Failure of Mass Antibiotic Prophylaxis to Control a Prolonged Outbreak of Meningococcal Disease in an Israeli VillageShehab, S.; Keller, N.; Barkay, A.; Leitner, L.; Leventhal, A.; Block, C.
doi: 10.1007/s100960050179pmid: 9923513
In January 1994 mass antibiotic prophylaxis was undertaken in the contiguous villages of Deir el-Asad and B'ine in northern Israel (combined population of 11 600) in response to a prolonged outbreak of serogroup B meningococcal infection with an overall annual rate of 37.4 cases of infection per 100 000 residents. The average case fatality rate in the villages was 23% compared with 11% in Israel during the same period. Neisseria meningitidis group B was identified in 9 of 13 (69%) cases. Seven of these were subtype P1.7,16. The persistence of the outbreak with its accompanying public reaction prompted the establishment of an intervention programme that included antibiotic prophylaxis for the whole community with monitoring for pharyngeal carriage of meningococci in a stratified sample of the population. The objectives were to achieve a reduction of carriage of the outbreak strain and to reduce morbidity and mortality. A total of 1036 pharyngeal swabs were taken 1 day before and 6 weeks after treatment. Antibiotic prophylaxis was administered in one dose: children under 5-years-old received ceftriaxone i.m.; all others received oral ciprofloxacin. Overall, 96% of the population received treatment. The carriage rate was 8.3% prior to treatment (three serogroup B:14 : P1.7,16), and 1.3% afterwards (one serogroup B:14 : P1.7,16). The intervention failed to eradicate carriage of the putative outbreak strain, or to reduce the incidence and fatality rates in the villages. The outbreak finally terminated in late 1996. Public health professionals should bear this experience in mind when faced with prolonged, localized, non-explosive outbreaks of meningococcal disease associated with low carriage rates of the outbreak strain.
Antibacterial Activity of Meropenem against Pseudomonas aeruginosa, Including Antibiotic-Induced Morphological Changes and Endotoxin-Liberating EffectsTrautmann, M.; Heinemann, M.; Zick, R.; Möricke, A.; Seidelmann, M.; Berger, D.
doi: 10.1007/s100960050180pmid: 9923514
The in vitro effects of meropenem on Pseudomonas aeruginosa were examined by studying (i) the inhibitory and bactericidal concentrations of meropenem versus those of imipenem for clinical isolates; (ii) changes in bacterial morphology during in vitro culture; and (iii) release of endotoxin induced by meropenem compared with that induced by other antipseudomonal compounds. Meropenem MIC90 and MBC90 values for 108 clinical isolates were 2 and 4.8 mg/l compared to 4.5 and 9.6 mg/l for imipenem. Morphological studies using phase-contrast and scanning electron microscopy showed that meropenem induced the formation of indeterminate bacterial cell forms at drug concentrations of 1–2.5 mg/l (0.5- to 1.25-fold the MIC), while spheroplasts predominated at drug levels exceeding 5 mg/l (2.5-fold the MIC). Determination of free and EDTA-releasable endotoxin activity by means of the Limulus lysate test showed that both meropenem and imipenem liberated significantly less endotoxin than did ceftazidime. Therefore, although meropenem binds to penicillin-binding proteins (PBPs) 2 and 3 (in contrast to imipenem, which binds to PBP2 only), endotoxin release should not be a cause of concern when treating systemic gram-negative infections with this drug.
Strain-Specific Differences in the Amount of Shiga Toxin Released from Enterohemorrhagic Escherichia coli O157 following Exposure to Subinhibitory Concentrations of Antimicrobial AgentsGrif, K.; Dierich, M. P.; Karch, H.; Allerberger, F.
doi: 10.1007/s100960050181pmid: 9923515
There is no consensus regarding the benefit versus harm of antibiotic therapy for treatment of disease due to enterohemorrhagic Escherichia coli O157. The effects in vitro of subinhibitory concentrations of 13 antimicrobial agents on the release of Shiga toxin (Stx) by three different Escherichia coli O157 strains expressing Stx 1 or Stx 2 either alone or in combination were investigated. The Stx-induced cell death of Vero cells was determined using a colorimetric assay based on the measurement of lactate dehydrogenase (LDH) released into the supernatant from the cytosol of damaged cells. Growth of all O157 strains in broth cultures containing subinhibitory concentrations of cotrimoxazole, trimethoprim, azithromycin, or gentamicin was accompanied by a marked increase in the release of Stx. Exposure to cefixime, ceftriaxone, or erythromycin caused a marked increase in the release of Stx by the O157 strain producing Stx 2 alone, but decreased toxin production was observed with the Stx 1 producer and the strain producing Stx 1 and Stx 2. Exposure to ampicillin caused increased Stx release in the Stx 2-producing strain but had no effect on Stx production in the other two test isolates. Exposure to penicillin G, streptomycin, ciprofloxacin, fosfomycin, or sulfamethoxazole caused an increase in toxin production in two of the three test strains in each case, while decreases were observed for the other isolates. The response of Escherichia coli O157 isolates to subinhibitory concentrations of antibiotics seems to be highly dependent on the nature of the strain involved.
Comparison of the Ligase Chain Reaction with Solid and Liquid Culture Media for Routine Detection of Mycobacterium tuberculosis in Nonrespiratory SpecimensPalacios, J. J.; Ferro, J.; Palma, N. Ruiz; Roces, S. G.; Villar, H.; Rodríguez, J.; Prendes, P.
doi: 10.1007/s100960050182pmid: 9923516
The aim of this study was to compare the results of a commercial assay based on the ligase chain reaction [(LCR) LCx Probe System MTB; Abbott, USA] with those of culture in liquid medium (Septi-Chek AFB; Becton-Dickinson, USA) and culture on the egg-based Löwenstein-Jensen solid medium for the direct detection of Mycobacterium tuberculosis complex in nonrespiratory specimens. The results were analyzed according to the standard definition of a true-positive result. Two hundred thirty-five nonrespiratory samples routinely submitted to rule out tuberculosis were analyzed. All samples were smear-negative. Mycobacterial growth in either culture medium was detected in 18 (7.6%) specimens: Mycobacterium tuberculosis was recovered from seven (38.9%) specimens cultured on Löwenstein-Jensen medium and from 18 (100%) specimens cultured in Septi-Chek AFB. The LCR protocol was positive in 22 specimens. None of the LCR-negative controls showed positive results. All samples positive by culture on Löwenstein-Jensen medium were positive by culture in liquid medium and by the LCR assay. However, Mycobacterium tuberculosis was detected by culture in liquid medium in two specimens that were negative by the LCR assay, whereas six specimens negative by culture in liquid medium were positive by the LCR protocol; three of these were identified as true-positive results of the LCR assay. The sensitivity, specificity, and positive and negative predictive values were 33.3%, 100%, 100%, and 93.8%, respectively, for Löwenstein-Jensen medium; 85.7%, 100%, 100%, and 98.6% for the liquid medium; and 90.4%, 98.5%, 86.3%, and 99% for the LCR assay. These findings indicate that the LCR assay may be a valid method of high diagnostic yield for direct detection of Mycobacterium tuberculosis complex in nonrespiratory specimens.
Comparison of Virulence between Clinical and Environmental Isolates of Aspergillus fumigatusAufauvre-Brown, A.; Brown, J. S.; Holden, D. W.
doi: 10.1007/s100960050184pmid: 9923518
Using a mixed infection model of murine invasive pulmonary aspergillosis, the comparative virulence of three clinical and four environmental isolates of Aspergillus fumigatus was investigated after intranasal inoculation. Coloured conidiospore mutants were first derived from clinical strains by ultraviolet mutagenesis and then compared with the parental strains and environmental strains. When the slight reductions in virulence associated with the spore colour mutations were taken into account, some environmental strains were shown to be less virulent than their corresponding clinical strains. It has yet to be determined whether these differences can account for the observation that many patients with invasive pulmonary aspergillosis appear to be infected with a single strain of Aspergillus fumigatus.
False-Positive Tests for Syphilis Associated with Human Immunodeficiency Virus and Hepatitis B Virus Infection among Intravenous Drug AbusersHernández-Aguado, I.; Bolumar, F.; Moreno, R.; Pardo, F. J.; Torres, N.; Belda, J.; Espacio, A.
doi: 10.1007/s100960050186pmid: 9923520
The role of HIV, hepatitis C virus, and hepatitis B virus infections in the production of biological false-positive reactions for syphilis was evaluated in two large samples of intravenous drug abusers and homosexual men attending AIDS prevention centers in Spain. A significantly increased odds ratio (OR) for false-positive tests for syphilis [OR 2.23, 95% confidence intervals (CI) 1.76–2.83] was observed for HIV-seropositive intravenous drug abusers; biological false-positive reactions were also more frequent (OR 1.73, 95% CI 1.30–2.31) among intravenous drug abusers who were hepatitis B virus seropositive but not among those who were hepatitis C virus seropositive (OR 0.90; 95% CI 0.48–1.69). Among homosexuals, the association between HIV and biological false-positive reactions was restricted to subjects who were also intravenous drug abusers, indicating the crucial role of intravenous drug abuse. Only 20.5% of intravenous drug abusers with a previous biological false-positive reaction yielded a false-positive result in their subsequent visit.