European Journal of Clinical Microbiology Infectious Diseases

Stratov, I.; Korman, T.; Johnson, P.

doi: 10.1007/s10096-003-0909-3pmid: 12734721

Presented here is a case of Aspergillus osteomyelitis in an immunocompetent patient that progressed despite surgery and prolonged treatment with liposomal amphotericin B; the report is followed by a review of the literature. The review of this case and 41 similar cases found an overall cure rate of 69%. The importance of surgery when amphotericin B is used as first-line therapy is indicated by a 14% cure rate when amphotericin B is used alone compared to 75% when combined with surgery. When therapy is failing or surgery is contraindicated, dose escalation using a lipid formulation was not effective. On review, the addition of another agent, in particular 5-fluorocytosine, appears to be more beneficial. The patient reported here responded rapidly to voriconazole, a promising new antifungal agent for Aspergillus infections.

Gool, T.; Weijts, R.; Lommerse, E.; Mank, T.

doi: 10.1007/s10096-003-0919-1pmid: 12736794

Microscopic examination of stool specimens is the cornerstone of detection of intestinal parasites in parasitology laboratories. In Europe, fresh, nonpreserved stool specimens are generally used for examination. Because intestinal parasites are shed intermittently, patients are asked to deliver multiple stool samples for examination. The limitation of this diagnostic approach is that detection of the vegetative stages of protozoa may be missed because of delays in processing and/or low compliance with the request to submit multiple stool samples. To overcome this limitation, a diagnostic test that combines multiple sampling (on 3 consecutive days), a fixative (SAF; sodium acetate acetic acid formalin), a concentration method and an easy-to-use permanent stain (chlorazol black dye) was developed for use in routine clinical practice. The results of the test, called the "Triple Faeces Test" (TFT), were compared with those of the conventional diagnostic method, i.e. ether sedimentation of a single fresh stool specimen. Stool samples from 544 patients were examined. Vials from the TFT-sets were filled by patients precisely according to instructions in 462 of 544 (85%) of the cases. Using the conventional method and the TFT, 106 and 209 patients, respectively, were diagnosed with infection by one or more parasitic species (P<0.005). Pathogenic species were detected by the conventional method and by the TFT in 39 and 94 cases, respectively, and nonpathogenic species were detected in 124 and 288 cases, respectively (P<0.05). Additional costs for the sampling device, laboratory reagents and handling of the TFT were acceptable. The results of this study suggest that the TFT is an effective method for detection of intestinal parasites in stool samples in routine clinical practice.

Taylor-Robinson, D.; Gilroy, C.; Keane, F.

doi: 10.1007/s10096-003-0910-xpmid: 12734722

In order to determine the colonisation patterns of several Mycoplasma species in homosexual men, urethral, oral and rectal specimens from 10 homosexual men with acute non-gonococcal urethritis (NGU) and 18 without NGU were examined using sensitive methods. Mycoplasma hominis and Ureaplasma urealyticum existed in both groups, which is in keeping with previous studies of heterosexual men. Mycoplasma genitalium was detected in the rectum of both NGU-positive and NGU-negative men and in the urethra of one man with chlamydia-negative NGU, but not in those without urethritis. Mycoplasma fermentans was found in the throat and rectum only and Mycoplasma penetrans in all three anatomical sites. In contrast, Mycoplasma pirum was found in the rectum only, that is, in 5 of the 28men studied. Infrequent examination of this site is a possible explanation for previous failures to detect Mycoplasma pirum at a mucosal surface.

Goetz, M.; Galle, P.; Schwarting, A.

doi: 10.1007/s10096-003-0914-6pmid: 12739107

Fulminant hepatic failure is an uncommon but life-threatening adverse reaction to antibiotic therapy. Reported here is a case of severe liver injury associated with ciprofloxacin administered for treatment of a gram-negative infection in a 79-year-old female. The patient presented with metabolic acidosis 48 hours after the first ciprofloxacin intake. Symptoms resolved after cessation of ciprofloxacin therapy. This report highlights an uncommon side effect of a commonly used antimicrobial agent.

Lastours, V.; Lefort, A.; Zappa, M.; Dufour, V.; Belmatoug, N.; Fantin, B.

doi: 10.1007/s10096-003-0934-2pmid: 12740666

Described here are two cases of cerebral aspergillosis successfully treated with voriconazole after the failure of first-line treatment with amphotericin B deoxycholate. In both cases, clinical and radiological cure was achieved within 6 weeks. Voriconazole should be considered as first-line therapy for cerebral aspergillosis.

Bishara, J.; Pitlik, S.; Kazakov, A.; Sahar, G.; Haddad, M.; Vojdani, A.; Rosenberg, S.; Samra, Z.

doi: 10.1007/s10096-003-0912-8pmid: 12739106

To detect Chlamydia pneumoniae in punch specimens of the aortic wall of 61 patients undergoing coronary-aortic bypass graft, and carotid atheromas of 32 patients undergoing carotid endarterectomy, cell culture (HEp-2 cells) and two polymerase chain reaction assays in two different laboratories were used. All cultures and polymerase chain reaction tests for Chlamydia pneumoniae were negative. Further studies are required to explore the complex relationship between Chlamydia pneumoniae and atherosclerosis.

Loewenich, F.; Stumpf, G.; Baumgarten, B.; Röllinghoff, M.; Dumler, J.; Bogdan, C.

doi: 10.1007/s10096-003-0935-1pmid: 12740667

Based on seroprevalence studies and tick infection rates, tick-borne human granulocytic ehrlichiosis (HGE) is thought to occur in Germany, but to date no clinical case has been detected. Reported here are the first ehrlichial sequences derived from a German horse that fell ill with granulocytic ehrlichiosis. The analysis of three different genes (16S rRNA gene, groESL, and ankA) revealed up to 100% identity with ehrlichial sequences derived from patients with HGE in other countries or from infected ticks in Germany. Thus, the current lack of clinical cases of HGE in Germany is unlikely to result from the absence of pathogenic granulocytic ehrlichiae strains in German ticks.

Mempel, M.; Lina, G.; Hojka, M.; Schnopp, C.; Seidl, H.-P.; Schäfer, T.; Ring, J.; Vandenesch, F.; Abeck, D.

doi: 10.1007/s10096-003-0928-0pmid: 12743832

The present study was aimed at identifying a possible correlation between disease severity and colonization with superantigen-producing Staphylococcus aureus strains in patients with atopic eczema. To this end, Staphylococcus aureus strains from 91 patients with atopic eczema were screened for various staphylococcal superantigens such as SEA, SEB, SEC, SED, TSST1, the recently described enterotoxin gene cluster egc (which encodes the enterotoxins SEG, SEI, SEK, SEM, and SEO), and the see, seh, and sej loci. Swabs were taken from seven different sites in each patient. The rate of colonization with Staphylococcus aureus was 87.9%. Of those patients colonized, 35% were colonized with more than one different strain. Of the 120 genetically different strains investigated, the egc locus was found in 48.3% and the sej locus in 7.5%. The see and seh loci were not found in any strain. The presence of the classical superantigens SEA-SED or TSST1 was found in 38.3%. Overall, 71.3% of the Staphylococcus aureus-positive patients harbored at least one superantigen-producing strain on their skin. There was no difference in the prevalence of superantigens between atopic eczema patients and healthy volunteers. Moreover, there was no difference in the extent of disease expression between patients colonized by superantigen-positive Staphylococcus aureus strains and those with superantigen-negative strains as measured by the SCORAD system. However, patients colonized with Staphylococcus aureus had a significantly higher SCORAD score than those not colonized.

Cohnen, M.; Lüthen, R.; Däubener, W.; Mödder, U.

doi: 10.1007/s10096-003-0911-9pmid: 12734723

The purpose of this study was to clarify whether bacteria are transferred from the portal venous system into central venous blood during the placement of a transjugular portosystemic stent shunt (TIPSS). TIPSS was created in 30 consecutive cirrhotic patients for recurrent variceal bleeding (n=12), refractory ascites (n=16), or hepatorenal syndrome (n=2). Microbiological analysis was performed prospectively on central venous blood before and on portal venous blood immediately after puncture of the portal vein. Twenty minutes after the placement of TIPSS, another sample of central venous blood was obtained. None of the first two sets of blood cultures showed bacterial growth, so that no bacterial transfer was seen at the time of TIPSS placement. Four of the third sets of blood samples showed skin and mouth flora, interpreted as iatrogenic contamination.

Cheng, V. C. C.; Woo, P. C. Y.; Lau, S. K. P.; Cheung, C. H. Y.; Yung, R. W. H.; Yam, L. Y. C.; Yuen, K. Y.

doi: 10.1007/s10096-003-0927-1pmid: 12743831

The aim of this study was to assess the clinical spectrum of peripartum tuberculosis from the perspective of immunorestitution disease. Of 29 patients with peripartum tuberculosis, 27 (93.1%) had extrapulmonary tuberculosis, 20 (69%) of whom were affected in the central nervous system. Twenty-two (75.9%) patients had no clinical features suggestive of tuberculosis during pregnancy. The median time from delivery to the onset of immunorestitution was 4 days, but treatment with anti-tuberculous therapy was delayed for a median time of 27 days after the onset of symptoms. Despite therapy, 11 (38%) patients died and 4 (13.8%) had residual functional deficits. Peripartum tuberculosis is an important differential diagnosis of postpartum fever (of unknown origin) without localized signs.