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Biomedical subjects

K L Ruoff

Publications and source records attributed to K L Ruoff.

At least 37 records · Page 2Linked to original sources

Nutritionally variant streptococci.

Streptococci requiring either pyridoxal or L-cysteine for growth were first observed 30 years ago as organisms forming satellite colonies adjacent to colonies of "helper" bacteria. Although they were previously considered nutritional mutants of viridans streptococcal species, the nutritionally variant streptococci (NVS) are currently thought to belong to distinct species of the genus Streptococcus. NVS strains may display pleomorphic cellular morphologies, depending on their growth conditions, and are distinguished from most other streptococci by enzymatic and serological characteristics and the presence of a cell wall chromophore. NVS are found as normal inhabitants of the oral cavity, and in addition to their participation in endocarditis, they have been isolated from a wide range of clinical specimens. Endocarditis caused by NVS is often difficult to eradicate; combinations of penicillin and an aminoglycoside are recommended for treatment. The unique physiological features of the NVS contribute to the difficulties encountered in their recovery from clinical specimens and may play a role in the problems associated with successful treatment of NVS endocarditis.

Endocarditis, Bacterial↗

Recent taxonomic changes in the genus Enterococcus.

Recent taxonomic changes among the catalase-negative gram-positive cocci have led to the recognition of a separate genus for bacteria previously considered to be members of the genus Streptococcus. Presently, a total of 12 species of the genus Enterococcus have been described. The characteristics, taxonomy and nomenclature of these species, along with the possible clinical implications of revised enterococcal taxonomy, are discussed.

Enterococcus faecalis↗

Species identities of enterococci isolated from clinical specimens.

Conventional tests and commercially available systems were used to determine the species identities of clinical isolates of enterococci. Strict adherence to the conventional test scheme of Facklam and Collins (R. R. Facklam and M. D. Collins, J. Clin. Microbiol. 27:731-734, 1989) resulted in the misidentification of lactose-negative Enterococcus faecalis isolates as Enterococcus solitarius, but this problem was overcome by the application of additional tests. The commercially available systems tested were unable to recognize some of the more recently described enterococcal species. E. faecalis accounted for 87.1% of 302 consecutive isolates. Enterococcus faecium (8.6%), Enterococcus avium (0.7%), Enterococcus durans (0.3%), Enterococcus gallinarum (1.0%), Enterococcus casseliflavus (1.0%), Enterococcus hirae (0.3%), and Enterococcus raffinosus (0.3%) isolates were also identified. None of the isolates produced beta-lactamase, but 15.4% of 235 isolates tested, including 1 strain of E. gallinarum, displayed high-level resistance to gentamicin.

Culture Media↗

In vitro activities of daptomycin and other antimicrobial agents against vancomycin-resistant gram-positive bacteria.

A comparative evaluation of daptomycin and eight other antimicrobial agents was performed by the agar dilution technique with 56 strains of vancomycin-resistant gram-positive bacteria, including Leuconostoc, Lactobacillus, and Pediococcus spp. Erythromycin, deptomycin, clindamycin, and gentamicin exhibited the greatest activities, whereas penicillin, ampicillin, and cefotaxime showed moderate activities. The organisms were all highly resistant to vancomycin and cefoxitin.

Anti-Bacterial Agents↗

Bacteremia with Streptococcus bovis and Streptococcus salivarius: clinical correlates of more accurate identification of isolates.

Two biotypes of Streptococcus bovis can be identified by laboratory testing and can be distinguished from the phenotypically similar organism Streptococcus salivarius. We assessed the clinical relevance of careful identification of these organisms in 68 patients with streptococcal bacteremia caused by these similar species. S. bovis was more likely to be clinically significant when isolated from blood (89%) than was S. salivarius (23%). There was a striking association between S. bovis I bacteremia and underlying endocarditis (94%) compared with that of S. bovis II bacteremia (18%). Bacteremia with S. bovis I was also highly correlated with an underlying colonic neoplasm (71% of patients overall, 100% of those with thorough colonic examinations) compared with bacteremia due to S. bovis II or S. salivarius (17% overall, 25% of patients with thorough colonic examinations). We conclude that careful identification of streptococcal bacteremic isolates as S. bovis biotype I provides clinically important information and should be more widely applied.

Adolescent↗

Streptococcus anginosus ("Streptococcus milleri"): the unrecognized pathogen.

"Streptococcus milleri" is an unofficial name that has been applied to a group of streptococci which, although basically similar, show various hemolytic, serological, and physiological characteristics. The species name Streptococcus anginosus has recently been recognized as the approved name for these organisms. Streptococci known as "S. milleri" have been implicated as etiologic agents in a variety of serious purulent infections, but because of their heterogeneous characteristics, these organisms may be unrecognized or misidentified by clinical laboratorians. This review describes the bacteriological aspects of organisms known as "S. milleri," their clinical significance, and the problems encountered with their identification in the clinical laboratory.

Humans↗

Vancomycin-resistant gram-positive bacteria isolated from human sources.

Recent reports of infections with vancomycin-resistant gram-positive bacteria prompted us to study vancomycin-resistant isolates from human sources to characterize the types of bacteria displaying this phenotype. Thirty-six vancomycin-resistant gram-positive isolates, 14 from clinical specimens and 22 from stool samples, were identified. These isolates were tentatively identified as Lactobacillus spp. (25 strains), Leuconostoc spp. (6 strains), and Pediococcus spp. (3 strains) on the basis of morphology and physiological tests. Two isolates of indeterminate morphology could not be unambiguously assigned to a genus. Four isolates of vancomycin-resistant lactobacilli from normally sterile body sites were considered to be clinically significant. Vancomycin-resistant gram-positive bacteria may represent an emerging class of nosocomial pathogens. Better methods for distinguishing the various genera in the clinical microbiology laboratory are needed.

Adult↗

Routine culture of stool specimens for Yersinia enterocolitica is not a cost-effective procedure.

Cefsulodin-Irgasin-novobiocin (CIN) agar was used to isolate Yersinia enterocolitica from 3,622 stool specimens received in our laboratory during a 1-year period. Seven specimens (0.2%) yielded Y. enterocolitica strains from a total of five patients. The low frequency of Y. enterocolitica isolation observed, coupled with the isolation of this pathogen from three of the five patients by our standard stool examination protocol, leads us to conclude that routine culture of stool specimens on CIN agar is not a cost-effective procedure.

Cost-Benefit Analysis↗

Hydrolytic enzymes of "Streptococcus milleri".

Seventy-two isolates classified as "Streptococcus milleri" were examined for the presence of various hydrolytic enzymes. While no protein or lipid-degrading activities were demonstrated, some isolates showed DNase and mucopolysaccharide-degrading activities. Beta-hemolytic isolates were more likely to produce these enzymes than were nonhemolytic strains. Isolates of one "S. milleri" biotype (mannitol fermentation positive) were uniformly devoid of all enzyme activities tested.

Chondroitinases and Chondroitin Lyases↗

Presumptive identification of "Streptococcus milleri" in 5 h.

Rapid miniaturized tests for acetoin production, arginine hydrolysis, and sorbitol fermentation were used for presumptive identification of non-beta-hemolytic "Streptococcus milleri" isolates in 5 h. All 77 "S. milleri" strains tested were Voges-Proskauer positive, arginine hydrolysis positive, and sorbitol fermentation negative. On the basis of these reactions, "S. milleri" was differentiated from isolates of other viridans group streptococcal species and from Streptococcus bovis.

Acetoin↗

Occurrence of Streptococcus milleri among beta-hemolytic streptococci isolated from clinical specimens.

A total of 256 beta-hemolytic streptococcal isolates were subjected to serological and physiological tests to identify those which could be classified as Streptococcus milleri. S. milleri accounted for 75% of 70 group C isolates, 15% of 69 group G isolates, 75% of 16 nongroupable isolates, and 100% of 20 group F isolates examined. No S. milleri isolates were encountered among the 90 group A streptococci studied. Of the 95 beta-hemolytic S. milleri isolates examined, 81% were recovered from respiratory specimens.

Humans↗

New cause for false-positive results with the cryptococcal antigen test by latex agglutination.

The highly specific and sensitive latex agglutination test for cryptococcal antigen detection in cerebrospinal fluid is routine in many hospitals. Contamination of cerebrospinal fluid by a minute amount of syneresis fluid (surface condensation) from agar gave a strongly positive reaction which was heat stable, was not eliminated by pronase treatment, and was not detected by the normal rabbit globulin controls. These observations were valid for three commercially available test kits and could represent a preventable cause of some unexplained false-positive tests despite the use of adequate controls.

Aged↗

Identification of Streptococcus bovis and Streptococcus salivarius in clinical laboratories.

Streptococci identified as Streptococcus bovis, S. bovis variant, and Streptococcus salivarius were examined with respect to physiological and serological characteristics and cellular fatty acid content. Similarities in physiological reactions and problems encountered in serological analysis were noted, suggesting that an expanded battery of physiological tests is needed to definitively identify these streptococci. Cellular fatty acid analysis provided an accurate method for distinguishing S. salivarius from S. bovis and S. bovis variant.

Antigens, Bacterial↗

Distribution and incidence of viridans streptococcal species in routine clinical specimens.

Five hundred consecutive isolates of viridans streptococci were identified to the species level in an effort to determine their distribution and incidence in routine clinical specimens. Viridans streptococci accounted for significant percentages of streptococcal isolates from urine, wounds, body fluids, and blood. The most commonly isolated strains belonged to the Streptococcus milleri, Streptococcus mitis, Streptococcus sanguis I, and Streptococcus sanguis II species. Patient charts were reviewed in order to investigate the possible role as a urinary pathogen of strains belonging to a subgroup of S. milleri. Although these strains frequently are isolated from urine, they appear to play no pathogenic role in urinary tract infections.

Humans↗

Multiply resistant viridans streptococci: susceptibility to beta-lactam antibiotics and comparison of penicillin-binding protein patterns.

A unique group of viridans streptococci has been found in South Africa. These organisms were isolated in close temporal and physical proximity to the isolation of penicillin-resistant pneumococci. The strains were resistant to penicillin, oxacillin, the cephalosporins (all generations), piperacillin, azlocillin, and mezlocillin but were susceptible to vancomycin. Penicillin-binding proteins of two penicillin-resistant South African strains of Streptococcus mitis differed markedly from those of two penicillin-susceptible strains but were identical to those seen in a penicillin-resistant strain isolated in Boston. Although both susceptible strains were identified as S. mitis with identical biochemical profiles, their penicillin-binding protein patterns differed from each other. This finding may have significance with regard to the need for additional taxonomic classification of the viridans streptococci.

Anti-Bacterial Agents↗

Use of the Rapid STREP system for identification of viridans streptococcal species.

A commercially available streptococcal identification system, Rapid STREP (API System S.A., Montalieu-Vercieu, France), was used to identify 119 viridans strains at the species level. A total of 92% of the strains tested were identified correctly with the Rapid STREP system, and 81% of the correct identifications were made at percentages of identification of 90 or greater. From these data it appears that the Rapid STREP system is a fairly accurate and rapid (24-h incubation) method for identifying species of viridans streptococci.

Humans↗

Identification of viridans streptococci isolated from clinical specimens.

Of 532 strains of viridans streptococci isolated from clinical specimens, 517 were identified by using a scheme based on the work of Facklam (R. R. Facklam, J. Clin. Microbiol. 5:184-201, 1977). The strains were distributed among nine of the species described by Facklam and an additional group of physiologically homogeneous streptococci not recognized in Facklam's scheme. The method for identification involves a battery of 10 tests that employ both conventional media and commercially prepared disks. The identification of most of the isolates was accomplished within 48 h.

Arginine↗