The experimental and clinical use of polymyxin,chloromycetin, and aureomycin

Polymyxin is an effective antibiotic for the treatment of severe infections produced by Ps. aeruginosa, H. pertussis, H. influenzae, E. coli, and A. aerogenes. Its toxicity to date precludes its general use in infections susceptible to its therapeutic effects. Chloromycetin has been demonstrated to be an effective antibiotic agent for the treatment of rickettsial diseases and typhoid fever. It will undoubtedly prove effective in the treatment of other infections produced by certain Gram-negative micro-organisms and viral agents. Aureomycin has been shown to be an active antibiotic agent against rickettsial diseases, primary atypical pneumonia, acute brucellosis, pneumococcal, streptococcal, and staphylococcal infections, urinary tract infections produced by E. coli, A. aerogenes and Strept. fecalis, certain types of infections of the eye, and in subacute bacterial endocarditis when the infecting agent is Strept. fecalis. Its clinical use in forms of extrapulmonary tuberculosis is in a completely experimental stage. It is not recommended in typhoid fever or in infections due to Ps. aeruginosa or P. vulgaris, and it seems to be ineffective in whooping cough. To date, neither chloromycetin nor aureomycin has shown significant signs of systemic toxicity.     

THE EXPERIMENTAL AND CLINICAL USE OF POLYMYXIN,CHLOROMYCETIN, AND AUREOMYCIN

Polymyxin is an effective antibiotic for the treatment of severe infections produced by Ps. aeruginosa, H. pertussis, H. influenzae, E. coli, and A. aerogenes. Its toxicity to date precludes its general use in infections susceptible to its therapeutic effects.Chloromycetin has been demonstrated to be an effective antibiotic agent for the treatment of rickettsial diseases and typhoid fever. It will undoubtedly prove effective in the treatment of other infections produced by certain Gram-negative micro-organisms and viral agents.Aureomycin has been shown to be an active antibiotic agent against rickettsial diseases, primary atypical pneumonia, acute brucellosis, pneumococcal, streptococcal, and staphylococcal infections, urinary tract infections produced by E. coli, A. aerogenes and Strept. fecalis, certain types of infections of the eye, and in subacute bacterial endocarditis when the infecting agent is Strept. fecalis. Its clinical use in forms of extrapulmonary tuberculosis is in a completely experimental stage. It is not recommended in typhoid fever or in infections due to Ps. aeruginosa or P. vulgaris, and it seems to be ineffective in whooping cough.To date, neither chloromycetin nor aureomycin has shown significant signs of systemic toxicity.     

Lochial secretions of Escherichia coli- or Arcanobacterium pyogenes-infected bovine uteri modulate the phenotype and the functional capacity of neutrophilic granulocytes

It has been suggested that in cases of puerperal endometritis of cattle infected with Escherichia coli and Arcanobacterium pyogenes, the neutrophils are compromised in their defense capacity or downregulated functionally. In addition to direct bacterial effects, contents of lochial secretions and secreted products of locally activated polymorphonuclear neutrophilic granulocytes (PMNs) may also account for changes in function of freshly immigrating neutrophils. In this study, lochial secretions were obtained from healthy cows and from cows infected by E. coli or A. pyogenes. Separated uterine PMN of infected cows displayed an altered phenotype and function which correlated with the degree of bacterial contamination. Concurrently tested circulating PMN showed no such changes. Infected lochial secretions sterilized by filtration also changed the phenotype of blood PMN. Lochial secretions of healthy cows displayed only minor effects. The effects on PMN function in infected cows varied: ingestion was less affected, whereas generation of reactive oxygen species (ROS) was severely depressed. Concurrently tested purified bacterial products (solubles and fragments) of E. coli and A. pyogenes did not induce the phenotypical and functional changes observed in blood PMN. Since infected lochia also contained high numbers of immigrated and probably activated PMN, the influence of supernatants from phorbol myristate acetate-activated PMN were tested on freshly isolated blood PMN. Such supernatants also increased the expression of certain surface molecules and inhibited the ROS generation. Thus, reduced function and altered phenotypes of PMN which immigrate into the uteri of cows with bacterial endometritis is due not only to interactions with bacteria or bacterial products, but is also to the uterine milieu.     

In vitro studies on bacterial colonization. The effects of beta-lactam antibiotics on the growth of Escherichia coli and Pseudomonas aeruginosa in mixed culture.

Many cases of Pseudomonas aeruginosa infection are considered to be secondary superinfections, resulting from bacterial colonization. Such cases of superinfection with P. aeruginosa developing after administration of cephalosporin or penicillin are offering serious clinical problems. To make a fundamental analysis of the development of such superinfections, attempts were made to compare the growth patterns of Escherichia coli and P. aeruginosa in pure and mixed cultures and to determine the effects of cephalothin, cefazolin, cephalexin, and ampicillin on the growth patterns. In mixed cultures, the growth of P. aeruginosa was markedly inhibited by E. coli. The higher the concentration of each of the cephalosporins and ampicillin added to the mixed culture, the smaller the population of E. coli sensitive to these agents. When the population of E. coli became smaller than that of P. aeruginosa, which is resistant to these agents, the latter was restored to the same population level as that in pure cultures. Experimental bacterial colonization, by which the predominant population of E. coli was replaced by that of P. aeruginosa in mixed culture, was brought about more efficiently with the cephalosporins than with ampicillin. This might be accounted for by the difference in minimal inhibitory concentration for P. aeruginosa between ampicillin and the other three agents.     

Role of NADPH oxidase in the mechanism of lung neutrophil sequestration and microvessel injury induced by Gram-negative sepsis: studies in p47phox-/- and gp91phox-/- mice

We addressed the role of O(2) generated by the NADPH oxidase complex in the mechanism of polymorphonuclear leukocyte (PMN) accumulation and transalveolar migration and lung microvascular injury. Studies were made in mice lacking the p47(phox) and gp91(phox) subunits of NADPH oxidase (p47(phox-/-) and gp91(phox-/-)) in which PMN are incapable of the respiratory burst. The mice were challenged i.p. with live Escherichia coli to induce sepsis. We observed time-dependent increases in PMN sequestration and migration from 1 to 6 h after challenge with 2 x 10(8) E. coli. The responses in knockout mice were greater post-E. coli challenge compared with control mice; i.e., transalveolar PMN migration post-E. coli challenge increased by approximately 50% in the null mice above values in wild type. The increased PMN infiltration was associated with decreased lung bacterial clearance. The generation of the chemoattractant macrophage-inflammatory protein-2 in lung tissue was greater in NADPH oxidase-defective mice after E. coli challenge than control mice; moreover, macrophage-inflammatory protein-2 Ab pretreatment prevented the PMN infiltration. We also observed that E. coli failed to increase lung microvascular permeability in p47(phox-/-) and gp91(phox-/-) mice despite the greater lung PMN sequestration. Thus, O(2) production is required for the induction of sepsis-induced lung microvascular injury. We conclude that NADPH oxidase-derived O(2) generation has an important bactericidal role, such that an impairment in bacterial clearance in NADPH oxidase-defective mice results in increased chemokine generation and lung tissue PMN infiltration.     

Effects of Indomethacin on Acute, Subacute, and Latent Infections in Mice and Rats

The comparative effect of indomethacin and hydrocortisone on the resistance of mice or rats to various acute, subacute, and latent bacterial infections was investigated. Large daily doses of indomethacin and hydrocortisone administered to mice challenged with bacterial pathogens, including Klebsiella pneumoniae AD, Salmonella schottmuelleri 3010, Staphylococcus aureus (Smith), Streptococcus pyogenes C203, Salmonella pullorum #2, Proteus vulgaris 1810, and Pseudomonas aeruginosa 2616, revealed that in essentially all of these acute infections, the mortality of the infected mice treated with indomethacin was essentially identical to that found in the infected controls. In contrast, hydrocortisone often lowered the resistance of mice to these acute infections. In a more chronic bacterial infection due to Corynebacterium kutscheri, hydrocortisone produced striking deleterious effects on resistance, whereas indomethacin administration in doses approaching the maximal tolerated level caused no observable adverse effects on host resistance. Indomethacin fed continuously to rats for 80 days, at maximal tolerated levels, caused no observable adverse effects on the host-parasite relationship of rats which were shown to harbor various latent infections. Hydrocortisone administration, however, lowered the resistance of rats as evidenced by increased mortality related directly to extensive bacterial infection. Insofar as infection is concerned, indomethacin behaved like other nonsteroid anti-inflammatory agents such as aspirin and phenylbutazone.     

Antibiotic sensitivity of the causative agents of suppurative surgical infection]

Sensitivity of 1492 strains of the causative agents of the surgical purulent infections, i. e. pathogenic Staphylococcus, Proteus, Ps. aeruginosa and E. coli to benzylpenicillin, streptomycin, levomycetin, tetracycline, erythromycin, oleandomycin, monomycin, kanamycin, novobiocin, ampicillin, oxacillin, ceporin, gentamicin and rifampicin was studied. Gentamicin was most active against all the bacterial species tested. The staphylococci were in addition sensitive in a high percentage of the cases to rifampicin, novobiocin, ceporin, monomycin and kanamycin. The isolates of E. coli were in addition sensitive to ceporin, monomycin and kanamycin. Sensitivity of the strains of Ps. aeruginosa and Proteus was low to all of the antibiotics except gentamycin. Most of the strains of the causative agents of the surgical purulent infections were multiresistant to 4 antibiotics. The number of the staphylococcal strains sensitive to benzylpenicillin, streptomycin and levomycetin increased in 1976 as compared to 1975 on the background of a limited use of these antibiotics in clinics.     

Restriction of bacterial growth by inhibition of polyamine biosynthesis by using monofluoromethylornithine, difluoromethylarginine and dicyclohexylammonium sulphate.

Bacterial growth was measurably slowed by a combination of drugs which inhibit polyamine-biosynthetic enzymes. Addition of DL-alpha-monofluoromethylornithine, which was shown to inactivate irreversibly ornithine decarboxylase extracted from Escherichia coli (Ki = 0.36 mM) and Pseudomonas aeruginosa (Ki = 0.30 mM), DL-alpha-difluoromethylarginine and dicyclohexylammonium sulphate to cultures of E. coli or P. aeruginosa resulted in a 40 and 70% increase in generation times (decreased growth rates) respectively, which was completely reversed by the addition of 0.1 mM-putrescine plus 0.1 mM-spermidine to the medium. Decreased intracellular polyamine concentrations correlated with increased generation times; putrescine concentration was decreased by 70% in E. coli and 80% in P. aeruginosa, while spermidine concentration was decreased by 50% in E. coli and 95% in P. aeruginosa. Subsequent investigation of the inactivation of the ornithine decarboxylase by monofluoromethylornithine indicated that it was active-site directed, as the normal substrate ornithine slowed the rate of inhibition. Specific interference with polyamine biosynthesis may be a viable approach to control of some bacterial infections.     

Distinctive cytokinetics of blastogenic responses by spleen cells fromLegionella pneumophila-sensitized mice

Legionella pneumophila, the etiologic agent of respiratory pneumonia and systemic infections of man and some experimental animals, was studied in regard to the ability of these bacteria to induce blastogenic responses by spleen cells from normal vs sensitized mice. Antigens from this organism, including whole cell vaccine, an outer membrane extract, and a purified lipopolysaccharide-rich antigen, induced blastogenesis of normal spleen cells with peak responses on day +3 in vitro, similar to the blastogenic responses of spleen cells from the same animals exposed to the plant mitogens phytohemagglutinin and Concanavalin A, or the nonspecific bacterial antigenEscherichia lipopolysaccharides coli (LPS). Spleen cells from mice vaccinated with killedLegionella or infected with a sublethal dose of these bacteria 3–4 weeks or more previously evinced increased blastogenic responses to theLegionella antigens but not to the nonspecific mitogens or theE. coli LPS. The spleen cells from legionellae-sensitized mice evinced not only heightened blastogenic responses on day +3 of culture but also heightened responses during day +5 of culture. Spleen cells from sensitized mice showed less responses to the nonspecific plant mitogens orE. coli LPS on day +5 of culture. These results support the view that, after sensitization of mice with a bacterial antigen such asL. pneumophila, spleen cells respond in a specific heightened blastogenic manner toLegionella antigen, and this response has a higher magnitude and is more prolonged than the non-specific responses of cells from normal mice.     

Role of phosphatidylinositol 3-kinase-gamma in mediating lung neutrophil sequestration and vascular injury induced by E. coli sepsis

We addressed the in vivo role of phosphatidylinositol 3-kinase-gamma (PI3K-gamma) in signaling the sequestration of polymorphonuclear leukocytes (PMNs) in lungs and in the mechanism of inflammatory lung vascular injury. We studied mice with deletion of the p110 catalytic subunit of PI3K-gamma (PI3K-gamma(-/-) mice). We measured lung tissue PMN sequestration, microvascular permeability, and edema formation after bacteremia induced by intraperitoneal Escherichia coli challenge. PMN infiltration into the lung interstitium in PI3K-gamma(-/-) mice as assessed morphometrically was increased 100% over that in control mice within 1 h after bacterial challenge. PI3K-gamma(-/-) mice also developed a greater increase in lung microvascular permeability after E. coli challenge, resulting in edema formation. The augmented lung tissue PMN sequestration in PI3K-gamma(-/-) mice was associated with increased expression of the PMN adhesive proteins CD47 and beta(3)-integrins. We observed increased association of CD47 and beta(3)-integrins with the extracellular matrix protein vitronectin in lungs of PI3K-gamma(-/-) mice after E. coli challenge. PMNs from these mice also showed increased beta(3)-integrin expression and augmented beta(3)-integrin-dependent PMN adhesion to vitronectin. These results point to a key role of PMN PI3K-gamma in negatively regulating CD47 and beta(3)-integrin expression in gram-negative sepsis. PI3K-gamma activation in PMNs induced by E. coli may modulate the extent of lung tissue PMN sequestration secondary to CD47 and beta(3)-integrin expression. Therefore, the level of PI3K-gamma activation may be an important determinant of PMN-dependent lung vascular injury.     

Interleukin-10 inhibits neutrophil phagocytic and bactericidal activity

Abstract Effective host defense against bacterial invasion is characterized by the vigorous recruitment and activation of inflammatory cells, which is dependent upon the coordinated expression of both pro- and anti-inflammatory cytokines. Interleukin-10 (IL-10) is a recently described cytokine with potent anti-inflammatory properties in vivo and in vitro. In this study we investigated whether IL-10 could directly regulate the ability of neutrophils (PMN) to phagocytose and kill bacteria. Initial studies demonstrated that human recombinant IL-10 (hrIL-10) inhibited the ability of PMN to phagocytose Escherichia coli in vitro. Inhibition of phagocytosis occurred in the absence of changes in CR1 (C3b) or Fc receptor expression, as treatment of PMN with IL-10 failed to induce significant changes in FcγIIR, FcγIIIR or CR1 cell surface expression. However, incubation of PMN with IL-10 resulted in a dose-dependent decrease in CD11b (Mac-1) expression. In addition to effects on PMN phagocytosis, hrIL-10 significantly attenuated PMN microbicidal activity, as bactericidal assays revealed that co-incubation of PMN with hrIL-10 resulted in a marked decrease in killing of phagocytosed bacteria. Furthermore, IL-10 inhibited the production of superoxide from PMA-stimulated PMN, suggesting that the detrimental effects of IL-10 on PMN microbicidal activity were due, in part, to suppression of respiratory burst. In summary, our studies indicate that IL-10 inhibits PMN-dependent phagocytosis and killing of E. coli in vitro, and suggest that this cytokine may impair effective antibacterial host defense in vivo.     

Colonization resistance against potentially pathogenic bacteria in hexaflora-associated gnotobiotic mice.

A study of colonization resistance against potentially pathogenic bacteria (Escherichia coli and Pseudomonas aeruginosa) was conducted in hexaflora-associated gnotobiotic mice. Groups of germfree AKR mice were swabbed with five bacterial and a single gastrointestinal yeast species: Streptococcus faecalis. Lactobacillus brevis. Staphylococcus epidermidis, Enterobacter aerogenes, Bacteroides fragilis var. vulgatus, and Torulopsis sp. All species became established in the gut in 8 weeks. Later these associated mice were divided and challenged by four graded doses of E. coli or P. aeruginosa. The presence of challenge organism was monitored specifically in the freshly voided fecal specimens of the challenged mice. Escherichia coli colonized the gut of each mouse at each level up to 60 days post challenge. Pseudomonas aeruginosa was completely eliminated from each mouse at each dose level after 30 days post challenge. Evidence suggests that all six species were sufficient to prevent the colonization of P. aeruginosa and not of E. coli in the gut of the gnotobiotic mice.     

Organism-specific neutrophil-endothelial cell interactions in response to Escherichia coli, Streptococcus pneumoniae, and Staphylococcus aureus

The recruitment of polymorphonuclear leukocytes (PMNs) from the vascular space into the lung interstitium and airspace is an early step in the host innate immune response to bacterial invasion of these sites. To determine the ability of intact bacteria to directly elicit PMN migration across an endothelial monolayer, we studied in vitro migration of PMNs across a monolayer of human pulmonary microvascular endothelial cells in response to Streptococcus pneumoniae, Staphylococcus aureus, and Escherichia coli, as well as to purified E. coli LPS. Bacterial induction of PMN migration was dose dependent and elicited by > or =10(4) bacteria/ml of each of the species tested. Pretreatment of PMNs with blocking Abs to CD18 significantly inhibited migration of PMN in response to all stimuli tested, but had the most profound effect on migration to S. pneumoniae and S. aureus. Intact E. coli were 10 times more potent in inducing transmigration of PMNs than a corresponding amount of purified LPS. Bacterial induction of PMN migration did not correlate with up-regulation of surface endothelial ICAM-1 expression (purified LPS > intact E. coli > S. aureus and S. pneumoniae) nor up-regulation of VCAM-1 and E-selectin. Neutralizing Ab to ICAM-1 had no effect on PMN migration to any of the bacteria or to purified LPS. These findings demonstrate that diverse bacterial pathogens induce PMN migration across a pulmonary microvascular endothelial cell monolayer in a fashion that appears to be organism specific. In addition, intact bacteria elicit PMN-endothelial cell interactions distinct from those seen when purified bacterial products are used as agonists.     

QS系统中LasR和RhlR蛋白对铜绿假单胞菌生物被膜形成的影响以及免疫原性研究

为探讨铜绿假单胞菌 PAO1 中 lasR 和 rhlR 基因表达产物的分子生物学特性,研究它们对铜绿假单胞菌生物被膜形成的影响以及对小鼠的免疫保护效果,采用聚合酶链式反应 (PCR) 方法扩增铜绿假单胞菌标准株 PAO1 中的 lasR 和 rhlR 基因,全自动荧光测序仪测序,并用 Blast 方法检测克隆片段. 利用 pGEX4T-1 载体分别构建 lasR/rhlR-pGEX4T-1 重组质粒,在大肠杆菌 BL21(DE3)中诱导表达,并经过免疫印迹实验验证其生物学活性. 用硅胶膜培养法建立生物被膜模型,诱导转入了pGFPuv 质粒的铜绿假单胞菌 PAG0305 形成生物被膜,并测定 LasR 蛋白和 RhlR 蛋白对生物被膜形成的影响. 同时用纯化的重组蛋白免疫小鼠,菌落计数法检测免疫组和对照组鼠肺对铜绿假单胞菌的清除率. 以 PAO1 染色体 DNA 为模板的 PCR 结果显示,lasR 的全基因序列为 720 bp,rhlR 基因序列为 726 bp,经序列分析和同源性比较分别与 GenBank 中 lasR/rhlR 基因(登录号:M59425; AE004768) 的同源性为 100%. 大肠杆菌 BL21 (DE3) 分别转化重组质粒 lasR/rhlR-pGEX4T-1 后,经 IPTG诱导和 SDS- 聚丙烯酰胺凝胶电泳分析,表达的融合蛋白分子质量均为 54 ku 左右,与预期蛋白质分子质量相同. 荧光显微镜观察和测定结果表明,在硅胶膜上 PAG0305 能够形成典型的发荧光的生物被膜,LasR 或 RhlR 蛋白 (10 mg/L) 存在的情况下,PAG0305 生物被膜的形成速度在前三天比对照组平均提高 40.77%,而且两蛋白单独存在与同时存在时的作用相同. 体内实验中,免疫小鼠肺部对铜绿假单胞菌的清除率显著高于未经免疫的正常组 (P < 0.05). 上述结果表明:构建的lasR/rhlR-pGEX4T-1 重组质粒能够在大肠杆菌 BL21(DE3)中成功地表达并具有生物学活性. LasR/RhlR 蛋白在体外模型中能够加快铜绿假单胞菌生物被膜的形成速度,是调节铜绿假单胞菌生物被膜形成的重要因素之一. 免疫结果表明,重组蛋白对小鼠表现出一定的保护作用,这为进一步开展疫苗研究奠定了基础.     

Protective effect of recombinant human granulocyte colony-stimulating factor (rG-CSF) against various microbial infections in neutropenic mice.

Protective effect of recombinant human granulocyte colony-stimulating factor (rG-CSF) on microbial infections was studied in cyclophosphamide (CPA)-induced neutropenic mice. The neutropenic mice showed severely decreased resistance against systemic infections of Pseudomonas aeruginosa, Escherichia coli, Serratia marcescens, Staphylococcus aureus, and Candida albicans. When such mice were injected subcutaneously with rG-CSF on four consecutive days beginning the day after CPA injection, the decreased anti-microbial resistance of the mice was restored to the level of that in normal mice. The anti-infective effect of rG-CSF was dose-dependent and the 50% effective doses (ED50) in various microbial infections tested were 1-10 micrograms/kg/day. The results suggest that rG-CSF is useful for protection of neutropenic patients from microbial infections.     

Matrix metalloproteinase-9 deficiency impairs host defense against abdominal sepsis

Matrix metalloproteinase (MMP)-9 is involved in extracellular matrix degradation and leukocyte migration. To determine the role of MMP-9 in the innate immune response to peritonitis, MMP-9 gene-deficient (MMP-9(-/-)) and normal wild-type mice were i.p. infected with Escherichia coli. MMP-9 mRNA and pro-MMP-9 protein levels increased rapidly upon induction of peritonitis. Although MMP-9(-/-) neutrophils showed a normal phagocytosis of E. coli in vitro, MMP-9(-/-) mice displayed a reduced resistance against E. coli peritonitis, as indicated by an enhanced bacterial outgrowth in the peritoneal cavity and increased dissemination of the infection. Furthermore, the cytokine response to LPS was not influenced by MMP-9 deficiency. However, during E. coli peritonitis, MMP-9(-/-) mice showed much higher peritoneal chemokine and cytokine levels compared with wild-type mice. Despite the increased local chemokine concentrations, MMP-9(-/-) mice displayed a diminished recruitment of leukocytes to the site of infection, indicating that cellular migration was impaired. Moreover, MMP-9(-/-) mice developed more severe distant organ damage during infection. These data suggest that MMP-9 is an essential component of an effective host response to E. coli peritonitis.     

Augmented inducible nitric oxide synthase expression and increased NO production reduce sepsis-induced lung injury and mortality in myeloperoxidase-null mice

The myeloperoxidase (MPO)-hydrogen peroxide-halide system is an efficient oxygen-dependent antimicrobial component of polymorphonuclear leukocyte (PMN)-mediated host defense. However, MPO deficiency results in few clinical consequences indicating the activation of compensatory mechanisms. Here, we determined possible mechanisms protecting the host using MPO(-/-) mice challenged with live gram-negative bacterium Escherichia coli. We observed that MPO(-/-) mice unexpectedly had improved survival compared with wild-type (WT) mice within 5-12 h after intraperitoneal E. coli challenge. Lungs of MPO(-/-) mice also demonstrated lower bacterial colonization and markedly attenuated increases in microvascular permeability and edema formation after E. coli challenge compared with WT. However, PMN sequestration in lungs of both groups was similar. Basal inducible nitric oxide synthase (iNOS) expression was significantly elevated in lungs and PMNs of MPO(-/-) mice, and NO production was increased two- to sixfold compared with WT. Nitrotyrosine levels doubled in lungs of WT mice within 1 h after E. coli challenge but did not change in MPO(-/-) mice. Inhibition of iNOS in MPO(-/-) mice significantly increased lung edema and reduced their survival after E. coli challenge, but iNOS inhibitor had the opposite effect in WT mice. Thus augmented iNOS expression and NO production in MPO(-/-) mice compensate for the lack of HOCl-mediated bacterial killing, and the absence of MPO-derived oxidants mitigates E. coli sepsis-induced lung inflammation and injury.     

Polymorphonuclear cell transmigration induced by Pseudomonas aeruginosa requires the eicosanoid hepoxilin A3

Lung inflammation resulting from bacterial infection of the respiratory mucosal surface in diseases such as cystic fibrosis and pneumonia contributes significantly to the pathology. A major consequence of the inflammatory response is the recruitment and accumulation of polymorphonuclear cells (PMNs) at the infection site. It is currently unclear what bacterial factors trigger this response and exactly how PMNs are directed across the epithelial barrier to the airway lumen. An in vitro model consisting of human PMNs and alveolar epithelial cells (A549) grown on inverted Transwell filters was used to determine whether bacteria are capable of inducing PMN migration across these epithelial barriers. A variety of lung pathogenic bacteria, including Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa are indeed capable of inducing PMN migration across A549 monolayers. This phenomenon is not mediated by LPS, but requires live bacteria infecting the apical surface. Bacterial interaction with the apical surface of A549 monolayers results in activation of epithelial responses, including the phosphorylation of ERK1/2 and secretion of the PMN chemokine IL-8. However, secretion of IL-8 in response to bacterial infection is neither necessary nor sufficient to mediate PMN transepithelial migration. Instead, PMN transepithelial migration is mediated by the eicosanoid hepoxilin A3, which is a PMN chemoattractant secreted by A549 cells in response to bacterial infection in a protein kinase C-dependent manner. These data suggest that bacterial-induced hepoxilin A3 secretion may represent a previously unrecognized inflammatory mechanism occurring within the lung epithelium during bacterial infections.     

Value of stool examination in patients with diarrhoea.

Findings of stool examinations in 1593 patients with diarrhoea due to a single enteric pathogen--enterotoxigenic Escherichia coli rotavirus, Shigella, Campylobacter jejuni, Vibrio cholerae 0:1, Entamoeba histolytica, or Giardia lamblia--were reviewed to determine how well they predicted the agent associated with the diarrhoea. Specimens were examined visually for blood and mucus, tested for pH, and examined under a microscope for the presence of red and white blood cells, parasites, and stool fat. Although visible blood was more common in specimens from patients infected with Shigella (51%) and Ent histolytica (39%) than in those from patients infected with other agents (6%; p less than 0.01), patients infected with Shigella were most likely to have numerous faecal leucocytes (greater than 50/high power field: 39% v 8% of all patients and 7% of patients infected with Ent histolytica, p less than 0.01 in both cases). Patients infected with enterotoxigenic E coli, rotavirus, V cholerae 0:1, or C jejuni had loose stools with fewer red or white cells. Patients infected with rotavirus and C jejuni were more likely to have acid stools with 3 to 4+ fat, but these findings were related to young age and breast feeding. Stool examination is most useful in establishing a diagnosis of dysentery and in helping to distinguish between patients infected with Shigella and Ent histolytica; it is of limited usefulness in discriminating between pathogens causing watery diarrhoea.