Antifungal Distribution Into Cerebrospinal Fluid,Vitreous Humor,Bone, and Other Difficult Sites

The incidence of invasive fungal infections continues to increase, especially in patients with immune dysfunction. Fungal infections are often difficult to treat, requiring therapy for weeks or months to eradicate infection. Although fungal infections of the central nervous system, eye, and bones occur less frequently than infections at other sites, it is necessary to assess the utility of the currently available antifungal agents in treating these infections. Unfortunately, information regarding drug distribution to these sites is often scarce and limited to a few animal studies or case reports. This review summarizes information about commonly used antifungal agents and their penetration into the central nervous system, eye, and bone.     

Pseudomonas aeruginosa, Candida albicans, and device-related nosocomial infections: implications, trends, and potential approaches for control

For many years, device-associated infections and particularly device-associated nosocomial infections have been of considerable concern. Recently, this concern was heightened as a result of increased antibiotic resistance among the common causal agents of nosocomial infections, the appearance of new strains which are intrinsically resistant to the antibiotics of choice, and the emerging understanding of the role biofilms may play in device-associated infections and the development of increased antibiotic resistance. Pseudomonas aeruginosa and Candida albicans are consistently identified as some of the more important agents of nosocomial infections. In light of the recent information regarding device-associated nosocomial infections, understanding the nature of P. aeruginosa and C. albicans infections is increasingly important. These two microorganisms demonstrate: (1) an ability to form biofilms on the majority of devices employed currently, (2) increased resistance/tolerance to antibiotics when associated with biofilms, (3) documented infections noted for virtually all indwelling devices, (4) opportunistic pathogenicity, and (5) persistence in the hospital environment. To these five demonstrated characteristics, two additional areas of interest are emerging: (a) the as yet unclear relationship of these two microorganisms to those species of highly resistant Pseudomonas spp and Candida spp that are of increasing concern with device-related infections, and (b) the recent research showing the dynamic interaction of P. aeruginosa and C. albicans in patients with cystic fibrosis. An understanding of these two opportunistic pathogens in the context of their ecosystems/biofilms also has significant potential for the development of novel and effective approaches for the control and treatment of device-associated infections.     

Cryptosporidium parvum infections in Bergen, Norway, during an extensive outbreak of waterborne giardiasis in autumn and winter 2004

During a large waterborne giardiasis outbreak in Norway, many diarrheic patients were found to have Cryptosporidium infections. Gene sequencing identified these infections as Cryptosporidium parvum infections, although they were not identical. Whether these infections were due to a simultaneous outbreak of waterborne cryptosporidiosis or reflected background levels not normally detected is discussed.     

Cryptosporidium parvum Infections in Bergen, Norway, during an Extensive Outbreak of Waterborne Giardiasis in Autumn and Winter 2004

During a large waterborne giardiasis outbreak in Norway, many diarrheic patients were found to have Cryptosporidium infections. Gene sequencing identified these infections as Cryptosporidium parvum infections, although they were not identical. Whether these infections were due to a simultaneous outbreak of waterborne cryptosporidiosis or reflected background levels not normally detected is discussed.     

Prevalence and Risk Factors for Intestinal Protozoan Infections with Cryptosporidium,Giardia, Blastocystis and Dientamoeba among Schoolchildren in Tripoli,Lebanon

BackgroundIntestinal protozoan infections are confirmed as major causes of diarrhea, particularly in children, and represent a significant, but often neglected, threat to public health. No recent data were available in Lebanon concerning the molecular epidemiology of protozoan infections in children, a vulnerable population at high risk of infection.ConclusionsThis is the first study performed in Lebanon reporting the prevalence and the clinical and molecular epidemiological data associated with intestinal protozoan infections among schoolchildren in Tripoli. A high prevalence of protozoan parasites was found, with Blastocystis spp. being the most predominant protozoans. Although only 50% of children reported digestive symptoms, asymptomatic infection was observed, and these children may act as unidentified carriers. This survey provides necessary information for designing prevention and control strategies to reduce the burden of these protozoan infections, especially in children.     

Asthma, viruses, and nitric oxide

Over the last two decades there has been a worldwide increase in the morbidity and mortality associated with asthma, a chronic inflammatory disease of the airways. There is a growing body of evidence that suggests there is an association between upper respiratory viral infections, particularly rhinovirus infections, and asthma exacerbations. Virally induced airways hyperreactivity has been associated with elevated numbers of inflammatory cells in the bronchial mucosa. Upon virus infection, respiratory epithelial cells produce proinflammatory cytokines, including IL-6, IL-8, RANTES, and GM-CSF, which could contribute to the increased inflammatory cell recruitment noted in the airways. Whether or not a viral infection triggers an asthma attack may depend upon many factors, including the types of inflammatory cells recruited to the airways, the viral load, and variations in the host antiviral response. There is evidence to support the idea that eosinophils from asthmatic and symptomatic atopic subjects may be primed to respond to chemotactic cytokines produced by infected epithelial cells. Rhinovirus infections may therefore enhance airway eosinophilia in asthmatics, leading to airway hyperresponsiveness and impaired pulmonary function. Nitric oxide is a potent inhibitor of both rhinovirus-induced cytokine production and viral replication and may play an important role in the host response to viral infections. Based upon these observations, we speculate that nitric oxide donors may represent a novel therapeutic approach for the treatment of rhinovirus infections and viral exacerbations of asthma.     

Maintenance, loss, and resurgence of T cell responses during acute, protracted, and chronic viral infections

The acute phase of many viral infections is associated with the induction of a pronounced CD8 T cell response which plays a principle role in clearing the infection. By contrast, certain infections are not as readily controlled. In this study, we have used the well-defined system of lymphocytic choriomeningitis virus (LCMV) infection of mice to determine quantitative and qualitative changes in virus-specific CD8 T cell responses that rapidly resolve acute infections, more slowly control protracted infections, or fail to clear chronic infections. Acute LCMV infection elicits potent, functional, multi-epitope-specific CD8 T cell responses. Virus-specific CD8 T cells also expand, albeit to a lesser extent, during protracted LCMV infection. Under these conditions, there is a progressive diminution in the capacity to produce IL-2, TNF-alpha, and IFN-gamma. Changes in cytotoxic activities are also detectable but differ depending upon the specificity of the responding cells. As the infection is slowly resolved, a resurgence of cytokine production by virus-specific CD8 T cells is observed. CD4-deficient mice cannot control infection with certain strains of LCMV, but do mount multi-epitope-specific CD8 T cell responses that also lose effector capabilities; however, they are not maintained indefinitely in an unresponsive state as these cells become deleted over time. Overall, our findings suggest that constant high viral loads result in the progressive diminution of T cell effector functions and subsequent physical loss of the responding cells, whereas if the viral load is brought under control a partial restoration of CD8 T cell functions can occur.     

Diarrhea,respiratory infections,protozoan gastrointestinal parasites,and child growth in Kathmandu,Nepal

The differential impact of diarrhea, respiratory infections, and protozoan parasitism on growth is investigated among children under five years of age living in periurban Kathmandu, Nepal. The children's parents are all carpet-making workers who live in an environment with crowded living conditions, poor sanitation, and contaminated water. Anthropometric data, both cross-sectional and longitudinal, were collected over a 9-month period. Morbidity data were gathered from maternal reports, and a subsample of children's stools were examined for gastrointestinal parasites. In a comparison of current growth status and growth velocity for children with and without diarrhea and respiratory infections, it is found that body weight is most affected by infections, particularly for children under 24 months of age. For a subsample of children whose stools were tested for parasites, there is a statistically significant association between stunting (low height-for-age) and the presence of a protozoan gastrointestinal parasite. It is concluded that although growth faltering is associated with diarrhea and respiratory infections, the impact of these infections is of less importance for long-term linear growth retardation than is infection by protozoan gastrointestinal parasites.     

Detection, eradication, and research implications of Helicobacter infections in laboratory rodents

Researchers first isolated and characterized Helicobacter hepaticus in 1994 as a cause of hepatitis that progressed to hepatocellular carcinoma in A/JCr mice. During the past decade, isolation and characterization of additional novel helicobacters from rodents has continued. In addition to causing overt disease, rodent helicobacter infections are important because intercurrent disease in select models will confound research data. Emerging evidence suggests that inflammatory responses to enterohepatic helicobacter infections may alter host responses to other experimental stimuli in unanticipated ways. Additionally, scientists have experimentally infected a variety of inbred mouse strains and genetically engineered mice with a variety of Helicobacter spp. isolated from rodents, birds, and higher mammals (including humans) to develop animal models of gastrointestinal diseases as well as idiopathic human disease syndromes. This review highlights current information about helicobacter infections in laboratory rodents and provides recommendations for the detection and eradication of these infections. The authors discuss the impact of subclinical and clinical disease and offer recommendations for managing helicobacter-free rodent colonies.     

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.     

Innovative Toolbox for the Quantification of Drosophila C Virus,Drosophila A Virus,and Nora Virus

Quantification of viral replication underlies investigations into host-virus interactions. In Drosophila melanogaster, persistent infections with Drosophila C virus, Drosophila A virus, and Nora virus are commonly observed in nature and in laboratory fly stocks. However, traditional endpoint dilution assays to quantify infectious titers are not compatible with persistently infecting isolates of these viruses that do not cause cytopathic effects in cell culture. Here we present a novel assay based on immunological detection of Drosophila C virus infection that allows quantification of infectious titers for a wider range of Drosophila C virus isolates. We also describe strand specific RT-qPCR assays for quantification of viral negative strand RNA produced during Drosophila C virus, Drosophila A virus, and Nora virus infection. Finally, we demonstrate the utility of these assays for quantification of viral replication during oral infections and persistent infections with each virus.     

Antifungal peptides: Origin, activity, and therapeutic potential

Antifungal peptides have been identified in a wide range of life forms which include plants, mammals, and microorganisms. Their structures are as varied as their antifungal properties. Semisynthetic and fully synthetic analogs have been developed from a few of these natural peptides that are superior to the parent compound. A few of these peptides hold promise in combating fungal infections and have entered clinical trials.     

Within-host parasite dynamics,emerging trade-off,and evolution of virulence with immune system

Abstract.— Virulence is an evolutionary paradox because parasites never benefit from their host's death. The adaptive explanation of virulence is classically based upon the existence of physiological constraints that create a trade-off between parasites' epidemiological traits (virulence, transmissibility, and clearance). Here we develop an epidemiological model where infections are dynamic processes and we demonstrate how these dynamics generate a trade-off between emerging epidemiological parameters. We then study how host's immune strength modifies this trade-off and hence influences virulence evolution. We found that in acute infections, where parasites are engaged in a race with immune cells, immunity restrains more the duration of the infection than its intensity. As a consequence parasites evolve to provoke more virulent but shorter infections in strongly immunized hosts.     

A screen for bacterial endosymbionts in the model organisms Tribolium castaneum,T. confusum,Callosobruchus maculatus,and related species

Reproductive parasites such as Wolbachia are extremely widespread amongst the arthropods and can have a large influence over the reproduction and fitness of their hosts. Undetected infections could thus confound the results of a wide range of studies that focus on aspects of host behavior, reproduction, fitness, and degrees of reproductive isolation. This potential problem has already been underlined by work investigating the incidence of Wolbachia infections in stocks of the model system Drosophila melanogaster. Here we survey a range of lab stocks of further commonly used model arthropods, focusing especially on the flour beetles Tribolium castaneum and Tribolium confusum, the cowpea weevil Callosobruchus maculatus and related species (Coleoptera: Tenebrionidae and Bruchidae). These species are widespread stored product pests so knowledge of infections with symbionts further has potential use in informing biocontrol measures. Beetles were assessed for infection with 3 known microbial reproductive parasites: Wolbachia, Rickettsia, Spiroplasma. Infections with some of these microbes were found in some of the lab stocks studied, although overall infections were relatively rare. The consequences of finding infections in these or other species and the type of previous studies likely to be affected most are discussed.     

Chlamydiae, rickettsiae, and their cell wall defective variants.

Inapparent chlamydial and rickettsial infections are an important source of the dissemination of the parasites and may cause explosive outbreaks of severe diseases in man and animal. However, it is engimatic how these obligate intracellular microbes induce latency and why or how inapparent infections convert into active disease. Currently, microbiologists believe that chlamydiae and rickettsiae are gram-negative bacteria unique in their intracellular habitat. This review presents evidence that these organisms have another peculiarity; namely, defective cell walls present throughout much of their life cycle. In this survey, the properties of the small and large forms of chlamydiae and rickettsiae are reexamined with regard to the current knowledge of cell wall defective variants of free-living bacteria. Data are presented in support of the concept that chlamydiae and rickettsiae are cell wall defective microbes whose small 'bacterial' forms have lost the ability to reproduce as bacteria during evolution; the large forms including ultrafilterable phases of the life cycle of these parasites are responsible for inapparent infections of healthy carriers, whereas conversion into small 'bacterial forms may cause, under appropriate conditions manifest diseases. This concept may provide challenging and profitable directions in the search to explain puzzling phenomena associated with chlamydiae and rickettsiae.     

A Survey of Hospital Infection in a Pediatric Hospital: Part I. Description of Hospital,Organization of Survey,Population Studied and Some General Findings

Of 17,836 children admitted in 1959, 6.5% developed infection following admission; most of these seemed to be hospital-acquired. Respiratory infections were commonest (2.7%), then gastroenteritis (1.3%), staphylococcal infections including miscellaneous and postoperative wounds (1.1%), pyrexias (0.5%), miscellaneous and post-operative wound infections due to other bacteria (0.4%), “communicable” diseases (0.3%) and monilial infections (0.2%). Incidences were highest in infants and on certain wards incapable of segregating all infected cases. Only 14.3% of infections were severe. They contributed to 16 deaths but not as the sole cause. Hospital infections made over 2070 extra patient-days necessary. Wound infection followed 3.1% of 5052 surgical operations-2.1% when considering only clean sites. Seventy per cent were staphylococcal; antibiograms suggested that some were not of hospital origin. Staphylococcal disease, present on admission or hospital-acquired, occurred in 2.6% of patients. None of these incidences seemed unduly high. Many varied factors underlie hospital infections, and complete control is unlikely with present knowledge and facilities.     

Schistosoma mansoni: Characterization of two circulating polysaccharide antigens and the immunological response to these antigens in mouse,hamster, and human infections

In this study the nature and occurrence of two circulating polysaccharide antigens of Schistosoma mansoni, circulating anodic antigen (CAA) and circulating cathodic antigen (CCA), and the immunological response to these antigens in mouse, hamster, and human infections were investigated. Both CAA and CCA showed a large molecular weight range, less than 50,000 to over 300,000 for CAA and 50,000 to over 300,000 for CCA, possibly representing monomers and polymers. CAA and CCA could be purified from the trichloroacetic acid-soluble fraction of adult worm antigen (AWA-TCA) by means of DEAE ion exchange chromatography. The presence of at least two other components in AWA-TCA was shown. Both CAA and CCA were found to be gut associated, and could be demonstrated in the vomitus and in the excretory and secretory antigens of adult worms. Both antigens were present in the kidney eluates of infected hamsters, while CCA could normally be detected in the urine of these hamsters and CAA only occasionally. CAA was demonstrated in the Kupffer cells of the livers of infected mice and hamsters. Antibodies against CAA and CCA were shown in mouse, hamster, and human infections. In human infections specific IgM titers against these antigens were especially elevated in children and in recent infections of adults.     

Trichinella spiralis: changes caused in the mouse's thymic, splenic, and lymph node cell populations.

Infections with the nematode Trichinella spiralis induce unresponsiveness in mice. A study was made to determine whether suppression could be due to a deficiency in the cells responsible for the immunological response. Mice were given low or moderate infections and were killed 7, 14, 28, or 56 days after inoculation; spleen macrophages and leucocytes, θ cells, and Con A- and LPS-sensitive cells were determined in the thymus, spleen, and the mesenteric and axillary lymph nodes. Spleen macrophages are diminished throughout the course of the infection, reaching significantly low levels on the 14th day. The thymus loses, whereas the spleen and the axillary node gain, cells bearing the θ antigen. In spite of the increase in leucocytes and θ cells in the secondary lymphoid tissue, the cells of these organs are insensitive to the blastogenic action of Con A in the heavier infections. In lower infections, however, spleen cells show an enhanced response to Con A and LPS; mesenteric cells, on the other hand, show an early enhanced susceptibility to LPS and a reduced susceptibility to Con A and, in the later phases of parasitism, an enhanced Con A and a reduced LPS susceptibility. It is suggested that these phenomena contribute to the immunosuppression phenomena which are characteristic of T. spiralis infections.     

The contribution of vaccination to global health: past,present and future

Vaccination has made an enormous contribution to global health. Two major infections, smallpox and rinderpest, have been eradicated. Global coverage of vaccination against many important infectious diseases of childhood has been enhanced dramatically since the creation of WHO''s Expanded Programme of Immunization in 1974 and of the Global Alliance for Vaccination and Immunization in 2000. Polio has almost been eradicated and success in controlling measles makes this infection another potential target for eradication. Despite these successes, approximately 6.6 million children still die each year and about a half of these deaths are caused by infections, including pneumonia and diarrhoea, which could be prevented by vaccination. Enhanced deployment of recently developed pneumococcal conjugate and rotavirus vaccines should, therefore, result in a further decline in childhood mortality. Development of vaccines against more complex infections, such as malaria, tuberculosis and HIV, has been challenging and achievements so far have been modest. Final success against these infections may require combination vaccinations, each component stimulating a different arm of the immune system. In the longer term, vaccines are likely to be used to prevent or modulate the course of some non-infectious diseases. Progress has already been made with therapeutic cancer vaccines and future potential targets include addiction, diabetes, hypertension and Alzheimer''s disease.     

Enterococcus: review of its physiology, pathogenesis, diseases and the challenges it poses for clinical microbiology

The genus Enterococcus is composed of 38 species, the most important of which are Enterococcus faecalis and Enterococcus faecium—both human intestinal colonizers. Hospitals within the United States and around the world commonly isolate these bacteria because they are a cause of bacteremia, urinary tract infections (UTIs), endocarditis, wound infections, meningitis, intraabdominal and pelvic infections, and nosocomial and iatrogenic infections. Given the ubiquity of enterococci within the human population, it is important for laboratories to be able to distinguish these agents within hospitalized patients from other bacterial genera and also differentiate different species within the Enterococcus genus as well as different strains within each species. Unfortunately, the enterococci are emerging as serious pathogens in both the developed world, where surveillance needs to be improved and speciation procedures are inadequate or cumbersome, and in developing nations, which lack the trained hospital personnel or funding to sufficiently identify enterococci to the genus or species level. This review explores the Enterococcus genus and highlights some of the concerns for national and international clinical microbiology laboratories.