[Evaluation of antimicrobial therapy by the measurement of blood bactericidal activity].
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A patient with a refractory anaemia preceding acute myeloblastic leukaemia had an increased susceptibility to infection due to Staphylococcus aureus. 36% of neutrophils lacked myeloperoxidase (MPO) activity and, in vitro, these polymorphonuclear neutrophils (PMN) had a defect of bactericidal activity against Staphylococcus aureus. Cytochemical studies of phagocytosis with the electron miscroscope have shown that the degranulation of primary granules (MPO+ or MPO-) was normal after phagocytosis of Escherichia coli which were normally lysed. A defective destruction of Staphylococcus aureus and Candida albicans was observed in some PMN with or without MPO activity, suggesting that MPO deficiency itself was not the only cause of this defect. In PMN which appeared normal, most MPO(+) granules were unable to fuse with the phagocytic vacuole containing intact germs even after 90 min of contact. There was, therefore, in addition to a partial MPO deficiency, a defect in cellular degranulation. This defect, the mechanism of which is unknown, may be in part responsible for the defective bacterial degradation.
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Investigated were a total of 59 cows presenting normal processes, of giving birth as well as dystocia, the time of delivery lasting 2, 10, 24, and 36 hours. Seventeen cows with dystocia were treated intravenously with 500 cm3 of a 4 per cent solution of sodium bicarbonate and 40 g glucose. It was found that the changes in the pH values, alkali reserves, glycogen, and the peroxydase activity of the neutrophiles in the mothers and fetuses were dependent on the duration of parturition. Cases of difficult labour with a prolonged calving period led to lowering the pH values the alkali reserves, and the enzyme activity of leukocytes both in the cows and the newborn calves. Newborns delivered 24 and 36 hours from the beginning of the parturition act showed low resistance and had weakly expressed phagocytic and bactericidal blood activity. The intravenous application of 50 ml of a 4% solution of sodium bicarbonate and 40 g glucose to cows with dystocia up to the 10th day led to a compensatory response on behalf of the acid-base balance in the calves.
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A comparative study of a series of 31 epidemic streptococci and 36 collection M protein producers showed no statistically significant difference in their resistance in human blood. Even highly resistant field strains did not produce M protein (as the main bactericidal activity receptor) under laboratory conditions, however, although under natural conditions they left an anti-M response in the exposed population. Streptococcal resistance is not generally associated with M protein, but is influenced by another factor.
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Fresh, defibrinated human blood (80 vol%, i.e., 80% [vol/vol] of a 2-ml final assay volume) from two healthy adult donors killed "delayed serum-sensitive" (DSS) and "promptly serum-sensitive" (PSS) strains of Serratia marcescens, PSS control strain Escherichia coli C, Bacillus subtilis strain ATCC 6633, and Micrococcus lysodeikticus ATCC 4698 in a kinetic manner comparable to that of fresh human serum (80 vol%). However, heat-inactivated (56 degrees C, 30 min), defibrinated human blood revealed markedly reduced or a total lack of beta-lysin activity against the B. subtilis assay strain. Similarly, lysozyme activity of defibrinated blood was diminished somewhat by heat treatment, as determined with the M. lysodeikticus assay strain. Addition of 500 mug of sodium polyanetholsulfonate (SPS) per ml to 80 vol% of fresh, defibrinated human blood completely neutralized blood bactericidal activity against all assay strains of S. marcescens, E. coli C, and B. subtilis; however, SPS at this concentration failed to abolish lysozyme activity for prolonged periods of incubation. Addition of 500 mug of sodium amylosulfate (SAS) per ml to 80 vol% of fresh defibtinated human blood resulted in protection of cell inocula of DSS strains of S. marcescens only; SAS failed to protect cell inocula of the PSS strains of S. marcescens, E. coli C, B. subtilis, and M. lysodeikticus for extended periods of observation. Based on these data, it is recommended that blood culture specimens that are first drawn into specimen containers (such as Vacutainer tubes or the like) at the patient's bedside, and which contain >/=250 mug of SPS per ml, be diluted into suitable broth media with at least >/=250 mug of SPS per ml by the receiving laboratory within 2 to 4 h after procurement of the specimen. This procedure would ensure continued, adequate neutralization of the specimen's inherent beta-lysin, lysozyme, and complement- and antibody-mediated bactericidal activities.
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One oxygen-independent antimicrobial system of human granulocytes consists of granular chymotropsin-like cationic proteins possessing heat-stable microbicidal activity. For elucidation of the mode of action of the cationic protein, effects on bacterial synthesis of macromolecules, ion transport, and oxygen consumption have been studied. Inhibition of incorporation of radioactive precursors into protein, ribonulceic acid, and deoxyribonucleic acid of both Staphylococcus aureus and Escherichia coli was found concomitantly with inhibition of colony formation. Cationic protein inhibited 86Rb+ influx but did not increase the leakage of intracellular 86Rb+, indicating inhibition of energy-dependent membrane transport without a breakdown of the semipermeable character of the membrane. Oxygen consumption was inhibited. Mg2+ and Ca2+ displayed a protective effect against the microbicidal activity, indicating the operation of charge interactions between cationic protein and bacterial surface. The various effects of cationic protein were more pronounced with S. aureus than with E. coli, parallelling the microbicidal activity.
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In the hemocytes of a control group and a group of immunised insects an enhanceable NADH-or NADPH-oxidase-activity is demonstrated histochemically which, according to KLEBANOFF, has a share in the development of an intracellular antibacterial activity via the synthesis of H2O2.
Deficiencies of components of the complement system in man are described. Clq was reconstituted in patients with severe combined immunodeficiency after bone marrow transplantation. Clr deficiency is associated with vascular disease and upper respiratory infections. Reconstitution of complement occurred in one patient with Clr deficiency after kidney transplantation. Our C2-deficient patient who developed systemic lupus erythematosus had elevated levels of C3. Following blood transfusion, ie by providing C2, dramatic activation of complement occurred in vivo.
The neutrophil bactericidal capacity of 31 patients with diabetes mellitus in a nonketoacidotic state, including 21 without infections and 10 with recurrent infections, were evaluated. The killed intracellular bacteria (KICB) expressed as the percentage of the initial inoculum for 25 normal control subjects was 95.4 (SD equal plus and minus (2.7) and that for the diabetic patients, the KICB was 72.8 (SD=+30.7)with a p value of less than or equal to 0.01. In 17 out of 31 diabetic atients, the KICB was greater than minus two standard deviations of the control mean. Using the lysostaphin assay technic, 11 patients were shown to phagocytize poorly, 3 had impaired intracellular killing and 3 had a combined defect. These defects were not correctable by normal serum nor related to blood-glucose levels. No apparent correlation with infection could be demonstrated. Fiver of the 10 patients with recurrent infections and 12 out ot of 21 patients without infections has a neutrophil dysfunction. However, all 3 patients with a combined defect had severe bacterial infections.