Eva Gruner

An Outbreak of Nontoxigenic Corynebacterium diphtheriae Infection: Single Bacterial Clone Causing Invasive Infection Among Swiss Drug Users

From 1990 to 1996, a total of 65 patients from whom Corynebacterium diphtheriae had been isolated were reported to the Swiss Federal Office of Public Health. A retrospective review of medical and microbiological records as well as results of ribotyping of available isolates was performed. Twenty-seven patients had acquired their infection without evidence of use of illicit drugs, mostly as a skin infection imported from subtropical areas (20 patients); 38 isolations were associated with intravenous drug use (IVDU) (skin, 15; respiratory tract, 10; blood, 13). Endocarditis was documented in nine patients with bloodstream infection, four of whom died. There were two additional deaths due to overwhelming sepsis. The same ribotype of nontoxigenic C. diphtheriae was found in 31 of the 32 examined isolates associated with IVDU. All non-IVDU isolates had different ribotypes. Among Swiss drug users, a single clone of nontoxigenic C. diphtheriae was found over a period of several years with a high potential to cause severe invasive infection.

The API ZYM system: a tabulated review from 1977 to date

Abstract The ApiZym system is a commercially available test system for the detection of enzymatic profiles of bacteria. This paper reviews published ApiZum studies from 1977 to date. It presents the results of 60 publications which were compiled and tabulated with special emphasis on practical subdivisions to facilitate clinical use. The ApiZym system results to be a rapid and simple performing tool for the discrimination of similar microorganisms.

Identification of coryneform and other Gram‐positive rods with several methods

The identification of 202 isolates of aerobically growing Gram‐positive rods from clinical material was attempted by using a combination of “traditional” morphological and biochemical tests (Hollis & Weaver (20)) plus patterns of cellular and metabolic fatty acids. This system served as the “gold standard” for three others, i.e. API Coryne (Rapid Coryne), MIDI TSBA and MIDI CLIN Aerobic. In addition, several growth, biochemical and susceptibility tests (growth on cystine‐tellurite blood agar, DNase, hippurate and starch hydrolysis, methanethiol formation, API ZYM, CAMP reaction, susceptibility to O/129 and to six antimicrobials) were done in order to check their usefulness for the identification of this group of bacteria. Our system, with the help of chemotaxonomic tests (m‐DAP and mycolic acids), was able to identify 154/202 (76%) of the isolates by species and an additional 41/202 (21%) by genus only; 7 (3%) could not be identified. The API Coryne system identified to species or genus level 140/195 isolates (72%). Corresponding figures for the MIDI TSBA and CLIN systems were 63/195 (32%) and 88/195 (45%); further details of species and genus identification are presented in the text. The main drawback of the commercial systems is the extent and probably the numerical depth of the data base. We recommend the use of our multisystem approach for the identification of Gram‐positive rods until commercial systems are based on a broader and numerically more extensive data base. The additional tests did not prove species‐ or genus‐specific.

Shigellemia in AIDS patients: Case report and review of the literature

SummaryShigella bacteremia in adult patients is rare and is usually associated with immunosuppressive diseases. To date, 12 HIV-positive patients withShigella bacteremia have been reported in the medical literature. We report a case ofShigella dysenteriae bacteremia in a 39-year-old HIV-positive patient. Although the patient presented with bloody and watery diarrhea, stool cultures failed to grow enteric pathogens. The patient responded well to appropriate antibiotic therapy.ZusammenfassungShigellenseptikaemien sind bei Erwachsenen sehr selten und meist mit Störungen des Immunsystems vergesellschaftet. Bisher wurden 12 HIV-positive Patienten mit Shigellensepsis in der medizinischen Literatur beschrieben. In der vorliegenden Arbeit wird ein 39-jähriger HIV-positiver Patient mit blutig-wässrigen Durchfällen beschrieben, bei demShigella dysenteriae aus der Blutkultur isoliert wurde. Gleichzeitig untersuchte Stuhlkulturen zeigten kein Wachstum von Enterocolitis-Erregern; der Patient sprach gut auf die eingeleitete Antibiotikatherapie an.

Brucellosis: An occupational hazard for medical laboratory personnel. Report of five cases

SummaryFive cases of laboratory-acquired infection withBrucella melitensis are reported. This pathogen is highly contagious when handled in the laboratory. Clinicians should alert technologists when brucellosis is suspected so that specimens are handled under the most stringent safety measures. Serological surveys and instructions of laboratory workers regarding the clinical diversity of the disease are helpful for early recognition of secondary cases. On the other hand, clinicians should consider brucellosis in medical laboratory workers with unexplained signs and symptoms.ZusammenfassungFünf Fälle von im Labor erworbener Infektion mitBrucella melitensis werden vorgestellt. Dieser Erreger ist bei Manipulationen im Labor hoch kontagiös. Falls eine Brucellose bei einem Patienten vermutet wird, sollte der Kliniker das Bakteriologielabor-Personal warnen, damit bei der Bearbeitung der Proben geeignete Vorsichtsmaßnahmen vorgenommen werden. Serologische Untersuchungen und Instruktion des Laborpersonals über das klinische Spektrum der Brucellose sind für die Früherkennung sekundärer Fälle hilfreich. Andererseits sollte der Kliniker bei Bakteriologielabor-Personal mit unklarem Krankheitsbild an die Möglichkeit einer Brucelleninfektion denken.

Brevibacterium species as a cause of osteomyelitis in a neonate

SummaryA case of osteomyelitis of the sternum due toBrevibacterium sp. in a neonate following mastitis of the mammary gland 20 days previously is described. The disease was successfully treated with cefazolin and oxacillin. The results of microbiological examinations and their significance are discussed.ZusammenfassungWir stellen einen Fall von Osteomyelitis des Sternums bei einem Neugeborenen vor. Die Erkrankung begann 20 Tage nach einer Mastitis und konnte durch eine Kombinationstherapie von Cefazolin und Oxacillin erfolgreich behandelt werden. Die Ergebnisse der mikrobiologischen Untersuchungen und deren Signifikanz werden diskutiert.

Outbreak of typhoid fever in a non-endemic area: comparison of three molecular typing methods

An outbreak of typhoid fever in Zurich, Switzerland, which involved seven customers and three employees of a city mall restaurant, was investigated by comparing three molecular typing methods: pulsed-field gel electrophoresis (PFGE), ribosomal RNA gene restriction patterns (ribotyping), and random amplified polymorphic DNA (RAPD). Both PFGE and ribotyping identified two molecular patterns among the outbreak-related isolates which differed in one band: these isolates were considered clonally related and differed clearly from other unrelated S. typhi strains. RAPD could not distinguish among outbreak isolates and control strains.