Bacterial ileocaecitis and appendicitis.
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Biomedical subjects
Publications and source records attributed to J Vandepitte.
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The aim of this study was to carry out a small-scale bacteriological comparison between a standard therapy with norfloxacin 400 mg twice daily, and fosfomycin trometamol (3 g) in single dose in uncomplicated urinary tract infections (UTI) in women. Only patients with UTI with cultures showing a bacterial count of 10(5) or more bacteria/ml were included in the study (n = 32; ages 16-75 years). After one week sterile cultures were obtained in 14 of 16 cases in the fosfomycin trometamol group, and in 14 of 16 cases in the norfloxacin group. After one month eradication was confirmed in 13 of 16 patients in the fosfomycin trometamol group, and in nine of 16 patients in the norfloxacin group. Recurrence was seen in one case in the fosfomycin trometamol group, and in five cases in the norfloxacin group. The reinfection and persistence rates were identical (1/16) in both groups. The main clinical symptoms disappeared very rapidly after initiating treatment, and the correlation with the bacteriological data after one week was excellent. Both drugs were well tolerated and the compliance for fosfomycin trometamol was 100%.
A prospective randomized controlled double-blind study was performed on 61 patients undergoing transurethral resection of the prostate. The first group of 31 patients received 3 g fosfomycin trometamol p.o. each on the evening before and after the operation; the second group of 30 patients received a placebo. Urine samples were taken by catheter puncture 24 and 48 h postoperative. After removal of the catheter (day 5) the first midstream urine was collected for culture, and from that moment on all patients were treated with a nitrofurantoin derivative for two weeks. Although the same strict antiseptic measures were standard practice for both groups, the incidence of early postoperative urinary tract infections was significantly lower for the fosfomycin trometamol group (0/31 versus 6/30 in placebo recipients). None of the patients suffered from a major symptomatic or complicated infection. There were no side effects registered.
A total of 2,765 strains of Streptococcus pneumoniae isolated in more than 60 Belgian laboratories from blood or normally sterile body fluids between 1 November 1980 and 31 December 1988 were serotyped. From January 1983 onwards susceptibility of the strains to antimicrobial agents was also tested. The 2,765 isolates belonged to 57 of the 84 currently identified serotypes. Overall, 94% of the strains were represented in the current 23-valent vaccine. The remaining 6% of strains were distributed among 18 serotypes. More than 84% of the middle ear fluid isolates came from children under ten years. Meningitis was commonest in children under five years and in adults over sixty years. Two-thirds of pneumococcal bacteremia isolates came from patients over 50 years. Of 1,933 isolates tested for susceptibility to antibiotics, 335 (17%) were resistant to one or more of the agents tested (tetracycline, erythromycin, chloramphenicol, penicillin). Only 19 strains were relatively resistant to penicillin, while six were fully resistant. Resistance to erythromycin increased significantly from 5.2% in 1986 to 11.5% in 1988. The resistance of Streptococcus pneumoniae to other antimicrobial agents did not change significantly during the study period. There was no relationship between age group and resistance to any of the agents tested.
Over a period of two years 98 cultures of Salmonella and 17 cultures of Shigella were isolated at the El Maarouf Hospital, Moroni, capital of the Comoros. Almost half of the isolates were from children under 5 years. Salmonella belonged to a limited range of serotypes, S. typhi dominating in adults and S. enteritidis in children, often with bacteraemia. Antibiotic resistance was virtually absent in Salmonella and without clinical significance in Shigella. The high isolation rate of S. enteritidis and the rarity of antibiotic resistance are commented.
Six newborns with Listeria monocytogenes infection were admitted to the same neonatal unit between 31 October and 3 December 1985. The index case, a preterm baby, was born to a mother who was febrile with an influenza-like illness at the time of delivery. This baby presented with Listeria sepsis and pneumonia. Another child was born from whose mother L. monocytogenes was isolated from the cervix with the same serotype as that in the CSF of her newborn. In the other cases blood and cervical cultures of the mothers were negative, while Listeria was isolated from the CSF of their babies. Five out of six infants developed meningitis between 9 and 12 days after birth. All isolates were serotype 4b and indistinguishable by phage typing. All babies were successfully treated without any major sequelae. Although cross-infection was strongly suggested, the source of the outbreak could not be established. This is the first documented report of human listeriosis in Kuwait.
Malassezia furfur fungaemia is reported in six preterm infants receiving a parenteral fat emulsion through a deep central venous catheter. The fungus was detected in blood cultures drawn through the catheter. The features of these cases are compared to those reported since 1981, when M. furfur was described for the first time as a cause of deep tissue infection. Clinical signs such as fever, in spite of broad-spectrum antibiotics, and the presence of pulmonary infiltrates, associated with leucocytosis and thrombocytopenia in neonates with cardiac or pulmonary disease should raise the suspicion of M. furfur fungaemia. The laboratory should be informed of this possibility since routine blood culture techniques are not appropriate for the isolation of this lipid-dependent organism. Treatment of the condition consists in removal of the catheter and discontinuation of the lipid administration. Effects and choice of antifungal therapy should be further investigated.
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Routine sterility control of a unit of leukocyte-depleted erythrocyte concentrate yielded growth of Yersinia enterocolitica serotype O:3. Plasma of the donor showed a high titer of agglutinins against the homologous organism. Although the donor was apparently well at the time of donation, he had a history of protracted terminal ileitis treated by surgery. The recipient of the contaminated blood was taking broad-spectrum antibiotics and did not experience any adverse effect. Fourteen other cases of transfusion-associated yersiniosis have been reported.
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A 26-year-old man addicted to alcohol was admitted to hospital with headache and rhinorrhoea. Investigation revealed Pasteurella ureae meningitis and bacteraemia. A course of intravenous cefotaxime and penicillin G, followed by surgical correction of a nasocranial fistula, led to full recovery. Fourteen cases of serious extrarespiratory infections due to P. ureae are briefly reviewed.
A new enrichment medium for the recovery of pathogenic Yersinia enterocolitica serogroup O:3 from naturally infected meat products based on three selective agents, Irgasan, ticarcillin, and potassium chlorate (ITC), was compared with several other one- or two-step enrichments. Y. enterocolitica serogroup O:3 was recovered from 96.5% of 29 pork tongues, 24% of 50 ground pork samples, 16% of 25 masseter muscle samples, and 61% of tonsils. ITC was by far the most sensitive method for the recovery of Y. enterocolitica O:3, especially from ground meat and masseter muscles, while cold and two-step enrichments yielded better results for nonpathogenic strains. Plating of ITC enrichments onto SS-deoxycholate-calcium agar gave overall better results than plating onto cefsulodin-Irgasan-novobiocin agar for serogroup O:3.
To examine the frequency of community acquired bacteraemia in children in Kigali, Rwanda, blood cultures were obtained from 900 consecutive febrile children (T degrees greater than or equal to 39 degrees C) seen at an outpatient clinic over the course of a year. A pathogen was isolated from 112 children (12.4%): Salmonella typhi from 47, S enteritidis from 23, S typhimurium from 13, Streptococcus pneumoniae from 14, Staphylococcus aureus from 9, and Haemophilus influenzae from 3. Salmonella species represented 74% of the isolates. The children with S typhi bacteraemia were older (mean age 75 months) than those with bacteraemia due to other organisms. Controls consisted of febrile, nonbacteraemic children without (group I) or with (group II) Plasmodium falciparum parasitaemia. Bacteraemic children were older and presented more frequently with diarrhoea, vomiting, and dehydration, but less frequently with convulsions than controls. The rate of hospital admission was higher among bacteraemic children (61%) than among group I (39%) or group II (46%) controls. The case-fatality rate was similar in the three groups (9.3% versus 2.9% and 7.3%). Community-acquired bacteraemia in Rwandese children is common and is mainly caused by Salmonella species.
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To determine the risk factors for Yersinia enterocolitica (YE) infection in Belgium, which is the country with the highest incidence of this infection, 40 persons with YE infections due to serotype O:3 (n = 36) or O:9 (n = 4) were compared with matched controls. Most patients had acute gastroenteritis; 1 had a liver abscess. 20% were admitted to hospital; the mean duration of hospital stay was 9 days. YE infection was strongly associated with eating raw pork in the 2 weeks before onset (odds ratio = 12, p = 0.00002), a factor that accounted for 58% of the YE infections studied. 14 (18%) of 79 families surveyed at a well-baby clinic fed their children raw pork from a median age of 18 months. Specific control measures to reduce contamination and consumption of raw pork may reduce the incidence of YE infections.
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