amino acid content of CA was determined, and no hexosamine or abnormal residues were observed. The amino acid content of CA was determined, and no hexosamine or abnormal residues were observed. The antigen was degraded when heated to 100 degrees C for 4 min or when exposed to pH below 4 or above 11 at 4 degree C. CA has been isolated from the cytoplasmic water-soluble fraction of disintegrated bacteria and only trace-amounts could be obtained from envelope fractions after solubilization with Triton X-100.

Brucella septicemia in pregnancy

A case of Brucella melitensis septicemia in a second-trimester pregnancy causing intrauterine fetal death and Gram-negative septic shock with diffuse intravascular coagulation is reported. The literature is reviewed. This is the first reported case of human brucellosis in association with Gram-negative sepsis and DIC during pregnancy. The importance of blood cultures and agglutinins for Brucella in febrile pregnant patients is re-emphasized.

Allergen-Specific Immunoglobulin E Antibodies in Tears and Serum of Vernal Conjunctivitis Patients

Tears and sera of 53 patients of vernal conjunctivitis were examined for antibodies of the IgE type to a panel of 18 allergens. In 18 of the patients (34.0%) allergen-specific IgE was demonstrated in both tears and serum, in 3 (5.7%) in tears only, and in 4 (7.5%) in serum only. The antigen-specific reactions with tear fluid were found in patients with the highest total IgE levels, not only in tears but also in serum. This is evidence for a specific, local allergic reaction in these patients. Most positive reactions were to perennial allergens, particularly house dust mites, cat epithelium and Bermuda grass. This fact is in harmony with the lack of season-linked symptoms in most patients in this geographical area.

Infections associated with genital Mycoplasma

Abstract Eleven case reports are presented in order to illustrate the part that genital Mycoplasma (M.) may play in human disease. Three cases were of pelvic inflammatory disease and T strain M. was isolated from the exudate in one and M. hominis in 2 cases. In four cases Mycoplasma was isolated from purulent postoperative wounds. Four cases developed sepsis after delivery or missed abortion; in one case the blood culture yielded T strain M., in the others M. hominis .