Robert C. Noble

Pseudomonas stutzeri infection : a review of hospital isolates and a review of the literature

Pseudomonas stutzeri is uncommonly isolated from patients and rarely causes disease. Clinical isolates of P. stutzeri from a university hospital were reviewed over a 16-year period. In the hospital review, only three patients were identified with P. stutzeri infection, and in only one of these was the organism present as the sole isolate. A review of the literature shows that P. stutzeri is most frequently isolated from blood, wounds, the respiratory tract, and urine. Patients with P. stutzeri infections often have serious underlying disease but generally respond to treatment with antibiotics including the aminoglycosides, the antipseudomonal penicillins, trimethoprim-sulfamethoxazole, and the third-generation cephalosporins.

Infectiousness of pulmonary tuberculosis after starting chemotherapy: Review of the available data on an unresolved question

Infection with Mycobacterium tuberculosis continues to be an occupational hazard for physicians, students, and employees of institutions caring for patients. Protection for these groups of individuals is currently accomplished by early recognition of individuals with pulmonary tuberculosis, effective respiratory isolation measures, and institution of appropriate chemotherapy. When does a patient with pulmonary tuberculosis become noninfectious after the start of appropriate chemotherapy? The current literature indicates that this occurs rapidly, but an examination of the studies on which these statements are based indicates that this question remains unanswered.

Ineffectiveness of annual chest roentgenograms in tuberculin skin test-positive hospital employees

Annual routine chest x-ray examinations have been recommended for many years for tuberculin skin test-positive hospital employees who have not received chemoprophylaxis. To examine the case-finding effectiveness of this policy in a university teaching hospital, employee health records covering an 18-year period were reviewed. Pulmonary tuberculosis was diagnosed in four employees during that time period. None of the patients were identified through the routine annual chest x-ray examination. In the study institution the policy requiring routine annual chest x-ray examinations for tuberculin-positive hospital employees who had not received preventive therapy was rescinded. Currently, the first chest x-ray examination is required at the time of skin test conversion, the second 1 year after conversion, and the third 2 years after conversion. Health teaching and counseling regarding the symptoms of tuberculosis have been initiated for tuberculin-positive hospital employees.

Incidence of disseminated gonococcal infection correlated with the presence of AHU auxotype of Neisseria gonorrhoeae in a community.

Strains of Neisseria gonorrhoeae requiring arginine, hypoxanthine, and uracil (AHU) may cause disseminated gonococcal infection (DGI). A significant epidemiologic association was noted between the incidence of disseminated gonococcal infection and the presence of gonococci of the AHU auxotype in the community over a nine-year period. Thirty-nine patients with DGI were identified from hospital records of January 1974-December 1982. During this interval, gonococcal isolates from patients in the community were collected at a venereal disease clinic and a hospital emergency room. The incidence of patients hospitalized for DGI dropped significantly after 1978. The year of highest incidence of DGI was 1977, when there were 429 cases of DGI per 100,000 cases of uncomplicated gonorrhea; the incidence of gonococcal isolates of the AHU auxotype in that year was 26.3%. In contrast, this auxotype accounted for only 4.6% of gonococcal isolates in 1980, when the incidence of DGI had decreased to 58 cases per 100,000 cases of uncomplicated gonorrhea. When DGI and gonococci of the AHU auxotype from the community were ranked for incidence by year, a significant correlation between the two was found (P < .001). Thus the incidence of patients with DGI in the hospital reflected the presence of gonococci of the AHU auxotype in the community.

A comparison of rosoxacin with ampicillin and probenecid in the treatment of uncomplicated gonorrhea.

Rosoxacin, a β-lactamase-resistant, pyridyl quinolone derivative with in vitro activity against Neisseria gonorrhoeae, was compared to an oral regimen of ampicillin plus probenecid for the treatement of uncomplicated gonococcal infection. Fifty-seven patients were evaluated for the effectiveness of the two antibiotics. Thirty (97%) of 31 patients receiving rosoxacin were cured of their infection as were 25 (96%) of 26 patients who received the oral regimen of ampicillin plus probenecid. Both drug regimens were associated with a significant number of side effects. Of the ampicillin-treated group, 29% had diarrhea and/or abdominal cramping. Of the rosoxacin-treated patients, 52% had reactions classified as central nervous system effects; these included headaches, dizziness, euphoria, and drowsiness.

Association of auxotypes of Neisseria gonorrhoeae and susceptibility to penicillin G, spectinomycin, tetracycline, cefaclor, cefoxitin, and moxalactam

Isolates of Neisseria gonorrhoeae from 304 patients attending a venereal disease clinic were examined by a plate dilution method for their susceptibility to six antibiotics: penicillin G, spectinomycin, tetracycline, cefaclor, cefoxitin, and moxalactam. The isolates were also characterized by gonococcal auxotyping. The most frequent auxotypes were Nonrequiring, 58%; Pro-, 14%; Pro- Arg (Orn*) Ura-, 14%; Arg- Hyx- Ura-, 6%; and a miscellaneous group consisting of 8% of the isolates. If the entire group of isolates were examined, moxalactam was the most active of the antibiotics; 94% of the isolates were inhibited by less than or equal to 0.25 microgram/ml. The Pro- Arg (Orn*) Ura- isolates were relatively resistant to penicillin G and cefoxitin. The Arg- Hyx- Ura- group of isolates was the most susceptible of the auxotypes to all of the antibiotics except spectinomycin. The uncommon auxotype Arg (Orn*) Ura- has a requirement for arginine that is satisfied by citrulline but not by ornithine. The results of the present study indicate that the nutritional requirements of gonococci may be associated with their response to certain antibiotics.

Changes in the prevalence of auxotypes of Neisseria gonorrhoeae among black and white patients attending a clinic for sexually transmitted diseases.

Before 1978, isolates of Neisseria gonorrhoeae from white patients attending a venereal disease clinic were more susceptible to penicillin G than were isolates from black patients, because the whites were more frequently infected with the Arg- Hyx- Ura- auxotype that was highly susceptible to penicillin. Recent isolates from the same clinic show a change both in the auxotypes and in the penicillin susceptibility of N. gonorrhoeae infecting the two patient groups. Of 211 isolates studied in 1978, the four most common auxotypes were, in decreasing frequency: Pro-, nonrequiring, Arg- Hyx- Ura- and Arg-. In the present study of 265 isolates, the order of frequency was nonrequiring; Pro-; Pro- Arg-(Orn*) Ura-; and Arg- Hyx- Ura-. The Pro- Arg-(Orn*) Ura- auxotype was new to the clinic and was significantly more frequent in white than in black patients and significantly more resistant to penicillin than were gonococci of the remaining auxotypes. With the appearance of the Pro- Arg-(Orn*) Ura- auxotype among white patients, there was no significant difference in the susceptibility to penicillin of isolates of N. gonorrhoeae from the two groups of patients.

Ocular Involvement in Yersinia Enterocoliticainfection Presenting as Parinaud's Oculoglandular Syndrome

Ocular involvement in Yersinia enterocolitica infection presenting as a Parinauds oculoglandular syndrome occurred in a 77-year-old woman with diabetes. Yersinia enterocolitica was recovered from cultures of the conjunctiva, cornea, fistula tract, and blood. The patient responded to parenteral and topical administration of gentamicin and a corneal transplant. While hospitalized, she developed peritonsillar inflammation and enlarged, tender lymph nodes in the preauricular, submaxillary, and submandibular areas. The combination of the unilateral granulomatous conjunctivitis and enlarged regional lymph nodes was consistent with the diagnosis of Parinauds oculoglandular syndrome. Yersinia enterocolitica may be another cause of Parinauds oculoglandular syndrome.

In vitro comparison of ceftazidime, aztreonam, cefpirome, gentamicin, imipenem, enoxacin, and ticarcillin plus clavulanic acid against 108 strains ofPseudomonas maltophilia

Pseudomonas maltophilia is an uncommon cause of hospital-acquired infection and is resistant to most of the antimicrobial agents used in the treatment of gram-negative infections. Susceptibility of 108 isolates ofP. maltophilia to ceftazidime, aztreonam, defpirome, gentamicin, imipenem, enoxacin, and ticarcillin plus clavulanic acid was determined by an agar dilution method. The isolates were in general resistant to the antibiotics. Imipenem and cefpirome were not active at clinically achievable levels. Of the isolates, 20% were susceptible to ≤16 μg/ml ceftazidime, 53% were susceptible to ≤4 μg/ml enoxacin, 10% were susceptible to ≤4 μg/ml gentamicin, and 25% were susceptible to ≤64 μg/ml ticarcillin plus 2 μg/ml clavulanic acid.

Chemotaxis of polymorphonuclear leukocytes from donors of different races toward Neisseria gonorrhoeae of three different auxotypes

Urethral gonorrhea is typified by the presence of large numbers of polymorphonuclear leukocytes, which are presumably attracted to the urethra by an as yet uncharacterized chemotaxin. Culture supernatants from three different auxotypes of Neisseria gonorrhoeae, one requiring arginine, hypoxanthine, and uracil (Arg-,Hyx-,Ura-), one requiring proline, arginine (not satisfied by ornithine), and uracil (Pro-,Arg-[Orn*],Ura-), and one requiring proline (Pro-), were tested for their chemotactic activity against leukocytes from men of two racial groups, white and black. These auxotypes were chosen because the Pro- auxotype is isolated more frequently from black patients, and the Arg-,Hyx-,Ura- and the Pro-,Arg-(Orn*),Ura- auxotypes are isolated more frequently from white patients. Chemotaxis was tested in blind-well chambers in the absence of complement; membranes with a pore size of 3 microns were used. The culture supernatants of the Pro- auxotype were the most chemotactic, while those of the Arg-,Hyx-,Ura- were the least chemotactic when analyzed by a three-way analysis of variance: F = 22.83, df = 2.6, P less than .001. There were no differences in migration with respect to the race of the donor. Gonococcal culture supernatants did not require complement for chemotaxis.