Biomedical subjects
Publications and source records attributed to H C Korting.
The typical clinical picture, common variants and frequent complications of chancroid are presented in cases proven by culture. In general, the conventional view of the clinical spectrum of chancroid is substantiated. Certain types such as "chancre mou volant," however, could not be found in the present material. Their existence or association with Haemophilus ducreyi remains speculative.
Although Chlamydia trachomatis is usually susceptible to the most frequently applied chemotherapeutic agents in non-gonococcal urethritis in men and its counterpart in women--i.e., tetracycline and erythromycin--the clinical results are less satisfying than those in comparable gonococcal infections. Therefore, potent therapeutical alternatives are urgently called for. From this point of view, we investigated the in vitro susceptibility of 35 recent isolates of genital Chlamydia trachomatis from Munich to the new quinolones ciprofloxacin and ofloxacin. With both chemotherapeutics, the highest minimum inhibitory concentration amounted to 2.0 micrograms/ml; 1.0 micrograms/ml of ofloxacin inhibited 97% of the strains, ciprofloxacin but 57%. The highest minimum bactericidal concentration was 6.0 micrograms/ml. 5.0 micrograms/ml of ciprofloxacin killed all infectious particles in 91% of the strains, the corresponding figure for ofloxacin read 74%. Thus both quinolones of the second generation proved more or less equally effective in vitro. In view of the limited clinical experience gained so far with regard to these chemotherapeutic agents, we suggest further clinical study in this matter.
The cell wall carbohydrates of 43 strains of Haemophilus ducreyi isolated in different parts of the world were subjected to lectin analysis using commercial panels containing 14 different plant lectins of known specificity. Preliminary evidence indicated both intrastrain and inter-strain variation in cell wall carbohydrate composition. In addition, it was possible to group strains from different geographical areas by lectin agglutination patterns. Lectin typing might thus become a useful marker system for epidemiological investigation of Haemophilus ducreyi infections.
Two Staphylococcus aureus (S. aureus) strains with differing susceptibility to penicillin G as expressed by the minimum inhibitory concentration were exposed in vitro over a period of 8 h to the continuously changing concentrations of ofloxacin achieved in human serum and cantharides blister fluid (CBF) after the single oral application of 600 mg. In both strains bacterial density was rapidly, but not totally reduced: a reduction by 99 percent took no longer than about 1 and 1.5 h resp. facing the serum level profile and about 1.5 h facing the tissue level profile. The maximum reduction of staphylococcal density in percent (kn) amounted to 0.0007 and 0.0034 and to 0.0038 and 0.0047 resp. Thus not only the serum level profiles but also the skin tissue level profiles obtainable in man proved highly effective in vitro against S. aureus irrespective of the bacterial suspectibility against penicillin G. Therefore oral ofloxacin should prove useful in staphylococcal diseases especially in so far as cutaneous tissue is involved.
One hundred and twenty-four strains of non-penicillinase-producing gonococci isolated in Munich in 1986 were characterized in terms of their plasmid content and protein I serovar. Eighty-two per cent of the strains belonged to serogroup 1-B with over half belonging to either serovar 1B-2 or 1B-3. Half of the 22 serogroup 1A strains belonged to serovar 1A-2. Nineteen strains (15.3%) were found to lack the 2.6 Md cryptic plasmid although seven of these strains contained the 24.4 Md conjugative plasmid. Nine of the 105 strains which harboured the cryptic plasmid also contained the conjugative plasmid. The 19 strains which lacked the cryptic plasmid comprised 10 different serovars, indicating the heterogeneous nature of this group of organisms.
Candida albicans strains were isolated from the oral cavities of 62 human immunodeficiency virus (HIV)-infected patients at different stages of HIV infection. Only patients with persistent generalized lymphadenopathy-acquired immunodeficiency syndrome (AIDS)-related complex or full-blown AIDS showed typical clinical symptoms for oral candidiasis. In general, the microbiological recovery of Candida strains from the oral cavity increased with more advanced stages of HIV infection. The antifungal activity of ketoconazole, itraconazole, nystatin, amphotericin B, and flucytosine against all 62 strains was evaluated by means of a photometer-read broth microdilution method for determination of the 30% inhibitory concentrations of the drugs. The 95% ranges of 30% inhibitory concentrations were as follows: less than or equal to 0.063 to 32 micrograms/ml for ketoconazole, less than or equal to 0.063 to 8 micrograms/ml for itraconazole, 0.5 to 4 micrograms/ml for nystatin, less than or equal to 0.063 to 4 micrograms/ml for amphotericin B, and less than or equal to 0.063 to 8 micrograms/ml for flucytosine. Two strains were resistant to flucytosine, one was resistant to ketoconazole, and three were resistant to itraconazole. Isolates from patients with full-blown AIDS showed significantly less susceptibility to itraconazole, amphotericin B, and flucytosine. Strains were biotyped by using the API 20C carbohydrate assimilation system. The major biotype accounted for 63.9% of the isolates. At repeated evaluation, a change in biotype pattern was seen in 27.3%.
Twenty three penicillinase producing strains of Neisseria gonorrhoeae (PPNG) isolated in Munich from 1981 to 1986 were characterised in terms of their plasmid content, auxotypes, protein I serovars, and sensitivity to antibiotics. Sixteen strains (70%) harboured a 4.4 megadalton plasmid, with 13 of these strains also containing a 24.4 megadalton plasmid. Seven strains (30%) contained a 3.2 megadalton plasmid, with only one of them containing a 24.4 megadalton plasmid. Thirteen strains (57%) were prototrophic, eight (35%) required proline, one required arginine, and one required proline and arginine for growth. Serovar analysis showed that 16 strains (70%) belonged to the protein IB serogroup and comprised four serovars (IB-1, IB-5, IB-7, and IB-8). The seven strains belonging to the IA serogroup also comprised four serovars (IA-2, IA-4, IA-6, and IA-10). Although 18 different categories of plasmid, auxotype, and serovar were found in the 23 PPNG strains, there was a similarity between the auxotypes in terms of the range of serovars they comprised. Measurement of minimum inhibitory concentrations (MICs) of antibiotics for the strains showed that they were all susceptible in vitro to spectinomycin (MIC less than or equal to 32 mg/l), enoxacin (MIC less than or equal to 0.25 mg/l), cefotaxime, ciprofloxacin, and ceftriaxone (MICs less than or equal to 0.064 mg/l), whereas about half showed some resistance to tetracycline or cefotiam, or both.
The susceptibility of 119 strains of Neisseria gonorrhoeae isolated in Munich in 1986 to eight antibiotics was assessed. Although some degree of resistance to penicillin and tetracycline, as well as high minimum inhibitory concentrations (MIC) of spectinomycin, were observed, all the strains were sensitive to ciprofloxacin, enoxacin, fleroxacin, cefotaxime, and FCE 22250.
During recent decades there has been a controversial discussion if comparable plasma level profiles which are rather constant or those which show a high peak are more efficient for the cure of gonorrhoea. So far, investigations in this field were not based on the Grasso apparatus. Although the findings with cefotiam and ceftizoxime do not allow to formulate a general hypothesis without any restriction, it can be stated that on the basis of an identical area under the antibiotic level time curve, 'peak concentration' profiles are more favourable.
Neisseria gonorrhoeae was cultured from the cervix, pharynx and blood stream of an 18-year-old woman who had a disseminated gonococcal infection. Two different phenotypes of N. gonorrhoeae, distinguished on the basis of their protein I serovar, whole-cell protein profile, lectin-type and antibiotic susceptibility, were isolated from both the cervix and pharynx, whereas only one of these phenotypes was isolated from the blood. This finding stresses the importance of blood cultures as a prelude to determining appropriate antimicrobial therapy in cases of disseminated gonococcal infection.
Xanthoma disseminatum, generalized eruptive histiocytoma, juvenile xanthogranuloma and Hand-Schüller-Christian disease are considered to be separate nosologic entities, but it can be difficult to differentiate them and establish the correct diagnosis in a given case. In this paper, the case of a young man is presented who showed lesions resembling those of generalized eruptive histiocytoma early in the course of disease while the lesions later showed typical signs of xanthoma disseminatum.
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While there have been several reports about the development of malignant neoplasms in porokeratosis of Mibelli and porokeratosis plantaris, palmaris et disseminata, only one case of squamous cell carcinoma in disseminated superficial actinic porokeratosis (DSAP) has been documented. A review is presented of the variants of porokeratosis that have so far been described in the literature as well as the differential diagnosis, genetic aspects and therapy of DSAP. The first case of DSAP with Bowen's disease is presented.
During the last decades many different methods have been devised for testing the antimicrobial susceptibility of yeasts in vitro. These methods range from agar diffusion and agar dilution to macro- and micro-broth-dilution methods. Although the ideal method has not yet been found, interest is currently focussed on micro-dilution tests. Yeasts that cause disease in man are not generally susceptible to the most frequently used antimycotics. This is especially true of 5-fluorocytosine, but strains resistant to ketoconazole, nystatin and amphotericin B have also been found. So far, many of the data obtained from in vitro studies of the antimicrobial susceptibility of yeasts have been found not to be closely correlated with clinical outcome. Most recently this situation has changed greatly, however, and this seems to be due to a large extent to new test procedures.
The microflora resident on human skin shows great interindividual and intraindividual differences. It is essentially composed of micrococci, staphylococci, aerobic and anaerobic coryneforms as well as pityrosporum species which, in accordance with the different environment in the different regions of the body, are in a steady state. With increasing age, human skin microflora undergoes qualitative changes: the streptococci, which are found in infants, disappear and coryneform bacteria occur, which are mainly responsible for odor production. Anaerobic propionibacteria are more numerous in juveniles and young adults, a fact that may be explained by increased sebum production. Only the coryneform bacteria are able to produce the typical axillary odor by decomposition of apocrine sweat. Cocci, however, obviously do not have this capacity. It remains to be established which substances participate in odor production. With sensitive chromatographic methods amino acids, steroids and free fatty acids were detected, which could be related to body odor. There are possibly only a few commonly occurring odorous substances. The necessity of analyzing these substances is stressed.
The adherence of the pathogen to the host cell is the first and decisive step in Candida albicans infections of the human organism. The mechanisms involved are mostly examined in human epithelial cells which are newly exfoliated and which therefore have a limited life expectancy. In this case, the glycoproteins on the cell surface of Candida albicans--mainly the mannan--are of central importance. They are the main component of the fungus to adhere to the host cell as well as to bind and activate the serum complement. Finally, the role of mannan in the interaction with host defence mechanisms is stressed.
Two beta-lactamase producing Neisseria gonorrhoeae strains with differing susceptibility to ofloxacin according to the minimum inhibitory concentration were exposed to the serum level time course of this chemotherapeutic agent in vitro. Within one hour, the bacterial density was markedly reduced, after another hour gonococci could not be subcultured anymore. In a comparative experimental setting the new cephalosporins have not led to total gonococcal eradication although they are also most efficient in gonorrhea. Therefore, quinolones such as ofloxacin should be also considered when it comes to gonorrhea treatment.
A total of 102 Neisseria gonorrhoeae isolates from Munich with known nutritional requirements were examined for lectin agglutination patterns using Taxonolectin panels containing 14 different plant originated lectins with known specificity. 29 different lectin agglutination patterns were found (in comparison auxotyping showed 17 different groups). All strains reacted with Concanavalin A and Trichosanthes kinlowii and did not show positive reactions with Limax flavus and Ulex europaeus I. 49 Isolates (48%) had lectin agglutination patterns associated with only four lectin groups (in comparison the four major auxotyping groups comprised 58 (57%) of the tested isolates). A correlation between auxotype and lectin agglutination pattern could not be demonstrated. Reproducibility of lectin agglutination patterns was excellent.