Ernö Gutschik

Urosepticemia and Fatal Endocarditis Caused by Aerococcus-like Organisms

Two cases of invasive infections with aerococcus-like organisms (ALO) are presented: an 81-year-old man with fatal endocarditis and a 63-year-old man with urosepticemia. No antigenic relationship was found between ALO and Aerococcus viridans (NCTC 8251) in crossed immunoelectrophoretic assay.

Soft tissue infections from drug abuse A clinical and microbiological review of 145 cases

We evaluated clinical and microbiological aspects in 145 hospitalizations of 89 intravenous drug abusers with acute soft tissue infections at the injection site. There were 58 superficial abscesses, 27 deep abscesses, 57 cellulitis with or without concomitant ulcer, 1 purulent arthritis, 1 tenosynovitis and 1 incompletely categorized abscess. The commonest location was the groin. Serious complications occurred in 17 cases, including 4 lower-extremity amputations due to arterial lesions. There was a predominance of polybacterial infections (53 percent polybacterial, 38 percent monobacterial, 9 percent sterile). The commonest bacteria isolates were Streptococcus species with a preponderance of oropharyngeal bacteria, Staphylococcus aureus, and anaerobes, especially Bacteroides species. Typical intestinal bacteria were rare. In addition to surgical treatment we recommend that aerobic and anaerobic culturing with susceptibility tests always are carried out, that primary antibacterial therapy should consist of an antistaphylococcal agent, such as dicloxacillin plus metronidazole, and that free injection paraphernalia with disinfection swabs are easily available.

Microbiologically verified diagnosis of infectious spondylitis using CT-guided fine needle biopsy

Using a computed tomography (CT)‐guided technique we have been able to obtain fine needle spine biopsies directly from an affected vertebra or disk plate in 14 patients suspected of infectious spondylitis. The bioptic material was cultivated immediately and incubated for 14 days. Cultures from eight patients were positive. No single microbiological agent was predominant though coagulase‐negative staphylococci were frequent. In no case were mycobacteria found. Bioptic material from six patients did not give rise to growth of microorganisms. We were able to successfully treat the eight patients with a culture‐positive biopsy. We think that biopsies are crucial for establishing a microbiological diagnosis. The whole procedure takes less than one hour; it is performed under local anaesthesia and is thus not very stressful for the patient: The success rate for obtaining a positive spine biopsy was 57%.

MOLECULAR CLONING AND EXPRESSION OF A NOVEL STAPHYLOCOCCUS AUREUS ANTIGEN

A novel gene encoding an antigen from Staphylococcus aureus was isolated from an expression library by screening with antisera from patients with deep Staphylococcus aureus infections. In one positive clone an open reading frame, named ORF-2, was identified. Recombinant ORF-2 protein reacted with human immune serum. ORF-2 was shown to be present in other Staphylococcus aureus strains, but not in related species.

Serological diagnosis of experimental Enterococcus faecalis endocarditis.

A modified rat model of endocarditis with catheterization for 2 days was established in female Lewis rats using different inocula of Enterococcus faecalis (strain no. EF 19) in order to measure IgG antibodies in serum during the course of infection. Increasing the inocula intravenously resulted in an increase in the CFU/g vegetation and the CFU/g spleen, the ID50 being about 10 CFU/ml and the ID90 about 1 × 102 CFU/ml. The lowest bacterial inoculum infecting 100% of the rats was 3 × 103 CFU/ml, and for further investigations we used this inoculum size. Rats were sacrificed on day 2, 5, 7, 9, 11 and 28 after infection. The CFU/g vegetation and the CFU/g spleen increased until day 7 and then decreased. Serum samples were collected from 129 rats at different times after challenge. Three different ELISA systems were established to measure the IgG antibody responses: E. faecalis sonicate ELISA (a pool of four sonicates of strain no. EF 10, EF 11, EF 19 and EF 48), E. faecalis whole cell ELISA (strain no. EF 19) and E. faecalis purified cell wall ELISA (strain no. EF 19). An IgG antibody response was detected already on day 2, and except for a minor decrease on day 6/7 the antibody response continued to increase until day 14 (whole cell ELISA and sonicate ELISA) and day 21 (purified cell wall ELISA) when a plateau was reached. Significant increases in IgG antibody responses (p<0.05) were found between groups of rats from days 0–2, 2–8/9 and 8/9–14 in the E. faecalis whole cell and sonicate ELISAs and from days 0–2, 2–10/11 and 10/11–21 in the E. faecalis purified cell wall ELISA. In conclusion, we established a model of endocarditis in rats with catheterization for 2 days and were able to demonstrate an increase in IgG antibodies during the course of infection.

Septicaemia caused by an unusual Neisseria meningitidis species following dental extraction.

Dental procedures are frequently followed by transient bacteraemia. Bacteria obtained in the blood cultures are similar to bacteria of the normal mouth flora such as oral streptococci. The potential risk of bacteraemia following dental manipulations is infective endocarditis. We report here a rare case of septicaemia following dental extraction in a 84-year-old woman. Neisseria meningitidis group B type 1P1.9 was cultured from the blood. Postextraction septicaemia caused by meningococci has not been described before. Meningococcaemia as a rare complication of dental extraction is emphasized.

Opportunistic screening for Chlamydia trachomatis cervicitis: the value of cytobrush specimens for detection by PCR compared with cell culture

Endocervical sampling for microbiological and pathological screening is laborious and expensive due to different sampling devices and techniques. The purpose of this study was to examine if the routine procedure could be simplified by using a cytobrush for concurrent cytology and sampling for Chlamydia trachomatis detection using the PCR method or cell culture. As a sampling device control we used a conventional rayon swab. Results: Culture: Out of 873 paired endocervical specimens, C. trachomatis was isolated in 68 swab specimens and in 65 cytobrush specimens (overall detection rate 8.4%). The cytobrush proved less suitable than the swab for the isolation of C. trachomatis as 31.5% of the cytobrush samples showed cytotoxicity to the cultured cells vs 0.9% of the swab samples. PCR: In a random sample of 427 paired endocervical specimens, C. trachomatis was detected in 45 pairs without any difference between the two sampling devices. The sensitivity of PCR was 93.8%vs 89.6% and 87.5% in cultured swab and cultured cytobrush specimens, respectively. The cytobrush can therefore be recommended as a cervical sampling device if a PCR assay is used for the detection of C. trachomatis, but not if the cell culture method is used, due to high cytotoxicity. Furthermore, the same cytobrush may be used for cervical cytological sampling and thereafter placed in transport medium for subsequent C. trachomatis detection if the PCR technique is used.

Killing curve activity of ciprofloxacin is comparable to synergistic effect of β-lactam-tobramycin combinations against Haemophilus species endocarditis strains

Nine Haemophilus species strains, all β‐lactamase negative, isolated from patients with endocarditis were tested in killing curve experiments. Antibiotics used were penicillin, amoxicillin, aztreonam alone and in combination with tobramycin, as well as ciprofloxacin alone. Synergism between β‐lactams and tobramycin with reduction of colony counts to zero was seen after 24 h for H. influenzae, H. parainfluenzae and H. segnis strains. Ciprofloxacin was as effective as β‐lactam‐tobramycin combinations. The H. aphrophilus strain was not killed as effectively as other strains by any of the antibiotics.