Promising Role of 18-F-Fluoro-D-Deoxyglucose Positron Emission Tomography in Clinical Infectious DiseasesDe Winter, F.; Vogelaers, D.; Gemmel, F.; Dierckx, R.
doi: 10.1007/s10096-002-0708-2pmid: 12072934
18-F-fluoro-D-deoxyglucose positron emission tomography (FDG PET) has become an established imaging tool in clinical oncology, cardiology and neurology and is now entering the field of clinical infectious diseases. The purpose of this article is to review the currently available, albeit limited, literature on FDG PET in the diagnosis of various infections and fever of unknown origin. Those indications for which FDG PET offers added value over more available techniques like labelled leucocyte scanning, gallium scanning and magnetic resonance imaging are especially highlighted. FDG PET seems to have an incremental value in the assessment of chronic osteomyelitis, especially in the axial skeleton, as well as in the diagnostic workup of fever of unknown origin and HIV complications. Cost-effectiveness studies are needed to define its place in the current diagnostic strategies of these pathologies.
Proteolytic Activity of Staphylococcus aureus Strains Isolated from the Colonized Skin of Patients with Acute-Phase Atopic DermatitisMiedzobrodzki, J.; Kaszycki, P.; Bialecka, A.; Kasprowicz, A.
doi: 10.1007/s10096-002-0706-4pmid: 12072937
Staphylococcus aureus strains isolated from the colonized skin lesions of 26 patients with acute-phase atopic dermatitis were reported to produce various extracellular proteolytic enzymes. Using the skim-milk-agar culture plating method, it was shown that 97% of the strains (65 of 67 examined) produced proteolytic activity, with 61% (42 strains) producing activity comparable to that of the proteolytically hyperactive reference strain Staphylococcus aureus V8. This observation was confirmed by azocasein degradation with culture supernatants, which indicated that 91% of the strains produced extracellular proteinases and 43% exceeded the 2% activity threshold of the reference strain. Control strains were isolated from the nose vestibules of 18 healthy carriers; the proteolytic activity of these strains never exceeded 2.5% of the activity of the reference strain. In 54% of the patients examined (n=14), the activity of the strains was higher than that determined for the isolates from the control group. The combined use of assays incorporating azocasein and a synthetic chromogenic substrate, N-CBZ-Phe-Leu-Glu-pNA, showed that two staphylococcal enzymes, Staphylococcus aureus metalloproteinase (SAMP) and Staphylococcus aureus serine proteinase (SASP), contributed to the total proteolytic activity released by the strains examined. The contribution of each of the two enzymes varied greatly between different isolates. The undamaged skin of the patients was not colonized with Staphylococcus aureus. The presence of several strains with atypical proteinase characteristics was also reported, suggesting the possible involvement of enzymes other than serine- and metallo-proteinases in the proteolytic activity of Staphylococcus aureus. Taken together, the results of the study imply that staphylococcal proteinases may contribute to the pathogenicity of atopic dermatitis.
Pediatric Visceral Leishmaniasis in Western Sicily, Italy: A Retrospective Analysis of 111 CasesCascio, A.; Colomba, C.; Antinori, S.; Orobello, M.; Paterson, D.; Titone, L.
doi: 10.1007/s10096-002-0707-3pmid: 12072938
. The clinical and epidemiological characteristics of 111 consecutive cases of visceral leishmaniasis identified from 1980 to 2000 in a Sicilian pediatric hospital were analyzed retrospectively. The mean age of the patients was 1.7 years. All children were HIV negative, but 15% were severely malnourished. Fever and splenomegaly were present in all cases and hepatomegaly in 101 (90.1%) cases. Thrombocytopenia and anemia were both observed in 78 (70.2%) cases and leukopenia in 47 (42.3%) cases. A bone marrow aspirate was obtained in all cases; Leishmania amastigotes were detected in 89 (80.2%) cases. Initial treatment consisted of meglumine antimoniate in 99 (89.2%) patients and amphotericin B in 12 (10.8%) patients. Only two children treated with meglumine antimoniate relapsed. The findings highlight the differences between the cases of visceral leishmaniasis observed in the Mediterranean basin and those observed in other regions. The use of the term "Mediterranean visceral leishmaniasis", rather than the term "kala-azar", is proposed for cases observed in the Mediterranean area.
Comparative Evaluation of Two Commercial Chromogenic Media for Detection and Presumptive Identification of Urinary Tract PathogensScarparo, C.; Piccoli, P.; Ricordi, P.; Scagnelli, M.
doi: 10.1007/s10096-002-0718-0pmid: 12072939
The performance of two commercial chromogenic media for the isolation and presumptive identification of urinary tract pathogens, the CPS ID2 (bioMérieux, France) and the CHROMagar Orientation (BBL Becton Dickinson, USA), was evaluated and compared with that of cystine-lactose-electrolyte-deficient agar and tryptic soy agar with 5% sheep blood. The detection, determination of bacterial counts, and presumptive identification of bacteria causing urinary tract infections were evaluated in 3,000 urine specimens. The two chromogenic media showed excellent correlation with the standard media for the detection and the bacterial count of urinary pathogens. The Escherichia coli strains produced the expected colour on the CHROMagar Orientation and the CPS ID2 media in 99% and 90% of the cases, respectively. The Klebsiella-Enterobacter-Citrobacter and the Proteus-Morganella-Providencia groups were easily identified on both chromogenic media, but further biochemical tests were needed to differentiate them to a species level. Both media enabled the differentiation, with varying degrees of difficulty, of Pseudomonas spp. strains from members of the family Enterobacteriaceae. All isolates of Enterococcus spp. were correctly identified and were easily distinguished from the Streptococcus agalactiae isolates. Staphylococcus saprophyticus isolates were easy to identify only on the CHROMagar Orientation medium. No substantial difference was observed when comparing the results of the susceptibility tests, which were performed according to the standardized disk diffusion method as described by the National Committee for Clinical Laboratory Standards, for colonies recovered from the blood agar versus those recovered from the chromogenic media. In conclusion, the CPS ID2 and CHROMagar Orientation media enabled excellent detection, count determination, and presumptive identification of urinary pathogens, both in pure and mixed cultures, and reliable and accurate antimicrobial susceptibility testing directly from primary isolates. Moreover, these media allowed a remarkable reduction in the workload and a significant savings of time. On the basis of their performance, these media can replace the standard primary plating media used in the routine diagnosis of urinary tract infections.
Analysis of Risk Factors for Bacteremia in Children with Nontyphoidal Salmonella GastroenteritisYang, Y.-J.; Huang, M.-C.; Wang, S.-M.; Wu, J.-J.; Cheng, C.-P.; Liu, C.-C.
doi: 10.1007/s10096-002-0715-3pmid: 12072940
To identify the risk factors for Salmonella bacteremia in infants and children with Salmonella gastroenteritis, a retrospective study of a 10-year period was conducted to evaluate 456 infants and children with culture-proven nontyphoidal Salmonella infection. Salmonella typhimurium was the most common isolate found. Among the 257 patients with gastroenteritis who had a concomitant blood culture performed, 50 exhibited bacteremia. Statistically significant differences were noted between patients with gastroenteritis and bacteremia and those without bacteremia in duration of fever ≥5 days (P<0.001; OR, 5.6; 95% CI, 2.6–12.1) and infection with group D1 Salmonella (P<0.001; OR, 6.5; 95% CI, 2.5–16.9) after adjustment for multivariate analysis. Of the 320 Salmonella strains that were serotyped, Salmonella panama was shown to be strongly associated with bacteremia (P<0.001) in children with gastroenteritis. In summary, in children with nontyphoidal Salmonella gastroenteritis, prolonged fever lasting 5 days or more and infection with a specific Salmonella serotype were risk factors closely associated with development of bacteremia.
Two Cases of Fungemia due to Candida lusitaniae and a Literature ReviewViudes, A.; Pemán, J.; Cantón, E.; Salavert, M.; Ubeda, P.; López-Ribot, J.; Gobernado, M.
doi: 10.1007/s10096-002-0713-5pmid: 12072941
Reported here are two cases of candidemia caused by Candida lusitaniae that occurred in two immunocompromised patients at Hospital Universitario "La Fe" in Valencia, Spain. Case 1 involved a low-birth-weight premature infant with congenital nephrotic syndrome who was successfully treated with amphotericin B, and case 2 involved a 50-year old woman with a high-grade malignancy lymphoma who succumbed to the infection. Antifungal susceptibility testing of the Candida lusitaniae isolates recovered from both patients revealed sensitivity to amphotericin, 5-flucytosine and fluconazole. Results are presented and discussed together with a comprehensive review of the literature, covering all previously reported cases of fungemia caused by this emerging pathogen.
Chlamydia pneumoniae Infection Among Healthy Children and Children Hospitalised with Pneumonia in GreeceTriga, M.; Anthracopoulos, M.; Saikku, P.; Syrogiannopoulos, G.
doi: 10.1007/s10096-002-0710-8pmid: 12072942
Chlamydia pneumoniae has been recognized as a cause of respiratory tract infection in humans, and its prevalence has been shown to vary among different age groups and populations. The prevalence of Chlamydia pneumoniae antibody was determined by serological investigation in 343 healthy children and in 77 children consecutively hospitalised for pneumonia in southwestern Greece. Seventy-eight (22.7%) healthy children had IgG Chlamydia pneumoniae titers ≥1/8. The prevalence of Chlamydia pneumoniae antibody in the age groups 6 months–5 years, 6–9 years and 10–15 years was 7.9%, 11.4% and 36%, respectively. One child hospitalised for pneumonia had serological results consistent with acute Chlamydia pneumoniae infection. The results of the present study suggest a low prevalence of Chlamydia pneumoniae antibody among preschoolers in Greece, followed by a steep rise in children 10–15 years of age. Chlamydia pneumoniae is not a common etiologic agent of childhood pneumonia requiring hospitalisation.
Tula Virus Infection Associated with Fever and Exanthema After a Wild Rodent BiteSchultze, D.; Lundkvist, Å.; Blauenstein, U.; Heyman, P.
doi: 10.1007/s10096-002-0705-5pmid: 12072943
. Reported here is the first case of human acute infection with Tula virus, which occurred in a 12-year-old boy in Switzerland. This hantavirus had been considered apathogenic to humans, and in Switzerland only TULV-genome sequences have been demonstrated in wild rodents to date. In this case, paronychia, fever and exanthema occurred after the patient was bitten by a wild rodent, indicating an unusual route of hantavirus transmission. Thus, Tula virus infection should be taken into account in patients with appropriate clinical symptoms and contact with rodents.