Study of the role of conditionally pathogenic enterobacteria in acute intestinal diseases]

Conditionally pathogenic enterobacteria were isolated in 34.2% of the patients with acute intestinal diseases (1559 cases examined in all). Such representatives of enterobacteria as Klebsiella, Hafnia, Citrobacter of 4, 8, and 22 serological groups. Proteus mirabilis of 6, 10, 13, 26, and 28 serological groups, and Proteus morganii mostly played the etiological role. In some of the patients conditionally pathogenic microbes only aggravated the main disease, taking part in the development of dysbacteriosis. In healthy individuals these microbes were much more rare and were encountered inconstantly.     

Proteus syndrome: clinical and surgical aspects

The authors report a new case of Proteus syndrome with delayed diagnosis and they discuss the place of surgery in this syndrome.     

The Proteus syndrome: the Elephant Man diagnosed.

Sir Frederick Treves first showed Joseph Merrick, the famous Elephant Man, to the Pathological Society of London in 1884. A diagnosis of neurofibromatosis was suggested in 1909 and was widely accepted. There is no evidence, however, of café au lait spots or histological proof of neurofibromas. It is also clear that Joseph Merrick''s manifestations were much more bizarre than those commonly seen in neurofibromatosis. Evidence indicates that Merrick suffered from the Proteus syndrome and had the following features compatible with this diagnosis: macrocephaly; hyperostosis of the skull; hypertrophy of long bones; and thickened skin and subcutaneous tissues, particularly of the hands and feet, including plantar hyperplasia, lipomas, and other unspecified subcutaneous masses.     

Growth of salmonellas in different enrichment media

The usefulness of selenite-F (S-F), tetrathionate (MKT) and Rappaport-10 (R-10) broths as enrichment media to support growth of salmonellas either alone or in the presence of other competing organisms was studied. Their ability to support the growth of stressed salmonellas from water was also investigated. It was observed that R-10 was more inhibitory to competing organisms than MKT and S-F. It strongly inhibited the growth of Pseudomonas aeruginosa, Citrobacter freundii and Proteus vulgaris though not of Escherichia coli and Enterobacter aerogenes. It was more toxic, however, to small numbers of salmonellas than MKT and S-F. Tetrathionate was strongly inhibitory for E. coli and Ent. aerogenes but much less so for Proteus and Pseudomonas species. Selenite-F was much less inhibitory than MKT to Ps. aeruginosa and it did not inhibit growth of E. coli and Ent. aerogenes as much as MKT. Salmonellas were inhibited by all three enrichment media and none of them is ideally suited for direct use. Of the three media, R-10 was much more inhibitory to stressed organisms than S-F or MKT.     

Growth of salmonellas in different enrichment media

The usefulness-of selenite-F (S-F), tetrathionate (MKT) and Rappaport-10 (R-10) broths as enrichment media to support growth of salmonellas either alone or in the presence of other competing organisms was studied. Their ability to support the growth of stressed salmonellas from water was also investigated. It was observed that R-10 was more inhibitory to competing organisms than MKT and S-F. It strongly inhibited the growth of Pseudomonas aeruginosa, Citrobacter freundii and Proteus vulgaris though not of Escherichia coli and Enterobacter aerogenes. It was more toxic, however, to small numbers of salmonellas than MKT and S-F. Tetrathionate was strongly inhibitory for E. coli and Ent. aerogenes but much less so for Proteus and Pseudomonas species. Selenite-F was much less inhibitory than MKT to Ps. aeruginosa and it did not inhibit growth of E. coli and Ent. aerogenes as much as MKT. Salmonellas were inhibited by all three enrichment media and none of them is ideally suited for direct use. Of the three media, R-10 was much more inhibitory to stressed organisms than S-F or MKT.     

In Vitro Studies of Semisynthetic α- (Substituted-Ureido) Penicillins

The activity of three alpha-(substituted-ureido) penicillins was evaluated in vitro against 599 clinical isolates of gram-negative bacilli, by use of the broth-dilution technique. At a concentration of 12.5 mug or less/ml, BL-P1597 inhibited 90% of isolates of Pseudomonas sp., 56% of Enterobacter sp., 67% of indole-positive Proteus spp., 72% of Escherichia coli, and 85% of Proteus mirabilis. BL-P1654 had similar activity, whereas BL-P1532 was much less active. At a concentration of 25 mug or less/ml, BL-P1597 also inhibited nearly 60% of isolates of Klebsiella sp. and nearly 40% of Serratia sp. BL-P1597 and BL-P1654 were as active as ampicillin and carbenicillin against E. coli and P. mirabilis. They were less active than carbenicillin against indole-positive Proteus spp. Both drugs were substantially more active than carbenicillin against Pseudomonas sp. A strain of Pseudomonas sp. which developed resistance to carbenicillin also developed resistance to the alpha-(substituted-ureido) penicillins simultaneously.     

Cholesterol incorporation into bacterial membranes.

The wall-covered bacteria Micrococcus lysodeikticus, Bacillus megaterium, and Proteus mirabilis incorporated exogenous cholesterol into their cytoplasmic membrane in quantities resembling those incorporated by sterol-nonrequiring mycoplasmas. Cholesterol incorporation into the outer membrane of P. mirabilis was much more restricted than into the cytoplasmic membrane.     

Pseudomonas aeruginosa and Proteus antigenemia and antibody formation in mono- and mixed infections in patients with suppurative inflammatory diseases

P. aeruginosa and Proteus antigenemia and antibody production have been studied in 335 patients with purulent inflammatory diseases. The study has revealed that in the association of P. aeruginosa and Proteus with staphylococci and representatives of the family Enterobacteriaceae the level of antigenemia is considerably lower than in monoinfections or in the association of these microorganisms with streptococci. In mixed infections humoral immune response develops later than in cases of monoinfection. An important role of ecological and physiological relationships between microorganisms in the course of purulent processes and in their influence on the host has been confirmed. The use of the enzyme immunoassay in the clinical practice has made it possible to determine the etiological role of P. aeruginosa and Proteus in the development of suppurative-inflammatory diseases, to select adequate immunotherapy, including the use of anti-P. aeruginosa and anti-Proteus plasmas, and to evaluate the effectiveness of treatment.     

The Meckel syndrome. Pathological and cytogenetic observations in eight cases

Summary Eight new cases of Meckel syndrome, two of them occurring in the same family, are presented. Occipital encephalocele of varying extent, multicystic renal dysplasia not associated with urinary tract obstruction, and postaxial hexadactyly comprise the three basic features of this lethal syndrome with autosomal recessive inheritance. From our observations it appears that congenital hepatic fibrosis, abnormal external genitalia in male infants and a malformed tongue with lipomatous excrescences are also frequently occurring anomalies with important diagnostic value.The statement that the majority of cases of Meckel syndrome can be detected prenatally is further supported by two cases in the present series. The incidence of this syndrome may be much higher than previously thought.     

Síndrome de la bolsa de orina púrpura en dos pacientes institucionalizados

Purple urine bag syndrome (PUBS) is an uncommon but particularly striking phenomenon characterised by a chemical reaction involving the urine, plastic and certain enzymes from some sulphatase- and phosphatase-producing bacteria, including Proteus mirabilis, Escherichia coli and Morganella morganii, amongst others. Following this reaction, the catheter and the bag may be stained red, blue or purple. This phenomenon tends to occur in patients with multiple pathology and with urinary catheters, as part of a urinary tract infection. We describe two clinical cases of PUBS in institutionalised patients with permanent urinary catheters.     

Appearance of microthrombi in vessels of central nervous system in the course of disseminated intravascular coagulation syndrome in acute leukemias

In 35 cases out of 37 (88%) microthrombi have been found in CNS. They appeared much more frequently than it could be expected on the basis of the clinical picture of DIC syndrome or changes in the coagulation system. Microthrombi occurred prevalently in white substance of the frontal and occipital lobes as well as in thalamus. In 15 cases the microthrombi were the only evidence of DIC syndrome, besides clinically "mute" one. It should be emphasized that almost in half of the cases we encountered numerous disseminated microthrombi in many regions of CNS. Unequal distribution of microthrombi in CNS points out the significance of the local factor in the pathogenesis of DIC syndrome.     

Somatic gene mutation and human disease other than cancer

While the focus of much mutation research is on germ-line mutation, somatic mutation is being found to be important in human disease. Neurofibromatosis 1 and McCune-Albright are disorders which are detected in the skin and other systems. The skin manifestations were essential for the demonstration of somatic mosaicism in neurofibromatosis 1, while analysis of blood DNA demonstrated somatic mutation in neurofibromatosis 2. Incontinentia pigmenti is also a disorder seen in skin and other tissues, but here it is the rare variant of the disorder in males, where it is usually lethal, that involves somatic mosaicism. Paroxysmal nocturnal hemoglobinuria is a disorder of the blood and cell separation of blood elements allows the demonstration of the somatic mosaicism. This review also discusses disorders in which somatic mosaicism, for mutations probably incompatible with life if the mutation had been germ-line, are likely to be involved. These include the Proteus syndrome, which involves both vascular tissues and bones, and two disorders which might be thought of as representing two subtypes of Proteus: Klippel-Trenaunay, which involves vascular tissues, and Maffuci, which involves bones. Embryonic mutations, which create mosaicism for both the soma and germ-line, are being increasingly found in a number of disorders and are discussed more briefly. Finally, reverse mutations involving the soma have been recently found in several disorders and such revertant mutations are also examined. While the review focuses on the clinical importance of somatic mutations, many of the mutations found to date are tabulated. It is too early to see if there is a different pattern of somatic mutation as compared to germ-line mutation. Although the parameters to allow careful quantitation are not yet available, it seems that the frequency of gene mutation in embryonic cells is not markedly different than that in the germ-line.     

CUSHING'S SYNDROME

Sixteen cases of verified Cushing''s syndrome, and twelve cases of probable Cushing''s syndrome were reviewed and data on them were compared with various reports on Cushing''s syndrome in the literature.The diagnosis hinges upon a high index of suspicion, and one or several of the major criteria may be lacking.Ultimate establishment of correct diagnosis should be based largely on the clinical features, although stimulation and suppression tests may help to confirm a clinical diagnosis.In well-established clinical cases, with borderline laboratory confirmation, exploration may be justified, especially if tests fail to identify a specific cause.In cases of adrenal cortical tumor, all pathological tissue should be removed if possible, with great care to support and stimulate the remaining atrophic adrenal gland during and following operation.In cases of bilateral adrenal cortical hyperplasia, the problem is one of how much to remove. At present most investigators advocate radical subtotal resection, leaving less than 10 per cent of one side.     

Trimethoprim resistance in Finland after five years' use of plain trimethoprim.

A total of 1388 urinary bacterial pathogens were tested for resistance to plain trimethoprim after five years'' use of this drug for prophylaxis against urinary tract infections. Samples were obtained in Turku, Finland, where use of the drug is much greater than in other parts of Finland. Resistance to trimethoprim (greater than 8 mg/l; agar-dilution method) occurred in 20.3% of strains isolated from outpatients and 39.8% of strains isolated from inpatients. Escherichia coli and Micrococcus showed low incidences of resistance (11% and 13% respectively in ouptatients and 23% and 19% respectively in inpatients); Enterobacter, Streptococcus faecalis, and Staphylococcus epidermidis occupied an intermediate position; and Proteus mirabilis and Klebsiella were resistant in 41-76% of cases. Similar incidences of resistance were observed to sulphamethoxazole-trimethoprim, sulphamethoxazole, ampicillin, and nitrofurantoin. These findings together with the rare occurrence of side effects and convenient dosage confirm the usefulness of plain trimethoprim for urinary tract infection.     

Intestinal microbiocenosis in children with intestinal enzymopathy

141 children with different kinds of intestinal enzymopathy were examined; of these, 33 had celiac disease, 39--the syndrome of celiac disease, 12--congenital lactase deficiency and 57--the syndrome of disaccharidase insufficiency. In these patients a significant decrease in the average characteristics of the main protective flora and the growth of hemolytic and lactose-negative enterobacteria were established. In all groups of patients increased amounts of Proteus were detected, which was indicative of profound dysbiosis. The content of bifidobacteria was found to be decreased in 89.5-97% of the patients and the content of lactic acid bacteria, in 15.8-33.3%. The decreased content of Escherichia coli with normal enzymatic activity (less than 10(7) colony-forming units) was noted in one-third of the patients with the syndrome of celiac disease and congenital lactase deficiency, in about a half of the patients with the syndrome of disaccharidase insufficiency and least of all in patients with celiac disease (9.1%). The association of opportunistic microbes was detected in 15.6% of the patients, more often in those with celiac disease, the syndrome of celiac disease and congenital lactase deficiency. The severity of disturbances in intestinal eubiosis was found to depend on the gravity of the patients' state.     

Proteus adhesion to intestinal epithelium

The adhesive properties of Proteus strains isolated from different sources have been studied under conditions similar to the real interaction of microorganisms with the epithelial cells of intestine. A comparison of the adhesive properties of Proteus and of colon Bacillus has shown that the value of the strong adhesion to the mucosa of Proteus isolated under enterocolitis at the same bulk concentrations of the infectious suspension is 2-3 order less than that of E. coli. The adhesion of Proteus to the surface of epithelial cells begins at bulk concentrations exceeding those for the colon Bacillus by 3-4 orders. Besides, a toxic effect of number of freshly isolated Proteus strains on the epithelial cells of intestine mucosa is observed. Strains isolated from patients with diarrhea and from environment differed from each other in the studied criteria. A conclusion is drawn that at the initial stage of the interaction with the intestine mucosa the Proteus strains differ considerably from the indigenous strain of the colon Bacillus in the ability to colonize the epithelial surface.     

Genetic markers of pathogenicity of conditionally pathogenic enterobacteria isolated from children with diarrheal diseases

In the process of examination of 89 children from different age groups with diarrheal disease caused by bacteria from Enterobacteriaceae family 89 microorganisms were isolated including Klebsiella spp. (37 isolates), Citrobacter spp. (9 isolates), Enterobacter spp. (17 isolates), Hafnia alvei (1 isolate), Morganella morganii (11 isolates), Proteus spp. (14 isolates). Presence of genes associated with pathogenicity islands (PAIS): hlyA, hlyB (hemolysin), sfaG (fimbria antigen type S), cnf1 (cytotoxic necrotizing factor 1), estB (heat-stable enterotoxin B)were studied in these cultures by PCR. It was found that 32.6% of examined isolates had fragments of PAIS's genes--hlyA was detected in 9 cases (10.1%), hlyB--in 10 cases (11.2%), sfaG --in 8 cases (9%), cnf1--in 9 cases (10.1%), and estB--in 3 cases (3.4%). Positive correlation between genetic determinants hlyB and cnf1 as well as hlyA and sfaG was found while estB was not associated with other genes. Weak positive correlation between presence of sfaG and resistance to tetracycline and chloramphenicol was detected. Factors coded by revealed determinants of PAIS can play a role in the development of diarrheal syndrome.     

V.A.T.E.R. association and its limits

Comparative investigation of 92 cases of V.A.T.E.R. syndrome (4 personal cases) and 62 cases of caudal regression (Duhamel syndrome) (2 personal cases) are performed. There is much analogy between these two entities. Initial impairment would be an early dysfunction of mesoderm setting up located on esophagus in V.A.T.E.R. syndrome and on kidneys in Duhamel syndrome. Etiopathogenic factors remain unknown. Genetic counseling is good. Detection of only one mesodermal malformation leads to inquire other unnoticed anomalies (kidneys, heart, spine, alimentary duct).     

Antibiotic sensitivity of Proteus, Pseudomonas pyocyanea and staphyloccoci isolated from scleroma and ozena patients]

Antibiotic sensitivity of 292 strains of Proteus, 60 strains of Ps, aeruginosa, 309 strains of S. aureus and 88 strains of S. epidermidis isolated from the upper respiratory tract of patients with scleroma and ozena was studied. The cultures of Pr. mirabilis were sensitive to aminoglucosides (54.9-96.2 per cent) and Pr. morganii were sensitive to levomycetin (81.5 per cent) and neomycin (92.6 per cnet). Sensitivity of Pr. vulgaris and Pr. morganii was reliably higher (p less than 0.001) than that of Pr. mirabilis. The strains of Pr. morganii were less sensitive to monomycin (P less than 0.001) and streptomycin (p less than 0.01) as compared to the cultures of other Proteus species tested. The strains of Ps. aeruginosa were sensitive only to gentamicin (90 per cent) and neomycin (81.1 per cent). Most of the strains of S. aureus (85.4-100 per cent) were sensitive to oleadomycin, erythromycin, olemorphocycline, tetraolean, oxacillin, methicillin ceporin, lincomycin, ristomycin, kanamycin, monomycin and gentamicin. Benzylpenicillin (90.8 per cent of the sensitive strains), ampicillin (67.1 per cent), tetracycline (66.7 per cent), levomycetin (68.6 per cent) and streptomycin (38.1 per cent) were less effective. Antibacterial therapy in cases with scleroma and ozena should be directed not only against causative agents of the diseases but also against the microbes developing due to disbacteriosis. Combination of parenteral and local use of the antibiotics in the treatment of chronic clebsiellesis decreased the isolation rate of Proteus and Ps. aeruginosa in the patients.     

Beta-lactamase activity of bacteria of the genus Proteus]

beta-Lactamases of Proteus and their role in the mechanism of the microbe resistance to penicillins and ceporin were studied. It was found that the beta-lactamase of Proteus had low activity and were produced by both beta-lactamide resistant and sensitive clinical strains of Proteus. The resistant cultures of Proteus produced enzymes more frequently (3.4--5 times) than the sensitive ones. The synthesis of beta-lactamase in the clinical Proteus strains was inducable. The high induction coefficient was achieved only in the presence of high concentrations of the inductor. No significant dependence of the culture sensitivity level of ampicillin and ceporin on the induction level was observed. The most significant part of the constitutive enzyme in Proteus was intracellular, while that of the inducable enzyme was extracellular. No correlative dependence between the culture resistance levels to penicillins and ceporin and the enzyme activity was noted. The beta-lactamase activity was not found in the transconjugants with the in vitro acquired R-factor controlling the ampicillin and ceporin resistance, as well as in the resistant mutants selected on the media with increasing concentrations of the above antibiotics. Induction of beta-lactamase synthesis was not found in these strains either. The ability of Proteus to synthesize beta-lactamase can be lost on the strain storage under laboratory conditions which was not always accompanied by reduction of the culture sensitivity to ampicillin and ceporin. The enzymatic destruction of beta-lactamides was not the main mechanism of Proteus resistance to the above antibiotics.