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Biomedical subjects

J Bille

Publications and source records attributed to J Bille.

At least 127 records · Page 7Linked to original sources
PubMed1990

Characterization by DNA restriction endonuclease analysis of Listeria monocytogenes strains related to the Swiss epidemic of listeriosis.

Listeria monocytogenes strains responsible for outbreaks of listeriosis were studied by using serotyping and phage typing. An additional approach based on restriction endonuclease analysis (REA) of the chromosomal DNA was used to characterize L. monocytogenes strains collected from various sources during and after a Swiss outbreak of listeriosis (1983 to 1987). Among the 169 wild-type strains of Listeria spp. that were examined, 161 (95%) belonged to the species L. monocytogenes, of which 109 were of human origin. Ten different REA profiles were obtained from the 120 L. monocytogenes serotype 4b strains tested. All 57 serotype 4b strains that were identified as Swiss epidemic strains by phage typing clustered in two closely related REA profiles. In particular, 10 L. monocytogenes 4b strains isolated from the brand of soft cheese responsible for the outbreak and from its direct environment were indistinguishable from isolates from 40 patients by both phage typing and REA analysis. However, 5 of the 17 non-phage-typeable L. monocytogenes strains and 18 L. monocytogenes strains with a phage type different from those of the Swiss epidemic types showed the same profile. REA enabled the characterization of non-phage-typeable strains and, thus, seems a promising tool for L. monocytogenes typing, especially during epidemiological investigations.

Bacteriophages↗
PubMed1990

[Coronary angioplasty in patients aged 70 and over. Immediate results and later outcome].

One hundred and ninety one consecutive patients over 70 years of age (127 men and 64 women, average age 75.6 years) underwent percutaneous transluminal coronary angioplasty (PTCA) between January 1986 and February 1989. One hundred and sixty patients had severe angina (20 Class III and 140 Class IV), 72 patients had previous myocardial infarction, 36 of which were recent (less than 1 month), and 6 patients had previously undergone coronary bypass surgery. The coronary lesions affected one vessel in 67 patients and more than one vessel in 124 patients. The left ventricular ejection fraction was less than 50% in 15 patients. Angioplasty was attempted on 245 lesions (228 stenoses and 17 occlusions): 1 lesion in 141 patients, 2 lesions in 46 patients, 3 lesions in 4 patients, with a primary success rate of 81% in stenotic and 41% in occluded arteries. There were 9 deaths (4.7%) 6 of which occurred in patients with multivessel disease and unstable angina; there were 6 Q-wave infarctions (3.1%), 8 non Q-wave infarctions (4.2%) and 3 emergency coronary bypass operations (1.6%). The first 123 patients of this series were followed up for an average of 18.8 months (7 to 37 months). Follow-up of the 100 patients successfully dilated (4 lost to follow-up) showed that 55 remained improved (53 asymptomatic), 25 had recurrent angina after the initial improvement due to restenosis in 19, progression of coronary athero-sclerosis in 3, restenosis and an evolution of coronary atherosclerosis in 1 and a lesion which had been neglected in 2 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1989

Clinical significance of Candida isolated from peritoneum in surgical patients.

Over a 2-year period, all surgical patients from whom Candida was isolated from intra-abdominal specimens were evaluated. All but 1 of the 49 evaluable patients had either a spontaneous perforation (57%) or a surgical opening of the gastrointestinal tract (41%). Candida caused infection in 19 patients (39%), of whom 7 had an intra-abdominal abscess and 12 peritonitis. In the other 30 patients (61%), there were no signs of infection and specific surgical or medical treatment was not required. Candida was more likely to cause infection when isolated in patients having surgery for acute pancreatitis than in those with either gastrointestinal perforations or other surgical conditions. The development of a clinical infection was significantly associated with a high initial or increasing amount of Candida in the semiquantitative culture. Surgery alone failed in 16 of 19 patients (84%), of whom 7 died and 9 recovered after combined antifungal and surgical treatment. The overall mortality and the mortality related to infections were significantly higher in the patients with intraabdominal candidal infections than in those without such infections.

Abscess↗
PubMed1989

[Candida fungemia].

From 1980 to 1986, 52 patients presented with an episode of fungemia due to Candida species at the Centre Hospitalier Universitaire Vaudois (representing 2% of the patients with positive blood cultures). In 51 of the 52 patients (98%) the infection was nosocomial, occurring after a median hospital stay of 24 days (range 4-250 days). Only 36 patients (69%) presented with an underlying condition (neoplasms in 18 patients, alcoholism in 7, diabetes in 6, immunosuppressive therapy in 5). In 19 patients (37%) an episode of bacteremia occurred prior to fungemia (median time 14 days, range 1-70 days). Candida albicans was the most commonly isolated species (71%). In 50 patients (96%) the episode of fungemia was associated with a significant, although nonspecific, clinical impairment. The digestive tract (38%) and N intravascular catheter (31%) were the two most common portals of entry for the fungemia. 32 patients (62%) received specific antifungal therapy consisting of amphotericin B in 29 patients (median total dose 450 mg, administered either alone or in association) or of ketoconazole in 3 patients. The global mortality was 46% and the fungemia-related mortality was 21%. Global and fungemia-related mortalities were significantly higher in patients not treated with antifungals than in those treated with them (87% versus 30%, p less than 0.001, and 47% versus 11%, p = 0.01 respectively).

Adolescent↗
PubMed1989

[Disseminated nocardiosis due to Nocardia brasiliensis in an ambulatory patient].

We report the case of a 76-year-old man with generalized nocardiosis. The microbiologic pattern, the different clinical manifestations and the treatment of nocardiosis are discussed in general. In the particular case of our patient the disease manifested itself primarily as a subcutaneous abscess, a metastasis secondary to pulmonary nocardiosis. The disease was caused by a Nocardia brasiliensis, which is rarely seen in Europe and which does not usually cause a generalized form of nocardiosis.

Abscess↗
PubMed1989

Diagnosis of pulmonary infections in patients infected with the human immunodeficiency virus.

Over a three-year period, 54 episodes of pneumonia were diagnosed in 45 adults infected with the human immunodeficiency virus (HIV). These episodes were reviewed in order to assess the distribution of pathogens and their clinical presentation. Thirty-six episodes were due to an opportunistic pathogen (Pneumocystis carinii in 31, Mycobacterium avium complex in 3, Mycobacterium tuberculosis in 2), and 18 were caused by non-opportunistic pathogens (11 Streptococcus pneumoniae, 2 Haemophilus influenzae, 5 unknown pathogens that responded to broad-spectrum antibiotics). Non-opportunistic pneumonias were characterized by an abrupt onset (18/18 had pulmonary symptoms of less than 7 days duration), high fever (13/18), and focal lung infiltrates (17/18). In contrast, opportunistic infections infrequently presented with pulmonary symptoms of less than 7 days duration (3/36) or high fever (7/36), and most of the chest radiograms (34/36) disclosed a diffuse lung infiltrate. In HIV-infected patients presenting with pneumonia, simple clinical and radiological data may point to bacterial pathogens. Such data could be used in selected cases to spare invasive procedures and to start empirical antibiotic therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Evaluation of the Cobas-Bact system for direct and rapid identification and antimicrobial susceptibility testing of Enterobacteriaceae from positive urine specimens.

A direct antimicrobial susceptibility test and a direct identification of Gram-stained urine specimens positive for Enterobacteriaceae using a new instrument (Cobas-Bact) were compared by means of the conventional Kirby-Bauer agar diffusion disk method and the spot indole test, an in-house set of identification tests or API 20E. Bacteria from 191 cases of monomicrobial bacteriuria due to members of the family Enterobacteriaceae were tested. Direct susceptibility testing was performed in 180 cases (94%), providing 1649 antibiotic-microorganism combinations. A complete agreement was reached in 82% and essential agreement in 92% of cases. Minor discrepancies were found in 163 (9.9%) major ones in 125 (7.6%) and very major ones in 10 (0.6%) of examinations. 72% of all minor and 71% of all major discrepancies were caused by two antibiotics: cephalothin and nitrofurantoin. Of the very major discrepancies, 50% were due to amoxicillin. Of 171 direct identifications obtained, 130 (76%) were "high-confidence" correct identifications (percentage of likelihood p greater than or equal to 80%), 25 (14.6%) "low-confidence" identifications (percentage of likelihood p less than 80%) and 16 (9.4%) misidentifications. On the whole, this direct and rapid Cobas-Bact identification and susceptibility testing procedure provided satisfying information within 5-6 h after collection of urine specimens positive for members of the Enterobacteriaceae family.

Anti-Bacterial Agents↗
PubMed1989

Genetic characterization of clones of the bacterium Listeria monocytogenes causing epidemic disease.

One hundred and seventy-five isolates of the pathogenic bacterium Listeria monocytogenes recovered from human clinical (blood and cerebrospinal fluid), animal, and environmental sources in Europe, North America, and elsewhere were analyzed electrophoretically for allelic variation at 16 genetic loci encoding metabolic enzymes. Forty-five distinctive allele profiles (electrophoretic types, ETs) were distinguished, among which mean genetic diversity per locus (H) was 0.424. Cluster analysis of a matrix of genetic distances between paired ETs revealed two primary phylogenetic divisions of the species separated at a distance of 0.54. ETs in division I were presented by strains of serotypes 4b, 1/2b, and 4a, whereas strains of ETs in division II were of serotypes 1/2a and 1/2c. Human and animal isolates did not represent distinctive subsets of ETs. The occurrence of linkage disequilibrium between enzyme loci and the widespread distribution of certain ETs indicate that the genetic structure of L. monocytogenes is clonal. One clone, marked by ET1, caused major epidemics of human disease in western Switzerland in the period 1983-1987 and in Los Angeles County, California, in 1985, both of which were attributed to contamination of soft cheese. ET 1 is closely related to the clone (ET7) that caused two large outbreaks of listeriosis in Massachusetts in 1979 and 1983.

Bacteriophage Typing↗
PubMed1989

New mechanism for methicillin resistance in Staphylococcus aureus: clinical isolates that lack the PBP 2a gene and contain normal penicillin-binding proteins with modified penicillin-binding capacity.

Seventeen clinical isolates of Staphylococcus aureus (from the United States and Europe) selected for low (borderline)-level methicillin resistance (MIC of methicillin, 2 to 4 micrograms/ml; MIC of oxacillin, 0.5 to 8 micrograms/ml) were examined for their mechanisms of resistance. Five strains were typical of heterogeneous S. aureus: they gave positive reactions with a DNA probe specific for mec and contained a small fraction (10(-6] of highly resistant cells (MIC, greater than 100 micrograms/ml). The rest of the 12 strains were homogeneous with respect to their methicillin resistance: the MIC of methicillin for all cells was 2 to 4 micrograms/ml, and no cells for which MICs were 50 micrograms/ml or higher were detectable (less than 10(-9]. None of these strains reacted with the mec-specific DNA probe. One representative strain of each group was characterized in more detail. Strain CDC-1, prototype of heterogeneous methicillin-resistant S. aureus, contained penicillin-binding protein (PBP) 2a; its DNA could transform a methicillin-susceptible and novobiocin-resistant recipient to methicillin resistance with ca. 35% linkage to Novr. Introduction of the "factor X" determinant (K. Murakami and A. Tomasz, J. Bacteriol. 171:874-879, 1989) converted strain CDC-1 to high, homogeneous resistance. Strain CDC-6, prototype of the second group of isolates, showed completely homogeneous MICs of methicillin, oxacillin, and cefotaxime. The strain contained modified "normal" PBPs: PBPs 1 and 2 showed low drug reactivity (and/or cellular amounts), and PBP 4 was present in elevated amounts. No PBP 2a could be detected. DNA isolated from strain CDC-6 could transform the methicillin-susceptible and novobiocin-resistant strain to methicillin resistance in a multistep fashion, but this resistance showed no genetic linkage to the Nov marker. We suggest that staphylococci with borderline resistance may contain at least three different classes of mechanism: heterogeneous, methicillin-resistant S. aureus, PBPs of modified drug reactivities, and the previously reported hyperproduction of beta-lactamase (L.K. McDougal and C. Thornsberry, J. Clin Microbiol. 23:832-839, 1986).

Bacterial Proteins↗
PubMed1989

Relationship between neutrophil-mediated oxidative injury during acute experimental pyelonephritis and chronic renal scarring.

Previous experiments with rats have suggested that pyelonephritic scarring after acute ascending Escherichia coli pyelonephritis partly results from excessive polymorphonuclear leukocyte (PMN) infiltration and activation in the kidney parenchyma. We have studied the role of PMN oxidative metabolism in generating tissue injury during acute pyelonephritis. Rats with acute pyelonephritis were treated with dapsone (25 mg/kg twice daily for 3 days), a compound known to prevent PMN oxidant damage. In vitro, levels of dapsone easily achieved in vivo inhibited myeloperoxidase (MPO)-mediated reactions involving the oxidation of halides to reactive cytotoxic hypohalites (such as MPO-mediated iodination and luminol-enhanced chemiluminescence). In contrast, dapsone had no effect on superoxide production, lysosomal enzyme release, or bacterial killing by activated PMN. In vivo, dapsone treatment had no significant effect on acute pyelonephritis with respect to (i) bacterial counts, (ii) inflammatory swelling, and (iii) PMN infiltration. However, dapsone-treated animals sacrificed 2 months after acute pyelonephritis had a 65% reduction of renal scars when compared with controls. Since dapsone had no antibacterial effect, this protection is compatible with the hypothesis that dapsone prevented oxidant-generated tissue injury due to the extracellular release of the MPO system by activated PMN during acute suppurative pyelonephritis.

Acute Disease↗
PubMed1989

Evaluation of the Cobas-Bact system for direct and rapid identification and antimicrobial susceptibility testing of gram-negative rods from positive blood culture broths.

A direct antimicrobial susceptibility test and a direct identification of positive blood culture broths for gram-negative rods confirmed with Gram stain by using a new instrument, Cobas-Bact, were compared with the conventional Kirby-Bauer agar diffusion disk method and with the in-house set of identification or API 20E, respectively. The bacterial pellet of centrifuged positive blood culture broth was used to inoculate a Cobas-Bact susceptibility and identification rotor. Bacteria from 206 cases of monomicrobial septicemia due to members of the family Enterobacteriaceae were tested. In 198 episodes (96%), direct identification and antimicrobial susceptibility testing results were obtained for the same bacterial pathogen within 5 h of detection. Of 204 direct identifications obtained, 177 (86.6%) were "high-confidence" correct identifications (percentage of likelihood [P] greater than or equal to 80%) and 25 (12.5%) "low-confidence" correct identifications (P less than 80%), whereas only 2 misidentifications occurred (1 Escherichia coli and 1 Proteus mirabilis). Direct susceptibility testing was performed in 199 episodes (96%), providing 1,885 antibiotic-microorganism combinations. Full agreement reached 86.3%, and essential agreement reached 92.8%. Minor discrepancies were found in 120 (6.5%) of the tests, major discrepancies were found in 127 (6.8%) tests, and very major discrepancies were found in only 7 (0.4%) tests. Subsequent MIC determinations in cases of major or very major discrepancies reduced the number of major discrepancies involving cephalosporins from 60 to 16, whereas all those involving aminoglycosides remained. Overall, this direct and rapid Cobas-Bact identification and susceptibility testing procedure offered accurate information with 5 to 6 h after the laboratory detection of bacteremia and septicemia due to members of the Enterobacteriacease.

Bacteriological Techniques↗
PubMed1989

Approximal caries progression in 13- to 15-year-old Danish children.

A total of 278 children aged 13 years in 1980, who lived in an area where preventive programs and professional attitudes towards restorative treatment had changed over a 10-year period, were dentally examined in 1980, 1981, and 1982. Different preventive treatments were given to the children, to decrease the variation in dental caries. The development of new lesions and the rate of progression of existing lesions were studied by means of bitewing radiographs. Ninety-four per cent of the surfaces remained unchanged. Of the surfaces diagnosed as carious at 13 years of age no progression had occurred in 63%, and 86% of enamel lesions remained within the enamel. Although caries progression was slow in this population, the variation in dental caries was only slightly altered.

Adolescent↗
PubMed1988

[Clinical spectrum of a common and insidious pathogen: Streptococcus milleri].

We studied the clinical significance of S. milleri isolated in our hospital in 68 patients during a 18-month period. In 51 patients (median age: 43 years, no underlying diseases in 29 patients), the isolates were associated with significant infections. They were beta-hemolytic in 32 cases and non-hemolytic in 19. The primary infection sites were the head and neck area (21 cases), the lungs (5 cases of pneumonia), the gastrointestinal tract (12 cases), the urogenital tract (3 cases), the soft tissues (6 cases), and the heart (2 endocarditis). Two septicemias were of unknown origin. Head and neck infections and pneumonia were most often associated with beta-hemolytic strains, and bacteremia, gastrointestinal and urogenital tract infections with alpha-hemolytic strains. S. milleri was found in pure culture in 24 cases. Polymicrobial associated flora (27 cases) was more frequent in the abdominal infections (87%) than in supra-diaphragmatic infections (42%). Severe complications were observed in 12 head and neck infections (57%) (cerebral abscesses 3, lethal mediastinitis 2, osteitis 1, meningitis 1, other suppurative lesions 5). When abscesses were present (27 cases), surgery was required in all cases. Despite the high frequency and severity of local complications, the clinical outcome was usually favorable. However, deaths directly related to S. milleri infections occurred in 2 cases of mediastinitis complicating the course of apparently harmless primary infections. Owing to the possible occurrence of life-threatening complications, S. milleri infections require early identification, treatment and surgery when indicated.

Female↗
PubMed1988

[Listeriosis].

Explore the source record for details and available documents.

Humans↗
PubMed1988

Predictors of endocarditis in isolates from cultures of blood following dental extractions in rats with periodontal disease.

Rats with periodontitis and catheter-induced aortic valve vegetations underwent dental extractions. Cultures of blood obtained 1 min later showed polymicrobial bacteremia in 19 of 19 rats, mostly due to viridans streptococci (18 of 19), Morganella (15 of 19), group G streptococci (13 of 19), and Staphylococcus aureus (10 of 19). Viridans streptococci circulated in higher numbers than did group G streptococci and S. aureus (P less than .01). Three days after dental extractions, 18 of 20 rats had endocarditis. Fifteen (83%) of 18 infections were due to group G streptococci, 9 (50%) of 18 were due to S. aureus, and 2 (11%) of 18 were due to viridans streptococci (P less than .05). In vitro, adherence to platelet-fibrin matrices of endocarditis strain 8 of group G streptococcus was two times greater than that of endocarditis strain S. aureus 23 and three to four times greater than that of Streptococcus sanguis 44 and Morganella morganii 93 (P less than 10(-5)). The inoculum size that produced endocarditis in 90% of rats after iv challenge was 10(5) cfu for group G streptococcus strain 8 and 10(7) for S. sanguis 44.

Animals↗
PubMed1988

A new selective medium for isolating Listeria spp. from heavily contaminated material.

Food-associated outbreaks of human listeriosis have emphasized the importance and necessity of screening food for the presence of Listeria isolates-selective agar medium combining acriflavine (10 mg/liter) with ceftazidime (50 mg/liter) was developed. A total of 1,099 cheese production specimens were cultured, from which 157 Listeria isolates. (14.3%) grew. When compared with modified McBride agar, the acriflavine-ceftazidime agar recovered more Listeria isolates (98 versus 65%, P less than 0.001) more rapidly (57% after 48 h of incubation of the enrichment broth versus 35%, P less than 0.01) and in greater amounts. Acriflavine-ceftazidime selective agar medium proved to be a highly sensitive medium to recover Listeria spp. from heavily contaminated food products.

Cheese↗