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We report the case of a 66 year-old-patient, who profited by a laminectomy T4 to T7 for spinal cord compression due to an osteomyelitis. Bacteriological samples showed positives gram cocci and Bacteroides fragilis by the culture. The systematic research of a primitive source permitted to find a parasigmoidis abscess, which was treated by a sigmoidectomy with a colorectal anastomosis.
We report the case of a 78-year-old-woman with a meningitis caused by Bacteroides fragilis revealing a malignant tumor. The epidemiologic, etiologic and therapeutic features of these meningitis are reviewed.
Beta-lactam antibiotics and 5-nitroimidazoles have been extensively used against anaerobic bacteria. However, antibiotic resistance is increasingly common among anaerobic Gram-negative bacilli. The classical mechanisms of resistance to beta-lactams are, (1) production of beta-lactamases; (2) alteration of penicillin-binding proteins (PBPs); and (3) changes in outer membrane permeability to beta-lactams. The 5-nitroimidazole molecule is a prodrug whose activation depends upon reduction of the nitro group in the absence of oxygen. Decreased uptake and altered reduction are believed to be responsible for metronidazole resistance. Five nim genes (A, B, C, D and E) have been identified in Bacteroides fragilis group spp. that confer resistance to 5-nitroimidazole antibiotics. Knowledge of the status and the mechanisms of resistance is critical for both the selection of antimicrobial therapy and the design of new antimicrobial agents. The purpose of this article is to review the mechanisms for and the prevalence of beta-lactam and metronidazole resistance in strains belonging to the B. fragilis group.
UNLABELLED: Cases of meningitis due to Bacteroides fragilis are rare; we report a case revealing a meningorectal fistula. CASE REPORT: A 2-month-old infant developed a severe sepsis syndrome following a rectosigmoidoscopy for rectal bleeding. Lumbar puncture diagnosed bacterial meningitis. Cerebrospinal fluid (CSF) culture evidenced B fragilis with betalactamase. The initial antibiotherapy was changed for imipenem-metronidazole, which is at present the recommended antibiotherapy. Malformation including pre-spinal tumor and meningorectal fistula was evoked on magnetic resonance imaging (MRI) and confirmed by surgery. The outcome was favorable after surgery and antibiotherapy. CONCLUSION: B fragilis meningitis are usually associated with sepsis, whose origin is obvious. In our case, meningitis was isolated, revealing a meningorectal fistula.
Bacteriodes fragilis isolated from aquatic environment, from infectious process and from human feces were compared as to their outer membrane protein electrophoretic profiles after staining with Coomassie blue and reacting with antibodies prepared against whole-cell antigens of a reference strain from a clinical source. A marked homogeneity was found among the strains with these methodologies. The profiles of all strains obtained after radio-iodination of the intact cell showed qualitative similarity when compared with the profiles obtained by the other methods. Thus, these data allow us to suggest the designation of the peptides observed in the autoradiograms as surface-exposed proteins. Differences observed in the autoradiograms in the expression of bands mainly detected at a molecular weight of 28 in the commensal strain 118,310 defined previously as avirulent, in addition to a distinction in the titres of agglutination with the sera tested and lower reactivity in the immunoblotting assays, suggest a relationship of the B. fragilis surface architecture with the virulence potential as well as with the origin of the strain.
Inactivation of the bacteriophages PHI X 174 (somatic coliphage), MS2 (F-specific coliphage) and B40-8 (phage infecting Bacteroides fragilis) suspended in tap water was studied applying gamma and electron beam irradiation as well. PHI X 174 phage was found to be a suitable viral indicator for water disinfection by means of ionizing radiation. The nutrient broths introduced simultaneously with the bacteriophages into the water when it is spiked with the phages for the experiments did not significantly change the scavenging capacity of the water matrix. No dose rate effect was observed with MS2 and B40-8 phages but PHI X 174 phage showed a clear dose rate effect. It was found that in water MS2 phage is significantly more sensitive to ionizing radiation than Escherichia coli.
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The most important factors in controlling postsurgical sepsis are appropriate surgical judgment and technique. Efficacious prophylactic antibiotics, when indicated, also significantly reduce the postoperative infection rate. Among the other techniques often heralded as important adjunctive measures, only duration of preoperative hospitalization, preoperative bathing, use of electrocautery, preoperative hair removal, use of prophylactic drains, and duration of operation are of proven significance.
Surgical wounds can become infected by a variety of organisms, leading to a variety of clinical courses. In this article, several types of infections, therapies, prognoses and prophylaxes are discussed. Skin and subcutaneous tissues infect with a range of gram-positive and gram-negative aerobic and anerobic bacteria. Gangrenous infections, whether necrotizing fasciitis or bacterial synergistic gangrene, can be devastating or fatal. Gangrenous infection in the muscle is also discussed, and various treatments outlined. The intention is to familiarize readers with the predisposing conditions, clinical manifestations and therapeutic alternatives for these surgical infections.
AIMS: To evaluate the feasibility of bacteriophages as a complementary tool for water quality assessment in surface waters from different parts of the globe. METHODS AND RESULTS: Faecal coliform bacteria, enterococci, spores of sulphite-reducing clostridia, somatic coliphages, F-specific RNA bacteriophages and bacteriophages infecting Bacteroides fragilis were determined by standardized methods in raw sewage and in 392 samples of river water from 22 sampling sites in 10 rivers in Argentina, Colombia, France and Spain, which represent very different climatic and socio-economic conditions. The results showed that the indicators studied maintained the same relative densities in the raw sewage from the different areas. Classifying the river water samples according to the content of faecal coliform bacteria, it can be observed that the relative densities of the different bacterial indicators and bacteriophages changed according to the concentration of faecal coliform bacteria. There was a relative increase in the densities of all groups of bacteriophages and sulphite-reducing clostridia with respect to faecal coliforms and enterococci in the samples with low counts of faecal coliform bacteria. CONCLUSIONS: The numbers of bacterial indicators and bacteriophages were similar in the different geographical areas studied. Once released in rivers, the persistence of the different micro-organisms differed significantly. Bacteriophages and spores of sulphite-reducing clostridia persisted longer than faecal coliforms and enterococci. SIGNIFICANCE AND IMPACT OF THE STUDY: Bacteriophages in river water samples provide additional information to that provided by bacteria about the fate of faecal micro-organisms in river water. The easy, fast and cheap methods for phage determination are feasible both in industrialized and developing countries.
AIMS: To assess the usefulness of bacterial and viral indicators in chlorination processes and to collect quantitative information necessary for risk assessment analysis in water disinfection processes based on chlorination. METHODS AND RESULTS: Naturally occurring bacterial indicators, bacteriophages and enteroviruses were determined to evaluate the effect of chlorination in groundwater and secondary sewage effluents. Additionally, the effect of chlorinating on selected bacteriophages, enteroviruses and Escherichia coli was also tested in spiked samples of bottled water and sewage effluents. Results indicate that chlorination inactivates more efficiently bacteria than phages and enteroviruses. Among the human viruses, phages infecting Bacteroides fragilis and selected somatic coliphages belonging to the Siphoviridae family were the most persistent to chlorination. CONCLUSIONS: The three groups of bacteriophages studied were all more resistant to chlorination than bacteria and some of the phages were more resistant than enteroviruses. Results presented here indicate that it is very risky to generalize from information obtained with inactivation experiments done with single isolates of any phage or virus. If possible, inactivation studies should be done with naturally occurring populations. Phages offer a good opportunity for studying naturally occurring populations. Thus, the bacteriophages offer a range of resistance to chlorination that may represent most of the viruses that can be found in water. SIGNIFICANCE AND IMPACT OF THE STUDY: Data reported in this study support the inclusion of bacteriophages as additional indicators of the efficiency of water chlorination processes and water quality.
Septic phlebitis of the portal vein, or pylephlebitis, is a rare but potentially severe complication of abdominal sepsis. The authors present a case of pylephlebitis after perforated retrocecal appendicitis in a child and discuss the etiology, presentation, diagnosis, and treatment of this disorder in the modern era.
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Eight days after an appendicectomy a 40-year-old man developed a fever of up to 40.5 degrees C. The concentration of the transaminases was elevated (GOT 61 U/l, GPT 115 U/l, gamma-GT 226 U/l). Operative revision discovered no unusual wound conditions. Ultrasonography revealed splenomegaly (15 x 7 cm) and dilatation of the portal vein (diameter of 19 mm). The portal vein contained echo-dense constituents indicating thrombosis. Colour Doppler duplex sonography recorded only minimal residual flow around the thrombus. The fever gradually subsided under antibiotic treatment (metronidazole, 500 mg twice daily; mezlocillin, 2 g three times daily; later also gentamicin, 80 mg three times daily). Blood culture grew Bacteroides fragilis. 14 days after the wound revision ultra-high short-term lysis with streptokinase was instituted (9 mill IU over 6 hours), followed by heparin i.v. 25,000-30,000 i.v. daily for 5 days. 12 hours after the start of thrombolysis treatment the portal vein thrombus had been dissolved, and after 8 days the size of the spleen was normal.
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