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Biomedical subjects

R J Wallace

Publications and source records attributed to R J Wallace.

At least 163 records · Page 9Linked to original sources
PubMed1991

Clinical and laboratory features of Nocardia nova.

Recent studies have shown that Nocardia asteroides isolates have five major antibiotic resistance patterns; one of these patterns identifies isolates of Nocardia farcinica. In the current study, we investigated a second pattern characterized by susceptibility to ampicillin and erythromycin. This pattern was seen in 17% of 223 clinical isolates identified by standard techniques as N. asteroides and associated with diseases typical for nocardiae. Biochemically, isolates with this drug pattern were relatively homogeneous and identical to the type strain and previous descriptions of Nocardia nova. The strains studied were unique among nocardiae in having both alpha- and beta-esterase activity (85 and 95%, respectively). However, the arylsulfatase activity at 14 days (75%) and antimicrobial susceptibility patterns, including susceptibility to erythromycin (100%), were the only routinely available methods that would separate N. nova strains from other members of N. asteroides. N. asteroides should be considered a complex because current clinical identification schemes include isolates of N. farcinica and N. nova and may well include additional species. This is the first detailed description of N. nova as a pathogen in humans.

Ampicillin Resistance↗
PubMed1991

Chromosomal DNA fingerprint patterns produced with IS6110 as strain-specific markers for epidemiologic study of tuberculosis.

Mycobacterium tuberculosis isolates were studied by comparing chromosomal DNA fingerprint patterns produced by digestion of chromosomal DNA with BamHI, followed by agarose electrophoresis and hybridization with radiolabeled probes of insertion sequence IS6110. DNA fingerprints of 14 isolates from separate members of five households or closely associated individuals were compared. Marked differences were observed when unrelated isolates were compared. There were no or minimal differences in the restriction fragment patterns generated from isolates of any one household or associated group. Among related isolates, the only noticeable difference was an additional fragment of IS6110 in the fingerprint pattern of one isolate. Insertional activity was also suggested when restriction fragment patterns of H37Rv DNA isolated in 1987 and 1990 were compared. In a similar manner, M. tuberculosis reference strain Erdman was compared to a clinical isolate from an individual working with that strain. These isolates had identical DNA fingerprints which were distinct from all other isolates, verifying laboratory-acquired infection. Chromosomal DNA fingerprint patterns produced with IS6110 are excellent stain-specific markers for the epidemiologic study of tuberculosis.

DNA Fingerprinting↗
PubMed1991

Nosocomial outbreak of respiratory tract colonization with Mycobacterium fortuitum: demonstration of the usefulness of pulsed-field gel electrophoresis in an epidemiologic investigation.

Between August 1989 and January 1990, 16 patients on an alcoholism rehabilitation ward (ARW) developed positive sputum cultures for Mycobacterium fortuitum. During a 2-wk surveillance period, six of 43 ARW patients but none of 20 staff members had positive sputum cultures. In addition, none of 54 patients and staff on an adjacent ward sharing the same ice machine and water supply had positive cultures, and none of 92 acid-fast bacilli cultures performed on all sputum specimens from all other inpatient sources during the same 2-wk period were positive. The only exposure factor common to all cases was the use of one or both of the ward showers. Compared with 36 ARW control patients, cases were more likely to report clinical criteria for chronic bronchitis (odds ratio, 6.6; 95% confidence interval, 1.5 to 28.6; p = 0.02). Using phenotype analysis, plasmid profiles, and pulsed-field gel electrophoresis of large genomic DNA restriction enzyme fragments, the 16 case isolates were found to be identical. This strain of M. fortuitum was also cultured from a tap connected to the water line supplying the ARW showers, but not from the showers themselves. No further cases were identified after the showers were disconnected and decontaminated. To our knowledge, this is the first clinical use of pulsed-field gel electrophoresis for genetic comparison of mycobacterial strains. It demonstrates the important potential of this technique for studying the epidemiology of mycobacterial infections. Showers should be considered a possible source of nosocomial respiratory tract colonization with M. fortuitum.

Case-Control Studies↗
PubMed1990

A descriptive study of 42 cases of Branhamella catarrhalis pneumonia.

PURPOSE: We studied the clinical and laboratory findings of patients with pneumonia due to Moraxella (Branhamella) catarrhalis to better characterize the types of patients who develop this pneumonia, the clinical features of the illness, and the type of and response to drug therapy, as well as the immediate and long-term survival of these patients. PATIENTS AND METHODS: Patients with sputum samples that met cellular criteria as quality samples and that grew B. catarrhalis as the sole pathogen were identified retrospectively from microbiology records at a regional referral hospital for cardiac and pulmonary diseases. Records of these patients were reviewed to identify patients with radiographic findings of pneumonia. Clinical and laboratory characteristics of these patients were then studied in detail. RESULTS: Forty-two patients who met the criteria for B. catarrhalis pneumonia were identified. Most patients were elderly (over 65 years; 55 percent), malnourished (69 percent), and had severe chronic obstructive pulmonary disease or another serious underlying disease (98 percent). The seasonal incidence of this pneumonia was October through April (88 percent), with the annual number of cases having increased since 1982. The clinical presentation was typically mild. Interstitial or mixed interstitial-alveolar infiltrates superimposed on pre-existing chronic lung disease was the most common radiographic finding. Approximately 90 percent of sputa were acceptable for Gram stain and contained 10 to more than 50 gram-negative cocci/1,000 x field. All cultures produced a heavy growth of B. catarrhalis, with 67 percent of strains positive for beta-lactamase. No patient had identified bacteremia (zero of 25 tested). Therapy with numerous agents including cefotaxime, amoxicillin/clavulanic acid, and trimethoprim/sulfamethoxazole resulted in a good clinical and bacteriologic response. However, 45 percent of patients died of their underlying diseases on this admission or within three months. CONCLUSION: These findings provide a good profile of B. catarrhalis pneumonia. Despite the mild character of the illness, the pneumonia occurs in patients with end-stage pulmonary or malignant disease and almost 50 percent of patients die of their underlying diseases within three months.

Adult↗
PubMed1990

Antibiotic susceptibilities and drug resistance in Moraxella (Branhamella) catarrhalis.

PURPOSE: To summarize current knowledge of drug susceptibility and mechanisms of drug resistance in Moraxella (Branhamella) catarrhalis. MATERIALS AND METHODS: The current medical literature was reviewed, with careful attention to recent studies of the BRO beta-lactamases. RESULTS: Although intrinsically resistant to a small group of drugs that included vancomycin and trimethoprim, acquired drug resistance in Branhamella catarrhalis was unknown in the early years of antimicrobial therapy. During 1976 to 1977, however, two previously unrecognized beta-lactamases appeared in this species almost simultaneously around the world. At the same time these enzymes, now known as BRO-1 and BRO-2, also appeared in two closely related commensal species of Moraxella. Within four years the BRO enzymes were found in up to 75 percent of B. catarrhalis in the United States where they provide low-level resistance to penicillin and ampicillin but not to most cephalosporins. The BRO genes appear to be chromosomal but are readily transferred by conjugation within the Moraxella genus. Resistance to aminoglycosides and trimethoprim-sulfamethoxazole has been reported from Spain, and resistance to both erythromycin and tetracycline has recently been described among United States isolates of B. catarrhalis. CONCLUSION: Despite this drug resistance, numerous oral and parenteral agents are available and appear useful for treatment of clinical disease, including amoxicillin/clavulanic acid, erythromycin, the tetracyclines, ciprofloxacin, and trimethoprim/sulfamethoxazole. Recent changes in drug resistance in this species suggest that continued monitoring of drug resistance in B. catarrhalis is needed.

Anti-Bacterial Agents↗
PubMed1990

Urogenital, maternal and neonatal isolates of Haemophilus influenzae: identification of unusually virulent serologically non-typable clone families and evidence for a new Haemophilus species.

A collection of 117 strains of Haemophilus influenzae, including 112 non-typable isolates recovered predominantly in the USA and France from genital, obstetric and neonatal sources, was characterized by the electrophoretic mobilities of 10 metabolic enzymes. Eighty-six distinctive multilocus chromosomal genotypes (electrophoretic types, ETs) were distinguished on the basis of allele profiles at the enzyme loci. Isolates of five allied biotype IV ETs were highly divergent from all other strains and hybridization of chromosomal DNA revealed that they undoubtedly represent a previously unrecognized species of Haemophilus. Isolates representing these ETs were recovered predominantly from obstetric infections and serious neonatal diseases and apparently possess specific tropism for the genital tract. Strains of these five ETs were present in samples from both the USA and France, but only in the USA did they cause bacteraemia and meningitis, an occurrence which probably reflects differences in patient management between the two countries. Although strains assigned to H. influenzae (sensu stricto) were strongly polymorphic in multilocus enzyme genotype, 69% of isolates recovered from patients with meningitis and/or septicaemia were assigned to only two clone families, a result suggesting that some serologically nontypable strains of H. influenzae originating from the genital tract are unusually virulent.

Alleles↗
PubMed1990

Activities of ciprofloxacin and ofloxacin against rapidly growing mycobacteria with demonstration of acquired resistance following single-drug therapy.

The susceptibility to ciprofloxacin of 548 clinical isolates of rapidly growing mycobacteria belonging to eight subgroups or species was determined. The 170 isolates of Mycobacterium fortuitum biovar.fortuitum were most susceptible; the MIC for 90% of the organisms was 0.125 micrograms/ml. The other biovariants of M. fortuitum, M. smegmatis, and the M. chelonae-like organisms were less susceptible; the modal MIC was 0.5 micrograms/ml, and the MIC for 90% of organisms was 1.0 micrograms/ml. The two subspecies of M. chelonae were generally resistant, with only 8% of 206 isolates falling in the moderately susceptible category (MIC, 2 micrograms/ml) and only 2% falling in the susceptible category (MIC, less than or equal to 1 micrograms/ml). MICs of ofloxacin averaged 1 to 2 dilutions higher than those of ciprofloxacin for all subgroups tested. Three patients with M. fortuitum cutaneous disease relapsed after an initial response to therapy with ciprofloxacin, and their isolate was shown to have acquired drug resistance. Mutational frequencies for M. fortuitum with ciprofloxacin were relatively high (10(-5) to 10(-7), and MICs for single-step mutants were similar to those for the clinically resistant strains. Thus, despite the excellent activity of ciprofloxacin against rapidly growing mycobacterial groups other than M. chelonae, single-drug therapy should be used with caution because of the risk of development of mutational resistance.

Adult↗
PubMed1990

Adhesion of cellulolytic ruminal bacteria to barley straw.

Adhesion of the cellulolytic ruminal bacteria Ruminococcus flavefaciens and Fibrobacter succinogenes to barley straw was measured by incubating bacterial suspensions with hammer-milled straw for 30 min, filtering the mixtures through sintered glass filters, and measuring the optical densities of the filtrates. Maximum adhesion of both species occurred at pH 6.0 and during mid- to late-exponential phase. Adhesion was saturable at 33 and 23 mg (dry weight) g of straw for R. flavefaciens and F. succinogenes, respectively. Methyl cellulose and carboxymethyl cellulose inhibited adhesion by 24 to 33%. Competition between species was determined by measuring characteristic cell-associated enzyme activities in filtrates of mixtures incubated with straw; p-nitrophenyl-beta-d-lactopyranoside hydrolysis was used as a marker for F. succinogenes, while either beta-xylosidase or carboxymethyl cellulase was used for R. flavefaciens, depending on the other species present. R. flavefaciens had no influence on F. succinogenes adhesion, and F. succinogenes had only a minor (<20%) effect on R. flavefaciens adhesion. The noncellulolytic ruminal bacteria Bacteroides ruminicola and Selenomonas ruminantium had no influence on adhesion of either cellulolytic species, although these organisms also adhered to the straw. We concluded that R. flavefaciens and F. succinogenes have separate, specific adhesion sites on barley straw that are not obscured by competition with non-cellulolytic species.

Journal Article↗
PubMed1990

Cefotaxime-resistant Nocardia asteroides strains are isolates of the controversial species Nocardia farcinica.

A recent study of Nocardia asteroides revealed that 95% of clinical strains had one of five antibiotic resistance patterns. We found the pattern of resistance to cefotaxime and cefamandole in 19% of 200 clinical N. asteroides isolates. Isolates with this drug resistance pattern were from numerous geographic sources and were associated with significant clinical disease (56% of patients had disseminated infections). Phenotypic studies revealed that these isolates were relatively homogeneous and matched previous descriptions and reference strains of the controversial species N. farcinica. Growth at 45 degrees C, acid production from rhamnose, ability to utilize acetamide as a nitrogen and carbon source, and resistance to tobramycin and cefamandole were features of N. farcinica that could be tested in the clinical laboratory and allowed their distinction from N. asteroides. The serious nature of disease due to N. farcinica and its resistance to the newer cephalosporins suggest a clinical need for laboratory identification of this species. (Current tests used in clinical laboratories do not distinguish N. farcinica from N. asteroides.) This is the first recognition that N. farcinica has a specific drug resistance pattern and confirms the previously described concept that drug resistance patterns of N. asteroides may be associated with specific taxonomic groups.

Cefotaxime↗
PubMed1990

Effects of the ionophore tetronasin on nitrogen metabolism by ruminal microorganisms in vitro.

The effects of tetronasin on ruminal protein metabolism were investigated in vitro using ruminal fluid from cattle receiving tetronasin in the diet, ovine ruminal fluid from animals not receiving tetronasin and pure cultures of proteolytic ruminal bacteria. Ruminal fluid from cattle receiving tetronasin in a predominantly barley diet had lower proteolytic (76% of control, P less than .10) and deaminative (58% of control, P less than .05) activities than controls after 42 d. The effect of deamination disappeared after 84 d, although the proteolytic activity remained lower (P less than .10) than that of controls. When tetronasin was added in vitro to ruminal fluid from sheep not receiving the ionophore, proteolytic activity (14C-labeled casein hydrolysis) was unaffected, but the rate of ammonia production from amino acids was decreased by 87% (P less than .01). Oligopeptide breakdown was inhibited to a lesser extent (21%, P less than .05). Dipeptidase activity (dialanine hydrolysis) was not affected. The addition of tetronasin to cultures of the ruminal bacteria Ruminobacter amylophilus and Bacteroides ruminicola had no influence on their protease, deaminase or dipeptidase activities. However, when the bacteria were adapted to grow in the presence of tetronasin, deamination of amino acids was severely inhibited (87 to 100%, P less than .01), even when tetronasin was absent from the incubation mixture. Tetronasin had no effect on the proteolytic activity of adapted cultures.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗
PubMed1989

Ofloxacin in community-acquired lower respiratory infections. A comparison with amoxicillin or erythromycin.

Ninety-one patients with community-acquired lower respiratory infections were treated orally in a comparative 10-day trial of ofloxacin versus amoxicillin or erythromycin. Approximately one-half of the patients had no major underlying disease and the other half had some form of chronic lung disease. Pneumonia was present in 31 percent of the patients and the remainder had purulent bronchitis. Bacterial pathogens were recovered from 60 percent of the patients, with Haemophilus influenzae (33 isolates) and Streptococcus pneumoniae (16 isolates) being the most common. Ofloxacin was found to be a safe, well-tolerated therapeutic agent, which was as effective clinically as amoxicillin or erythromycin and with an advantage of less frequent administration. Ofloxacin was more effective than amoxicillin (90 percent versus 75 percent; p = 0.05) in elimination of pathogenic bacteria from lower airway cultures. Caution should be exercised in the use of ofloxacin, at least in short-term treatment regimens, with anaerobic pulmonary infections; additional information is needed for S. pneumoniae given the relatively high minimal inhibitory concentrations for this species.

Adult↗
PubMed1989

Does aminoglycoside-acetyltransferase in rapidly growing mycobacteria have a metabolic function in addition to aminoglycoside inactivation?

All the rapidly growing mycobacteria tested, Mycobacterium fortuitum complex, M. smegmatis, M. phlei, and M. vaccae, contained one of two characteristics, but were different from previously recognized aminoglycoside-acetyltransferases. The acetylation reaction of both the enzymes from M. fortuitum and Pseudomonas aeruginosa (3-N-acetyltransferase-III) with radiolabeled acetyl coenzyme A was inhibited severely by oxalacetate. It was suggested that the inhibitory effect of oxalacetate is due to the condensation reaction between oxalacetate and acetyl coenzyme A resulting in the generation of citrate.

Acetyltransferases↗
PubMed1989

Disseminated Mycobacterium chelonae ssp. abscessus in an immunocompetent host and with a known portal of entry.

A unique case is presented in which disseminated Mycobacterium chelonae ssp. abscessus was found in a normal immunocompetent host after a traumatic injury. Although disseminated disease is known to occur in immunocompromised and postsurgical patients, this case is unusual in that it occurred in a patient with no evidence of immunodeficiency and with a known portal of entry.

Adult↗
PubMed1989

Diversity and sources of rapidly growing mycobacteria associated with infections following cardiac surgery.

Eighty-nine isolates of rapidly growing mycobacteria associated with cardiac bypass-related infections were characterized. Isolates from sporadic infections belonged to eight taxonomic groups and displayed numerous multilocus enzyme genotypes, plasmid profiles, and heavy metal and antibiotic resistance patterns. Compared with 449 noncardiac wound isolates, 45 sporadic cardiac isolates were more likely to be Mycobacterium fortuitum and M. smegmatis and less likely to be M. chelonae. About 80% of cardiac and noncardiac isolates were from southern coastal states. Eight outbreaks of cardiac bypass-related infections were identified. Strains from each outbreak were genotypically distinctive, and five outbreaks involved more than one strain. In two outbreaks, isolates from environmental sources and noncardiac infections were similar or identical to isolates from sternal wound infections. The heterogeneity of these isolates suggests that most isolates are unrelated and are derived from local environmental sources rather than from contaminated commercial surgical materials or devices.

Cardiopulmonary Bypass↗
PubMed1989

Heterogeneity among isolates of rapidly growing mycobacteria responsible for infections following augmentation mammaplasty despite case clustering in Texas and other southern coastal states.

Thirty-seven cases of rapidly growing mycobacterial wound infections following augmentation mammaplasty were identified between 1979 and 1988. The infections were usually unilateral and had a narrow geographic distribution: almost 60% were from Texas and 92% from five southern coastal states. In Texas a seasonal incidence was observed; 45% of all previously reported and current patients had undergone mammaplasty in April, May, or June. Although these findings suggested a possible common source, analysis of 35 available isolates revealed 19 different phenotype patterns. Five different taxonomic groups were represented, although most isolates (70%) were Mycobacterium fortuitum biovar fortuitum. Plasmid bands were identified in 10 of 15 strains studied, with nine different profiles. An additional 11 cases of breast infection due to rapidly growing mycobacteria not associated with augmentation were also identified, of which nine came from the same states that contributed mammaplasty cases. Rapidly growing mycobacterial infections of the breast are endemic in Texas and other southern coastal states, and the heterogeneity of the isolates suggests that most cases are unrelated.

Adult↗