Efficacy and safety of cefepime in the treatment of bronchopulmonary disease exacerbation in pediatric patients with mucoviscidosis]

Clinicobacteriological effect of cefepime (in combination with amikacin) was studies in 25 pediatric patients of the age of 7 to 17 years with a mixed form of mucoviscidosis at the stage of the bronchopulmonary infection exacerbation. The basic pathogens isolated from the sputum were: Pseudomonas aeruginosa sm., P. aeruginosa muc. (67.5%) and Staphylococcus aureus (29.1%). The 2-week treatment course resulted in a marked clinical effect with improvement of the lung functional indices and eradication of the majority of the S. aureus strains (81.2%) and half of the P. aeruginosa strains (49.6%). The only side effect was moderate diarrhea not requiring discontinuation of the drug use.     

Pefloxacin in the treatment of patients with mucoviscidosis]

It was shown that microbial flora isolated from the bronchial secretion of 39 patients with mucoviscidosis in 1999-2001 consisted in one third (32.8%) of S. aureus strains. Evaluation of pefloxacin efficacy in the case of monoinfection and pathogens association revealed potent antistaphylococcal effect of the drug. Positive result was demonstrated in 82.3% cases by the 7th day. Among the side effects dominated arthropathy which disappeared at the period from 3 days to 3 months after drug administration was stopped.     

Evaluation of the influence of the bacterial vaccines Pneumo-23 and Act-HIB on the course of the chronic inflammatory process of the respiratory organs in children

The effectiveness and safety of vaccination of children having chronic inflammatory lung diseses with Pneumo-23 and Act-HIB were evaluated. The group under study included 38 children having chronic pneumonia, congenital defects of lung development, Kartagener's syndrome, mucoviscidosis; of these children, 25 were vaccinated with Pneumo-23 and 13--with Act-HIB. For comparison a group of 40 children with the same pathology, but not vaccinated, was used. A favorable course of the postvaccinal period was noted. Prior to vaccination Streptococcus pneumoniae in association with Haemophilus influenzae were isolated from all patients; in a year after vaccination with Pneumo-23 these microorganisms were isolated only in monoculture: S. pneumoniae in 3 out of 25 cases (88% elimination) and H. influenzae in 10 out of 25 cases (60% elimination).     

Rational use of antibiotics in mucoviscidosis pediatric cases with an account of local microbiological monitoring]

The results of local microbiological monitoring of bronchial secretion in 482 children with mucoviscidosis observed within 2000-2004 in the Republican Centre of Mucoviscidosis are presented. The results provided development of recommendations for rational use of antibiotics in the treatment of infectious processes in pediatric patients with mucoviscidosis. Since the emergence of MRSA in such patients is low, it is recommended to use antistaphylococcal betalactams (oxacillin, cefazolin, amoxycillin/clavulanate) for the treatment of infections due to S. aureus. For the treatment of infections due to some other pathogens, except S. maltophilia, the most active betalactams were carbapenems (imipenem and meropenem). Ciprofloxacin was active against numerous etiological agents causing low respiratory tract infections in children with mucoviscidosis except S. maltophila and A. xylosoxidans subsp. xylosoxidans. For the treatment of infections due to P. aeruginosa, P. aeruginosa muc. and K. pneumoniae the most active aminoglycosides were amikacin and tobramycin (for P. aeruginosa and P. aeruginosa muc.), while gentamicin was not active in such cases. As for antibiotics of other groups, high activity against S. aureus in the treatment of children with mucoviscidosis was recarded with the use of vancomycin, fusidic acid and rifampicin. Azithromycin and co-trimoxazole were active against H. influenzae. Chloramphenicol was active against S. maltophilia, B. cepacia and H. influenzae in the treatment of such patients.     

Polymorphism of nucleotide sequences of human genomic DNA linked to a mucoviscidosis locus

Polymorphism in the restriction fragments length of human DNA sequences linked to mucoviscidosis locus was studied in the healthy control group and in the families affected by mucoviscidosis. The plasmid clones metH, pJ3.11,XV-2c and pKM.19 were used as hybridization probes. The allelic frequencies of the polymorphic loci were determined for total population and for affected families. The linkage disequilibrium between the disease locus and linked polymorphic loci detectable with XV-2c (TaqI endonuclease) and pKM.19 (PstI endonuclease) was demonstrated. The high informational value of DNA-diagnosis of mucoviscidosis in the family studies with the use of four DNA probes combination has been demonstrated.     

On fluoroquinolones treatment safety in children (clinical, morphological and catamnesis data)]

Results of prospective comparative investigation of monofluoroquinolones (ciprofloxacin, ofloxacin, pefloxacin) arthropathy are presented. The trial was performed at 144 children with mucoviscidosis (aged 0.5-16) and at 37 children with aplastic anemia (aged 1.75-15). Two groups differ by necessary antibacterials regimes and hence by different abilities for arthropathy development: patients with mucoviscidosis were treated with fluoroquinolones followed by repeated short courses in combination with other antibacterials; patients with aplastic anemia--were treated permanently for a long time with low doses as monotherapy for autoinfection prophylaxis. Analysis was performed on the base of catamnesis, year growth rate, postmortal morphological investigation of the right knee joint. It was shown that quinolone arthropathy development didn't depend on treatment duration, as it developed during the first three weeks of the fluoroquinolone use, but depended on the drug, patient age and nosology. Arthropathy has favourable prognosis and was fully resolved at the period from 7 days to 3 month according to the arthropathy form (arthrologic, arthritic). Quinolones arthropathy at the children has specific features, the main one is absence of cartilage damage confirmed by morphological analysis.     

Comparative morphological analysis of the articular cartilage, epiphyseal plate, spongy bone, and synovial membrane of the knee joint in children treated and not treated with ciprofloxacin]

Comparative data on he postmortem morphological examination of the knee joint in children treated and not treated with ciprofloxacin while alive are presented. Nine children were ill with mucoviscidosis and 8 children were ill with aplastic anemia. The patients were ill with mucoviscidosis and 8 children were ill with aplastic anemia. The patients were treated with ciprofloxacin in a daily dose of 20 to 40 mg/kg body weight at the average for 148 days. The condition of the articular cartilage, growth area, spongy bone and synovial membrane of the knee joint was examined visually, histologically and morphologically. It was revealed that ciprofloxacin had no chondrotoxic effect. The structure affected in some cases by the ciprofloxacin treatment was the synovial membrane which developed subacute synovitis not clinically manifested (latent) in life. The phenomenon is explained.     

Evaluation of tolerance and efficacy of pefloxacin in the treatment and prevention of severe infections in children with mucoviscidosis and aplastic anemia]

Pefloxacin (Abaktal) efficacy and safety were investigated at 21 children (7-16 years old) randomized in 2 groups: children with mucoviscidosis and children with aplastic anemia. The drug was used at the dose 15-20 mg/kg per day bid for 14-28 days. Pefloxacin was used in combination with ceftazidime and amikacin. Combined therapy demonstrated good clinical efficacy. Bacteriological efficacy was not uniform: staphylococci were not isolated from sputum since the 7th day of treatment, but pseudomonads were cultured even on the 14th day of the treatment (the sensitivity to pefloxacin remained). The only but frequent side-effect was arthropathy. The background and some peculiarities of arthropathy development were analyzed. This phenomenon is called quinolone-induced synovitis. The risk group for quinolone-induced synovitis was estimated--children elder than 10 years with allergic anamnesis. Good clinical efficacy and tolerability of pefloxacin at the children with mucoviscidosis or aplastic anemia is a reason and base to cancel the limits to its use in pediatrics.     

The use of polymerase chain reaction in the diagnosis of diphtheria infection

624 Corynebacterium diphtheriae strains, newly isolated from patients and carriers, were studied with the use of the methods of gel immunodiffusion (Elek's test) and polymerase chain reaction (PCR). In the evaluation of 388 C. diptheriae strains, found to be toxigenic in PCR, the results of Elek's test coincided with those of PCR on 98% of cases. In 38 out of 143 strains (26.5%), nontoxigenic according to the results of Elek's test, the presence of the A-fragment of the tox-gene was established. Subculturing in nutrient media made it possible to determine the presence of toxin in 19 out of 38 of these strains; the remaining strains, isolated mainly from carriers, were found to have the "silent" gene. The advantage of using PCR for the detection of toxigenic and nontoxigenic C. diphtheriae strains of different origin was shown.     

Clinical and bacteriological efficacy and tolerability of meropenem in the treatment of bronchopulmonary affections in children with mucoviscidosis]

Meropenem (in combination with amikacin) was used in the treatment of children and adolescents with mucoviscidosis and severe exacerbation of bronchopulmonary affections. The drug showed satisfactory clinical and moderate bacteriological effects (48.3%) as dependent on the severity and duration of the disease and the microbial flora. Meropenem was well tolerated: no side effects were observed during the treatment, whereas it was used in high doses (60-105 mg/kg daily).     

Possible location of the gene of mucoviscidosis (pancreatic cystic fibrosis) in chromosome 21]

On the basis of the data available in the literature pertaining to the relatively high frequency of mucoviscidosis in children affected with Down's syndrome a hypothesis is advanced concerning the possible location of the mucoviscidosis gene in the chromosome 21. The author's own preliminary data are presented. Approaches to the verification of this hypothesis are described.     

Contribution of Pseudomonas Aeruginosa strains to infections in patients of specialistic outpatients clinics of the SP ZOZ in Nidzica

The aim of this study was to examine a frequency of isolation and analysis of drug susceptibility o P. aeruginosa strains cultured from clinical specimens obtained from patients treated in specialistic outpatient clinics of the Samodzielny Publiczny Zespó? Opieki Zdrowotnej (SP ZOZ) in Nidzica durin 40 months (01. 09. 2000 - 31. 12. 2003). Ninety six P. aeruginosa strains were cultured out of 829 clinical samples collected from ambulatory patients and processed in the Bacteriological Laboratory of SP ZOZ in Nidzica during over three years. P. aeruginosa strains were isolated from 11.6% of examined specimens. The greatest number of strains (49.0%) were cultured from urine samples obtained from children. Identification of strains was performed using biochemical tests (Becton Dickinson, Emapol, bio-Merieux). Susceptibility of strains to antimicrobial agents was determined with disc diffusion method according to NCCLS recommendations. Special tests were applied to detect extended-spectrum beta-lactamases (ESBL). The most active in vitro against isolated P. aeruginosa strains was a carbapenem - imipenem. All strains were susceptible to this antibiotic. Ciprofloxacin (94.8% of susceptible strains), ceftazidime (89.6%), gentamicin (86.5%), piperacillin (84.4%) and aztreonam (76.0%) were active against the majority of P. aeruginosa strains isolated from ambulatory patients. Six strains (6.25% of all strains) producing extended--spectrum beta--lactamases (ESBL) were detected. It is alarming, that the majority of P. aeruginosa strains from outpatients were cultured out of pediatric samples (61.5%). Because of an increase in resistance and appearance of new mechanisms of resistance to antibiotics/chemotherapeutics in P. aeruginosa strains, it is necessary to monitor a drug susceptibility of these strains causing infections in ambulatory patients.     

Pneumococcal serotypes in children with acute and chronic inflammatory diseases of the lungs and in healthy children

The serotyping of 350 Streptococcus pneumoniae strains isolated from patients with acute and chronic diseases of the respiratory organs and from healthy children was carried out with the use of the agglutination test. 145 pleural fluid samples were tested for the presence of the pneumococcal antigen and its K-type. The prevailing pneumococcal serotypes were 6, 1, 19, 12 and 9 in acute pneumonia and 6, 19, 42, 3 and 12 in chronic pneumonia, including, respectively, 64.8% and 62% of all typed strains. Cases of pneumonia with complications in the form of pleuritis were mostly induced by serotypes 3, 1, 12 and 14, while in the destructive forms of pneumonia K-types 3, 14, 9 and 12 were isolated. Examinations of healthy pre-school children have shown 16.1% of them to be transitory pneumococcus carriers. Multiple biological examinations carried out during 1.5 years revealed that in this period 42.4% of the children were pneumococcus carriers.     

Etiology of acute pneumonia occurring against a background of influenza and other acute respiratory viral infections

The etiology of acute pneumonia (AP) was studied in 229 patients who had the disease simultaneously with influenza (106 patients), other viral and mycoplasmal infections (48 patients), and without concomitant acute viral infections (75 patients). The use of the quantitative microbiological method and the indirect immunofluorescence test with autostrains or Streptococcus pneumoniae strains of serotypes 2, 3, and 6, prevailing in Leningrad in patients with acute inflammatory diseases of the lungs, made it possible to find out the pneumococcal etiology of AP in 95% of patients irrespective of the presence of acute respiratory viral infections. The etiological role of opportunistic bacteria was revealed in 13 AP patients (5.7%); in 2 of them the causative agent of AP was Staphylococcus aureus and in 11, various species of Gram-negative enterobacteria. The latter were the cause of complications in 8 cases of pneumococcal pneumonia.     

A study of pathogenic factors of Streptococcus pneumoniae strains causing meningitis

Abstract Pneumococcal meningitis in St. Petersburg in the period 1985–1991 occurred in 1.7–2.3 children per 100 000 annually. The most common serotypes among pneumococcal strains isolated from patients with meningitis were 19, 1, 6, 15, and 2, whereas, among the capsulated strains isolated from carriers, type 3 predominated. Only one third of strains from cases of meningitis were highly virulent for mice (types 1, 2, 3). Hyaluronidase was produced by all the 39 studied strains, 22 (84.6±7.1%) out of 26 strains from patients with otitis media, and only by 15 (11.5±2.8%) out of 130 strains isolated from carriers. Non-capsulated strains lacked this enzyme. Results of intranasal inoculation of pneumococcal strains with different hyaluronidase activity and addition of exogenous hyaluronidase to strains which did not produce the enzyme confirm the hypothesis that this enzyme plays an important role in bacterial dissemination and breaching of the blood brain barrier by pneumococci. It was concluded that high hyaluronidase activity, presence of capsule, and pneumolysin or serotype (1, 2, and 19) despite hyaluronidase titer, are the most important factors contributing to the development of pneumococcal meningitis. The role of the mouse toxic factor is unclear.     

Resistance of Haemophilus influenzae to Trimethoprim

Out of 210 isolates of Haemophilus influenzae obtained from the sputum of 63 patients with chronic respiratory infections 109 (52%) were resistant to trimethoprim-sulphamethoxazole by the disc test. The minimal inhibitory concentrations of trimethoprim for 17 out of 18 strains recorded as resistant were 10 μg/ml or higher. Resistant strains were isolated from time to time from 32 (82%) out of 39 patients known to have been treated with trimethoprim-sulphamethoxazole, compared with only 1 (12·5%) out of 8 patients known not to have been treated with this drug combination. Resistant strains were isolated most frequently from patients who had received long-term treatment. Since sulphamethoxazole penetrates from the blood into the bronchial secretions less readily than does trimethoprim it seems likely that the ratio of the two drugs in the bronchial tree is far from ideal. This may be an important factor in the use of these drugs for chest infections.     

Strongyloides venezuelensis: the antigenic identity of eight strains for the immunodiagnosis of human strongyloidiasis

The antigens of eight strains of Strongyloides venezuelensis were identified by means of the indirect immunofluorescence antibody (IFAT), enzyme-linked immunosorbent assay (ELISA) and immunoblot (IB) tests. Infective larvae (L3) from these strains were obtained from Rattus norvegicus feces cultures. For IFAT, sections of L3 were used while the ELISA and IB, tests were conducted with alkaline extract. Ninety serum samples were tested: 30 from patients with S. stercoralis, 30 from patients with other parasitic diseases, and 30 from healthy subjects (free of parasites). Average sensitivity and specificity among all eight strains, both for IFAT and ELISA, were, respectively, 93% and 100%. In the IB, anti-S. stercoralis IgG recognized a single antigenic fraction with 45 kDa. Serum samples from patients with S. stercoralis revealed antigens from different strains of S. venezuelensis, indicating antigenic identity for possible use in the synthesis of recombinant antigen that could be useful in immunodiagnosis and vaccine against this parasite.     

Analysis of the microorganisms isolated from kidney recipients treated in the Department of Clinical Transplantology and General Surgery, Medical University in Bydgoszcz in 2001 year

One of the most important reasons of complications after organ transplantation may be the infections. The aim of the present work was to analyse of microorganisms isolated from patients, which were the recipients for kidney transplantation in 2001 year. The diagnostic material contained 140 samples from 53 patients, 40 (22.2%) samples from Euro-Collins fluid used for kidney storage before the transplantation and 3 end-pieces of catheter. The positive cultures were found in 125 (69.4%) samples. Gram-positive bacteria constituted 58.4%, Gram-negative bacteria--34.2%, fungi--7.4%. 140 strains of microorganisms were isolated from pharyngeal swabs and 55 strains of bacteria were isolated from palm swabs. Most of them were considered as a physiological flora. It was found 4-time significant bacteriuria among positive cultures from urine samples. In the cultures of fluid used for kidney storage 12 (30.0%) positive samples were obtained, out of which 16 strains of microorganisms were isolated. Among the strains of Staphylococcus 35.3% were MR. Among 18 strains of Gram-negative rods one strain was multiresistant to antibiotics. None of analyzed strains was ES beta L-producing. A high percentage of positive cultures from fluid used for kidney storage suggests the possibility of contamination of the organ with bacteria coming from kidney donor or during the storage, transport and actions connected with taking the organ to the transplantation.     

The prevalence of Yersinia and its serologic variants in patients with acute intestinal diseases of undetermined etiology in Leningrad

Among Yersinia enterocolitica strains of 32 serovars, proposed as typing strains, some strains were found to belong to new species. Y. enterocolitica sensu stricto was represented by 21 serovars in the collection of typing strains. The occurrence of different Yersinia serovars in patients with acute enteric diseases of unknown etiology in Leningrad in 1983-1986 was determined with the use of the set of monoreceptor to 21 serovars. Out of 2,947 cultures studied by biochemical and serological methods, 81% were typed. Among them 18 Y. enterocolitica serovars were determined. Their characteristic feature was the prevalence of serovar O3 and an insignificant proportion of serovar O9. More frequently Yersinia were detected in patients with the primary diagnosis of acute enteric diseases (93.5%). The overwhelming majority (two-thirds) of Yersinia strains were isolated from children. A great number of strains detected in this study (70%) was isolated on days 10-15 of the bacteriological examination. In 927 cultures the following biovars were determined: the strains of serovar O3 belonged to biovar 4 and all other strains, to biovar 1.     

Metronidazole resistance and virulence factors in Helicobacter pylori as markers for treatment failure in a paediatric population

The eradication rate obtained using the classical triple therapy containing metronidazole, amoxicillin and bismuth citrate, was determined in 57 paediatric patients with digestive disorders, according to the susceptibility to metronidazole of the Helicobacter pylori strains (determined by agar dilution) and the cagA and vacA status (determined by PCR). Eradication was obtained in 38 out of 43 patients (88.3%) infected by H. pylori with metronidazole MIC < or = 2 mg l(-1), in 3 out of 6 patients (50%) when MIC was 4-8 mg l(-1) and in 4 out of 8 patients (50%) when MIC was > 8 mg l(-1). Among patients infected with cagA+ and cagA- strains an eradication rate of 75% (6/8) and 75% (18/24) was found, and 50% (3/6) and 80% (21/26) among vacA s1- and vacA s2-infected subjects (P > 0.05). H. pylori eradication depends on the susceptibility of the strain to metronidazole, being higher in patients infected with susceptible H. pylori. However, according to our data the cagA or vacA status was not an important factor in treatment failure in the eradication of H. pylori.