Acute infections of the gastrointestinal tract

Even though "shot-gun" treatment often proves effective in acute enteric infections, attempt to establish accurate diagnosis is still worthwhile. In most cases acute enteric infection is self limited and responds well to symptomatic treatment. Postantibiotic diarrhea is relatively common and is often severe. Usually the organism is staphylococcus and at present, at least, erythromycin seems to be the drug of choice in treatment. Antibiotics should be used only when definitely indicated. Indiscriminate "specific" treatment for acute diarrheas may mask acute infections with organisms which are suppressed-not conquered. These infections present a potential public health problem. Cases of acute gastroenteritis that are apparently of staphylococcic or viral origin should be managed symptomatically at first. If satisfactory response is not obtained quickly, accurate bacteriological diagnosis should be sought.     

Urinary tract infections due to Staphylococcus saprophyticus biotype 3.

Staphylococcus saprophyticus biotype 3 (Micrococcus subgroup 3 or M3) has usually been shown to be the second commonset cause of urinary tract infections in European women who are not in hospital. It generally causes pyuria and symptoms as severe as those caused by Escherichia coli. Unlike S. epidermidis it is seldom found as a contaminant in midstream urine specimens, and almost exclusively infects women in their reproductive years. However, S. saprophyticus is seldom differentiated from S. epidermidis in Canadian clinical laboratories. Urinary isolates of S. saprophyticus were presumptively differentiated from other coagulase-negative Micrococcaceae by their resistance to novobiocin as demonstrated by a simple disc susceptibility test that misidentified the infecting organism in only 3.4% of specimens. These novobiocin-resistant, coagulase-negative organisms caused similar proportions of the urinary tract infections in young women in York, England and Vancouver -- 6.6% and 6.9% respectively. In York these organisms were associated with significantly greater pyuria than novobiocin-sensitive organisms or bile-tolerant streptococci but not S. aureus or Enterobacteriaceae. In both communities novobiocin-sensitive, coagulase-negative Micrococcaceae were appreciably more resistant to penicillin than novobiocin-resistant organisms. Thus, differentiating S. saprophyticus from novobiocin-sensitive, coagulase-negative organisms provides information that is clinically useful, particularly for primary care practitioners working in the community or in outpatient clinics.     

Cytologic diagnosis of suppurative cholecystitis due to Candida albicans and actinomyces. A report of 2 cases

BACKGROUND: Cholecystitis is a common inflammatory disease of the gallbladder. Actinomycosis and candidiasis of the gallbladder are uncommon causes of acute cholecystitis. There has been no previous report on the cytologic diagnosis of actinomycosis and candidiasis from aspirated gallbladder bile intraoperatively. CASES: Purulent bile was intraoperatively aspirated from the gallbladder of 71-year-old Indian and a 30-year-old Australian woman. The specimens were sent for cytologic examination. The first case revealed sulphur granules characteristic of Actinomyces spp. The second case showed budding spores and pseudohyphae of Candida spp. Pure colonies of Candida albicans grew from the bile culture. CONCLUSION: Actinomycosis and candidiasis rarely cause acute suppurative cholecystitis. Initial diagnosis can be made by cytologic examination of the aspirated purulent bile intraoperatively.     

Acute emphysematous cholecystitis

Acute emphysematous cholecystitis is an uncommon condition caused by gas-forming organisms and characterized by the presence of gas in the wall and lumen of the gallbladder. Its incidence is higher among male diabetics. AEC in an elderly North American diabetic man with Indian ancestry is reported with a brief review of the world literature. The diagnosis was made preoperatively with the aid of plain radiographic films of the abdomen. A gangrenous distended gallbladder was removed at operation. Clostridium perfringens was cultured from the gallbladder contents and wall. If AEC is suspected, intensive antimicrobial therapy and fluid and electrolyte replacement should be given prior to early surgical intervention.     

119例胆道感染患者胆汁病原菌分布及耐药性分析

目的探讨胆道感染患者胆汁培养的病原菌的分布及耐药性,为临床医师有针对性的选择抗菌药物治疗胆道感染提供依据。方法对2010年6月至2012年6月119例胆道感染患者胆汁中分离得到的菌株进行回顾性分析。结果 119例胆道感染患者的胆汁标本中共分离出病原菌80株,阳性检出率为67.2%。其中,检出的革兰阴性杆菌57株,占71.3%;革兰阳性球菌14株,占17.5%,真菌9株,占11.2%。排名病原菌前3位的分别为大肠埃希菌(36.3%)、粪肠球菌(13.8%)、肺炎克雷伯杆菌(12.5%);大肠埃希菌及肺炎克雷伯杆菌对美罗培南的耐药率分别为3.4%和0.0%、哌拉西林/他唑巴坦及阿米卡星的耐药率均是6.9%和10.0%。肺炎克雷伯杆菌对左氧氟沙星的敏感率明显高于大肠埃希菌,分别为64.4%与38.4%。头孢菌素类药物中头孢噻肟的耐药率最高,分别是72.4%和60.0%。粪肠球菌除对糖肽类万古霉素及替考拉宁的敏感率为100.0%外,对其他抗菌药物均有一定的耐药性。在检测出的39株大肠埃希菌和肺炎克雷伯杆菌中分离到产ESBLs细菌17株,阳性检出率为43.6%。结论摒弃经验性用药、避免预防性用药、增加标本送检率、结合药敏结果合理选择抗菌药物以及规范手术操作,才能达到提高治疗胆道感染成功率的目的。     

Ciprofloxacin and therapy of urinary tract infections, including those due to Staphylococcus saprophyticus]

Staphylococcus saprophyticus is one of the main pathogens of cystitis in young women. The human biotopes are contaminated by the staphylococcus on direct contacts with domestic animals or after using not properly cooked food of animal origin. Young women are more susceptible to colonization of the urinary tract by S. saprophyticus vs. the other contingents. Sexual intercourse is conducive to the colonization and infection. Shifts in the urinary tract microflora due to the use of spermicide, as well as candidiasis promote colonization of the urinary tract by S. saprophyticus. At present fluoroquinolones are considered as a significant independent group of chemotherapeutics within the class of quinolones, inhibitors of DNA gyrase, characterized by high clinical efficacy in the treatment of urinary tract infections. Especially significant clinical experience with ciprofloxacin in the therapy of urinary tract infections is available.     

Acute cholecystitis and thiazides.

Drugs purchased by a random sample (17 000) of the population of Jämtland county, Sweden, are continuously monitored. Patients who had been admitted to the county''s only hospital with acute cholecystitis and who were part of this sample were studied, and controls matched for age and sex were drawn from the sample. The purchase of thiazides and other drugs prescribed to the patients with acute cholecystitis was compared with that of the controls. The estimated relative risk of developing acute cholecystitis in patients who had purchased thiazides in the year before admission to hospital, as compared with those who had not, was 2.1 (95% confidence limit 1.1-3.9). As it has been reliably reported that the use of thiazides is not itself associated with cholelithiasis, the association found between thiazides and cholecystitis suggests that thiazides may increase the risk of acute cholecystitis developing in a patient with gall stones.     

Acute respiratory infections due to enterovirus 68 in Yamagata, Japan between 2005 and 2010

To clarify the epidemiology of enterovirus 68 (EV68), which is one of the most rarely identified enteroviruses, virus isolation and molecular screening using RT-PCR was performed on 6307 respiratory specimens collected at pediatric clinics in Yamagata, Japan between 2005 and 2010. In the years 2005-2009, 10, 1, 2, 0, and 2 (40) EV68-positive cases, respectively, were identified by RT-PCR. In 2010, 40 cases were identified altogether: 2 by isolation only, 26 by RT-PCR only, and 12 by both isolation and RT-PCR. Phylogenetic analysis indicated that plural genetically distinct clusters co-circulated. These results suggest that that difficulty in EV68 isolation leads to an underestimation of the prevalence of EV68 infections.     

Canine mycotic stomatitis due to Candida albicans

Candida albicans, a medically important opportunistic yeast is described as the etiologic agent of stomatitis in dogs. The oral swabs collected from 34 dogs showing symptoms of stomatitis or gingivitis such as anorexia, halitosis, bleeding within the oral cavity, dysphagia, ptyalism (salivation) and submandibular lymphadenopathy were cultured for isolation of the causative agent. C. albicans was isolated from four (11.8%) dogs. The isolates were sensitive to clotrimazole, fluconazole and amphotericin-B but were resistant to nystatin. The routine application of Pal's sunflower seed medium and Narayan stain in microbiological laboratories is highly emphasized. It is recommended that the role of C. albicans, as the etiologic agent of canine stomatitis, should be carefully investigated in various clinical related disorders of dogs as well as in other animals.     

Systemic Candida infections.

Over the past two decades, Candida species have come to be regarded as important agents of nosocomial infection. In this paper, initially presented as a teaching conference at the Yale University School of Medicine, we summarize recent information pertaining to the epidemiology, diagnosis, and treatment of systemic Candida infections.