RESUMEN
OBJECTIVE: Recent studies have suggested that the origin of bacteria that enter the lateral wall of the nose and paranasal sinuses arise from the nasopharynx. The purpose of this study was to compare the molecular biological profiles of potential pathogens found in the nasopharynx and lateral wall of the nose concomittantly in children undergoing surgery for upper respiratory tract disease. STUDY DESIGN AND SETTING: Fifty-two children undergoing adenoidectomy for either tonsillectomy or adenoidectomy (hypertrophy) or otitis media with effusion were studied. Bacterial cultures were taken from the crypts of the adenoids and from the lateral wall of the nose under endoscopic control after sterilization of the vestibule and inferior turbinate. Routine cultures of these areas were performed in the bacteriology laboratory of the Children's Hospital of Buffalo. RESULTS: Bacterial pathogens were isolated from 79% of adenoids and 46% of lateral walls of the nose. Molecular typing of pairs of nontypable Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis revealed that in 16 of 18 pairs (89%) the identical strain was present in both sites simultaneously. CONCLUSIONS: These results support the concept that when potential bacterial pathogens that may cause acute bacterial rhinosinusitis are found concomitantly in the nasopharynx and lateral wall of the nose, they are usually identical.
Asunto(s)
Adenoidectomía , Tonsila Faríngea/microbiología , Portador Sano/microbiología , Dermatoglifia del ADN , ADN Bacteriano/genética , Infecciones por Haemophilus/microbiología , Haemophilus influenzae/genética , Moraxella catarrhalis/genética , Mucosa Nasal/microbiología , Nasofaringe/microbiología , Infecciones por Neisseriaceae/microbiología , Infecciones Neumocócicas/microbiología , Rinitis/microbiología , Sinusitis/microbiología , Streptococcus pneumoniae/genética , Enfermedad Aguda , Adenoidectomía/efectos adversos , Tonsila Faríngea/patología , Técnicas de Tipificación Bacteriana , Niño , Preescolar , Dermatoglifia del ADN/métodos , Electroforesis en Gel de Campo Pulsado , Femenino , Infecciones por Haemophilus/complicaciones , Humanos , Hipertrofia , Masculino , Infecciones por Neisseriaceae/complicaciones , Otitis Media con Derrame/complicaciones , Otitis Media con Derrame/cirugía , Infecciones Neumocócicas/complicaciones , Rinitis/complicaciones , Sinusitis/complicaciones , Tonsilitis/complicaciones , Tonsilitis/cirugíaRESUMEN
Concordance between gram-negative enteric and other toxin-producing bacteria in blood and stool culture, endotoxin (lipopolysaccharide), and interleukin 6 (IL-6) was measured in 60 preterm infants (600-1600 g) as a clinical index in neonatal necrotizing enterocolitis (NEC). Escherichia coli, Klebsiella, Enterobacter, and Clostridium spp, identified by routine bacteriology, were each strongly associated with elevated concentrations of endotoxin (P < 0.01) in stool filtrates with Clostridium spp most strongly associated with NEC disease. Stool filtrate endotoxin (endotoxin units [EU] per gram) measured by a Limulus amebocyte lysate assay was age-dependent. Samples from stage I NEC (61%) and infants with advanced disease (67%) had notably elevated levels of stool endotoxin (>10 ln EU/g) compared with NEC-negative (47%) samples tested. Plasma and stool IL-6 generally tested at the low, nonmeasurable limit of the enzyme-linked immunosorbent assay (ELISA) for NEC-negative (88%) and stage I NEC (93%), although a small proportion of samples (25%) from infants with stage II or II NEC had elevated stool concentrations of IL-6. We conclude that identification of toxin-producing organisms and endotoxin elevations in stool filtrates are more useful than circulating levels of endotoxin in plasma in predicting mucosally limited disease in the gastrointestinal tract. The prognostic value of monitoring stool endotoxin in infants with overgrowth of gram-negative bacteria has implications for therapeutic strategies for patients with early and advanced stages of disease. Monitoring inflammatory cytokines (IL-6) in relation to endotoxin values in stool appears of limited clinical value in controlling this devastating disease in preterm neonates.
Asunto(s)
Toxinas Bacterianas/análisis , Nutrición Enteral , Enterocolitis Necrotizante/microbiología , Enterocolitis Necrotizante/terapia , Recién Nacido de Bajo Peso , Recien Nacido Prematuro , Peso al Nacer , Sangre/microbiología , Clostridium/aislamiento & purificación , Enterobacter/aislamiento & purificación , Enterobacteriaceae/aislamiento & purificación , Escherichia coli/aislamiento & purificación , Heces/química , Heces/microbiología , Humanos , Recién Nacido , Interleucina-6/análisis , Klebsiella/aislamiento & purificación , Lipopolisacáridos/análisis , Leche Humana , Factores de RiesgoRESUMEN
Patients with cystic fibrosis are severely affected by an infection with Pseudomonas aeruginosa, a microbe known to synthesize phospholipase C. This study was designed to determine whether that enzyme would affect the function of pulmonary surfactant phospholipids. Mucoid and nonmucoid strains of P. aeruginosa, freshly obtained from patients with cystic fibrosis, were cultured for 12 h on agar plates. The bacteria were suspended in saline solution and then pelleted by centrifugation. The supernatant was used to dilute the surfactant preparation, calf lung surfactant extract, from 35 to 2 mg/mL. Surfactant function, before and after incubation, was examined with a capillary surfactometer, an instrument specifically developed for an evaluation of the ability of surfactant to maintain patency of a narrow glass tube, simulating a terminal conducting airway. Phospholipid hydrolysis was also evaluated biochemically by determining the total content of phospholipids in surfactant before and after incubation. In five experiments, the lipids were separated with thin-layer chromatography, and the phosphorus content was determined in the diacylphosphatidylcholine band before and after incubation for 6, 24, and 48 h. Capillary openness and phospholipid concentration decreased as enzyme concentration and time of incubation increased (p<0.0001). Linear regression showed a significant correlation between time of capillary openness and phospholipid concentration (r = 0.957; p<0.0001). Calf lung surfactant extract hydrolysis was catalyzed by extracts of the bacteria, particularly the nonmucoid, analogous to the catalysis observed with phospholipase C. Surfactant hydrolysis catalyzed by enzymes from P. aeruginosa might severely affect surfactant function provided enzyme concentration is high and time of incubation is long.
Asunto(s)
Fibrosis Quística/microbiología , Pseudomonas aeruginosa/aislamiento & purificación , Surfactantes Pulmonares/fisiología , Humanos , Hidrólisis , Pseudomonas aeruginosa/fisiología , Surfactantes Pulmonares/metabolismoAsunto(s)
Bifidobacterium , Terapia Biológica , Enfermedades Gastrointestinales/terapia , Infecciones/terapia , Animales , Traslocación Bacteriana/fisiología , Bifidobacterium/crecimiento & desarrollo , Bifidobacterium/fisiología , Terapia Biológica/tendencias , Nutrición Enteral , Humanos , Intestinos/microbiología , PermeabilidadRESUMEN
We reviewed a consecutive case series of 178 immunocompetent children aged 3-36 months without central venous lines who had blood cultures positive for Streptococcus pneumoniae by either of paired broth and quantitative culture methods. The incidence of accompanying focal infection was significantly greater in patients with > 10 colony-forming units (cfu)/mL than in patients with < or = 10 cfu/mL (30.4% vs 12.9% respectively, p = 0.04). No significant relationships existed between the magnitude of bacteremia and the age, gender, presenting temperature, interval until the blood culture turned positive, total peripheral blood white cell count, absolute neutrophil count, or absolute band count. Overall, the quantitative method detected 59/178 (33.1%) of the isolates, including five isolates (2.8%) that the broth method failed to detect.
Asunto(s)
Bacteriemia/microbiología , Infección Focal/microbiología , Infecciones Neumocócicas/microbiología , Factores de Edad , Bacteriemia/diagnóstico , Preescolar , Femenino , Infección Focal/diagnóstico , Humanos , Lactante , Masculino , Infecciones Neumocócicas/diagnóstico , Razón de MasculinidadRESUMEN
To determine whether the nasopharynx of children is colonized by a single or multiple strains of nontypeable Haemophilus influenzae, cultures were obtained from six nasopharyngeal sites in five children. For each child, all isolates yielded identical polymerase chain reaction fingerprints. The results indicate that these children were colonized in the nasopharynx with a single strain of nontypeable Haemophilus influenzae at one time.
Asunto(s)
ADN Bacteriano/análisis , Haemophilus influenzae/aislamiento & purificación , Nasofaringe/microbiología , Preescolar , Dermatoglifia del ADN , Haemophilus influenzae/genética , Humanos , Masculino , Reacción en Cadena de la Polimerasa , Polimorfismo GenéticoRESUMEN
Concordance between gram-negative enteric and other toxin-producing bacteria in blood and stool culture, endotoxin (lipopolysaccharide), and interleukin-6 (IL-6) was measured in 60 preterm infants (600-1600 g) as a clinical index in neonatal necrotizing enterocolitis (NEC). E. coli, Klebsiella, Enterobacter, and Clostridium spp., identified by routine bacteriology, were each strongly associated with elevated concentrations of endotoxin (P < 0.01) in stool filtrates, with Clostridium spp. most strongly associated with NEC disease. Stool filtrate endotoxin (EU/g) measured by a Limulus amebocyte lysate assay was age dependent. Samples from stage I NEC (61%) and infants with advanced disease (67%) had notably elevated levels of stool endotoxin (> 10 ln EU/g) compared to NEC-negative (47%) samples tested. Plasma and stool IL-6 generally tested at the low, nonmeasurable limit of the ELISA for NEC-negative (88%) and stage I NEC (93%), although a small proportion of samples (25%) from infants with stage II or III NEC had elevated stool concentrations of IL-6. We conclude that identification of toxin-producing organisms and endotoxin elevations in stool filtrates are more useful than circulating levels of endotoxin in plasma in predicting mucosally limited disease in the gastrointestinal tract. The prognostic value of monitoring stool endotoxin in infants with overgrowth of gram-negative bacteria has implications for therapeutic strategies in patients with early and advanced stages of disease. Monitoring inflammatory cytokines (IL-6) in relation to endotoxin values in stool appears of limited clinical value in controlling this devastating disease in preterm neonates.
Asunto(s)
Endotoxinas/análisis , Enterocolitis Seudomembranosa/metabolismo , Enterocolitis Seudomembranosa/microbiología , Bacterias Gramnegativas/aislamiento & purificación , Enfermedades del Prematuro/microbiología , Interleucina-6/metabolismo , Heces/química , Heces/microbiología , Humanos , Recién Nacido , Enfermedades del Prematuro/metabolismo , Prueba de LimulusRESUMEN
The protective effect of a human strain of Bifidobacterium bifidum (B. bifidum) against murine group A rotavirus (MRV) was examined in the intestines of BALB/c infected mice. In experiments designed to determine whether B. bifidum mediated MRV shedding during diarrheal disease, pregnant dams (and their expected litters) were randomly assigned to the following groups: (1) mice infected with MRV alone; (2) B. bifidum-treated + MRV-infected mice; (3) B. bifidum-treated controls; and (4) saline control animals. An enzyme-linked immunosorbent assay (ELISA) for the detection of group A rotavirus was used to measure virus protein. The sensitivity of the MRV antigen detector ELISA was determined by serially diluting the rotavirus antigen in test samples. Antigen was detected in dilution ranges of 1:256-1:4096 during the acute phase and 1:16-1:512 in the recovery phase of MRV clinical disease, in the samples tested. Treatment with B. bifidum significantly reduced shedding of MRV antigen (P < 0.009) on days 2-10 postinoculation. The reduction in shedding of virus protein corresponded well with delayed onset of acute diarrhea (P < 0.02). Closer examination of tissue cross sections under electron microscopy revealed that the B. bifidum-ingested strain adhered to the epithelium of the small intestine. These results suggest that priming the intestine with B. bifidum is effective against experimental MRV challenge and confirmed the potential usefulness of this detector ELISA for studying the kinetics of group A rotavirus infection in animals and humans.
Asunto(s)
Bifidobacterium/fisiología , Gastroenteritis/virología , Infecciones por Rotavirus/virología , Esparcimiento de Virus , Animales , Antígenos Virales/análisis , Bifidobacterium/virología , Ensayo de Inmunoadsorción Enzimática , Femenino , Gastroenteritis/terapia , Intestinos/virología , Ratones , Ratones Endogámicos BALB C , Rotavirus/inmunología , Rotavirus/aislamiento & purificación , Infecciones por Rotavirus/terapiaRESUMEN
Human Bifidobacterium sp strain bifidum (B. bifidum) was administered to BALB/c lactating mice (n = 58) and their litters (n = 327 pups) to evaluate the ingested strain's adherent properties and ability to inhibit murine rotavirus (MRV) infection. ELISA and anaerobic bacteriologic techniques were used to measure MRV shedding and colonization of Bifidobacterium in the small intestine. At 13-16 d gestation, pregnant dams (and their expected litters) were randomly assigned to one of four experimental groups: 1) normal controls; 2) B. bifidum-treated only; 3) MRV-infected only; and 4) B. bifidum-treated + MRV-infected dams and litters. During the acute phase of diarrhea, 80% of small-intestine cultures in B. bifidum-treated litters were positive for the ingested B. bifidum strain compared with 24% of fecal cultures. Examination of tissue cross sections under electron microscopy revealed the ingested B. bifidum strain survived passage through the upper gastrointestinal tract and adhered to the small-intestine epithelium. After the administration of the high dose of virus, diarrhea developed in all pups, but onset was significantly delayed in B. bifidum-treated + MRV-infected litters compared with litters infected with MRV only (p < 0.02). B. bifidum-treated+MRV-infected pups demonstrated a significant reduction in MRV shedding compared with litters challenged with MRV only at d 2 to 10 after inoculation (p < 0.009). More direct studies are needed to assess mechanisms by which this anaerobe can alter the course of MRV infection at the level of gut epithelium.
Asunto(s)
Bifidobacterium/fisiología , Diarrea/prevención & control , Infecciones por Rotavirus/prevención & control , Administración Oral , Animales , Anticuerpos Antivirales/sangre , Antígenos Virales/aislamiento & purificación , Diarrea/inmunología , Diarrea/virología , Estudios de Evaluación como Asunto , Femenino , Gastroenteritis/inmunología , Gastroenteritis/prevención & control , Gastroenteritis/virología , Inmunoglobulina G/sangre , Masculino , Ratones , Ratones Endogámicos BALB C , Ganglios Linfáticos Agregados/inmunología , Ganglios Linfáticos Agregados/virología , Embarazo , Distribución Aleatoria , Rotavirus/inmunología , Rotavirus/aislamiento & purificación , Infecciones por Rotavirus/inmunología , Infecciones por Rotavirus/virologíaRESUMEN
A total of 952 consecutive vaginal swabs were obtained from patients who attended obstetric or gynecologic clinics affiliated with the Children's Hospital of Buffalo, New York. Swabs were cultured comparatively on 5% sheep blood agar (BA), selective sheep blood agar containing 1.25 micrograms/ml trimethoprim-23.75 micrograms/ml sulfamethoxazole (SXT), and Lim broth (Todd-Hewitt broth containing 1% yeast extract, 10 micrograms/ml colistin, and 15 micrograms/ml nalidixic acid). A total of 168 swabs (18%) were positive (by at least one method) for group B Streptococcus (GBS). The overall agreement among the three techniques was 90% (858 of 952); 94 specimens (10%, 94 of 952) had discrepant results, and 74 of these (44%, 74 of 168) were positive, only by Lim as opposed to two (1%) and 0 by BA and SXT, respectively. There were only two (2%, 2 of 168) false negative for Lim as compared with 82 (49%) for BA and 86 (51%) for SXT. Thus, the sensitivity of GBS detection by BA, SXT, and Lim is 51%, 49%, and 99%, respectively. These data suggest that the use of Lim broth increases the recovery rate of GBS by 48% after 48 h while the use of the SXT plate reduced the recovery rate by 2% as compared with the conventional BA plate.
Asunto(s)
Antibacterianos/farmacología , Medios de Cultivo , Infecciones Estreptocócicas/diagnóstico , Streptococcus agalactiae/aislamiento & purificación , Vagina/microbiología , Colistina/farmacología , Femenino , Humanos , Ácido Nalidíxico/farmacología , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Factores de Riesgo , Sensibilidad y Especificidad , Streptococcus agalactiae/efectos de los fármacos , Combinación Trimetoprim y Sulfametoxazol/farmacologíaRESUMEN
Using strains of Neisseria gonorrhoeae from Western New York, the National Committee for Clinical Laboratory Standards' (NCCLS) interpretive criteria for disk diffusion susceptibility testing was evaluated on chocolate-Mueller-Hinton agar (CMH) and GC agar. The reference method for comparison was the NCCLS agar dilution minimum inhibitory concentration (MIC) method. Even though the zone sizes were significantly smaller on the CMH agar, the interpretations were not significantly different on either GC or CMH agars except for tetracycline. On the CMH agar, the number of tetracycline-resistant strains was greater than on GC agar: 3% of the strains failed to grow on CMH agar and 4% did not produce interpretable zone sizes for ceftriaxone. Therefore, the use of CMH is not recommended. There was a significant difference between the interpretative criteria of the MIC and the disk diffusion method only for tetracycline. Therefore, the NCCLS zone-diameter interpretation criteria for tetracycline does not seem applicable for N. gonorrhoeae isolates in the Buffalo, New York, area.
Asunto(s)
Antibacterianos/farmacología , Recuento de Colonia Microbiana/métodos , Pruebas de Sensibilidad Microbiana/métodos , Neisseria gonorrhoeae/efectos de los fármacos , Medios de Cultivo , Farmacorresistencia Microbiana , Gonorrea/microbiología , Humanos , Neisseria gonorrhoeae/enzimología , Resistencia a la Tetraciclina , beta-Lactamasas/metabolismoRESUMEN
The quantitative bacteriology of the adenoid was studied in 34 otitis-prone and 25 non-otitis prone children. Viridans streptococci appeared to be the predominant normal flora in children who are non-otitis prone. There was a significant decrease in viridans streptococci in the otitis-prone child compared to the non-otitis-prone child. There was a significant increase in nontypable Haemophilus influenzae (NTHI) in the otitis-prone child. The mechanisms responsible for this alteration of the microecology of bacteria of the nasopharynx may be related, in part, to bacterial interference or to the inappropriate use and over-use of antibiotics. In vitro inhibition of growth of NTHI was demonstrated with selective strains of viridans streptococci. A preliminary analysis of an inhibitory strain and a non-inhibitory strain of viridans streptococci are presented and their biochemical profiles and antibiotic sensitivities were entirely different. A possible mechanism for the inhibition on NTHI by viridans streptococci has been suggested. This mechanism may be related to an alteration of pH in the growth media or the possibility of the utilization of nutrients required for growth of NTHI.
Asunto(s)
Tonsila Faríngea/microbiología , Haemophilus influenzae/aislamiento & purificación , Otitis Media/microbiología , Streptococcus/aislamiento & purificación , Técnicas Bacteriológicas , Preescolar , Femenino , Haemophilus influenzae/crecimiento & desarrollo , Humanos , Lactante , Masculino , Pruebas de Sensibilidad Microbiana , Nasofaringe/microbiología , Streptococcus/crecimiento & desarrolloRESUMEN
Clostridium difficile is the cause of most cases of pseudomembranous colitis, the most severe form of antibiotic-associated diarrhea. Rapid diagnosis guides both the treatment and the control of nosocomial spread of infection. Two enzyme immunoassay (EIA) kits developed for the rapid detection of C. difficile toxin A in fecal specimens, Premier (Meridian Diagnostics, Cincinnati, Ohio) and Tox-A test (TechLab, Virginia Polytechnic Institute Research Park, Blacksburg), were evaluated by using 410 fecal specimens. Seventy-six specimens were positive for C. difficile toxin B by the cytotoxin assay (prevalence rate, 19%). The Meridian EIA was positive for 71 of the 76 samples, yielding a sensitivity of 93%. The TechLab EIA detected 75 of the 76 positive samples, yielding a sensitivity of 99%. The Meridian and TechLab EIAs had specificities of 100 and 93%, respectively. These data indicate that both EIAs are suitable alternatives to the cytotoxin assay in routine diagnostic laboratories. However, confirmation of TechLab EIA-positive test results by the cytotoxin assay remains necessary.
Asunto(s)
Proteínas Bacterianas , Clostridioides difficile/aislamiento & purificación , Enterocolitis Seudomembranosa/microbiología , Heces/microbiología , Técnicas para Inmunoenzimas , Juego de Reactivos para Diagnóstico , Adolescente , Adulto , Toxinas Bacterianas/aislamiento & purificación , Niño , Preescolar , Enterotoxinas/aislamiento & purificación , Humanos , Manejo de EspecímenesRESUMEN
The protective effect of a human strain of Bifidobacterium bifidum (B. bifidum) against murine Group A rotavirus (MRV) was examined in the intestines of BALB/c infected mice. In experiments designed to determine whether B. bifidum mediated MRV shedding during diarrheal disease, pregnant dams (and their expected litters) were randomly assigned to the following groups: 1. Mice infected with MRV alone; 2. B. bifidum treated + MRV infected mice; 3. B. bifidum treated controls; 4. Saline control animals. An enzyme-linked immunosorbent assay (ELISA) for the detection of group A rotavirus was used to measure virus protein. Treatment with B. bifidum significantly reduced shedding of MRV antigen (P < 0.009) days 2-10 post-inoculation. The reduction in shedding of virus protein corresponded well with delayed onset of acute diarrhea (P < 0.02). Closer examination of tissue cross-sections under electron microscopy revealed that the B. bifidum ingested strain adhered to the epithelium of the small intestine. In further experiments, adherent properties of the ingested strain were related to enhancement, although nonsignificant, in immunoglobulin secreting cell responses in Peyer's patch lymphocytes. These results suggest that priming the intestine with B. bifidum is effective against experimental MRV challenge. Closer examination of B. bifidum and related growth factors in suckling neonates on gut physiology and enhancement of local immune responses has potential dietary implications in formulas for newborns.
Asunto(s)
Bifidobacterium/fisiología , Alimentos Formulados , Alimentos Infantiles , Infecciones por Rotavirus/prevención & control , Animales , Antígenos Virales/análisis , Adhesión Bacteriana , Bifidobacterium/aislamiento & purificación , Modelos Animales de Enfermedad , Ensayo de Inmunoadsorción Enzimática , Femenino , Gastroenteritis/prevención & control , Humanos , Recién Nacido , Intestino Delgado/microbiología , Intestino Delgado/ultraestructura , Ratones , Ratones Endogámicos BALB C , Microscopía Electrónica , Embarazo , Rotavirus/inmunología , Infecciones por Rotavirus/inmunologíaRESUMEN
The quantitative bacteriology of the adenoid was studied in otitis-prone and non-otitis-prone children. alpha-hemolytic Streptococci (Viridans Streptococci) appeared to be predominant normal flora in the healthy nasopharynx. There was a decrease in alpha-hemolytic Streptococci in the otitis-prone child compared to the non-otitis-prone child. Concomitantly, there appears to be an increase in both nontypable Haemophilus influenzae (NTHI) and S. pneumoniae in the nasopharyngeal flora in the otitis-prone child. The mechanisms responsible for this alteration of the micro-ecology of bacteria of the nasopharynx may be related, in part, to factors that alter mucociliary function. These factors could be viral infection, allergy, local and systemic immunological deficiency and the indiscriminate use of antibiotics. An understanding of the relationship between the normal flora and the potential pathogens may be important in the understanding of both the pathogenesis of otitis media (OM) and possibly the treatment of this disease entity.
Asunto(s)
Nasofaringe/microbiología , Otitis Media/microbiología , Streptococcus/aislamiento & purificación , Preescolar , Susceptibilidad a Enfermedades , Oído Medio/microbiología , Femenino , Humanos , Lactante , MasculinoRESUMEN
The diagnosis of bacterial meningitis depends on a lumbar puncture (LP). Sometimes, antibiotics are administered before a LP that is delayed owing to prior need for computerized tomography (CT) scan, technical problems, inability to obtain consent, or an unstable patient. We examined the accuracy of blood culture, cerebrospinal fluid (CSF) Gram's stain, and antigen detection by latex for organism identification of meningitis. All patients admitted to the Children's Hospital of Buffalo between January 1, 1984 and December 31, 1989 and having a CSF culture diagnosis of bacterial meningitis had their charts retrospectively reviewed. Patients excluded from the study were those with neural tube defects or CSF catheters, those admitted directly to the Intensive Care Nursery (ICN), those whose positive CSF cultures were determined to be a contaminant, those whose medical records were not found, or those older than 16 years. We analyzed a total of 178 patients with positive CSF cultures and the confirmed diagnosis of bacterial meningitis. Of 169 patients who had a blood culture performed, 86% had the organism responsible for meningitis recovered by this test, with the highest yield of 91% occurring in the 2.5-month to 24-month age group. Blood culture identified the bacteria in 94% of those patients with Haemophilus influenzae meningitis, and this yield increased to 100% when patients who had been pretreated with antibiotics were excluded. The combination of blood culture, CSF Gram's stain, and/or latex agglutination identified the causative bacteria in 92% of patients with meningitis. Blood culture, CSF Gram's stain, and latex agglutination are useful in identifying the organism causing pediatric meningitis.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Sangre/microbiología , Meningitis Bacterianas/microbiología , Adolescente , Antibacterianos/administración & dosificación , Niño , Preescolar , Diagnóstico Diferencial , Humanos , Lactante , Recién Nacido , Pruebas de Fijación de Látex , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/diagnóstico , Meningitis Bacterianas/tratamiento farmacológico , Meningitis por Haemophilus/diagnóstico , Estudios Retrospectivos , Sensibilidad y Especificidad , Punción Espinal , Coloración y Etiquetado , Factores de TiempoRESUMEN
The middle ear fluids of 10 children with persistent otitis media with effusion (OME) were found to contain an unclassified, slow-growing, gram-positive organism. Large gram-positive cocci, often present as diplococci or tetrads, were readily seen in each effusion. Culture of the fluid on a blood agar plate required 2 to 5 days of incubation at 37 degrees C and yielded a slow-growing coccus in pure culture in 70% of cases and in mixed culture in 30% of cases. The organism in question was unique and could be distinguished from aerococci, gemellas, enterococci, and micrococci. It grew in 6.5% saline and on bile esculin agar. It did not grow at 45 degrees C or anaerobically. It was uniformly catalase and hippurate positive. It gave negative reactions with tellurite, tetrazolium, and pyruvate and did not utilize any of the carbohydrates tested. Reactions to bile esculin were variable. The episodes of OME associated with the bacterium in question were asymptomatic, had been present from 1 to 8 months, and occurred in children who had previously experienced OME. The middle ear fluids were typically serous or seromucinous and contained inflammatory cells. The data suggest that the gram-positive coccus is a newly described middle ear pathogen and may be responsible, in part, for persistent middle ear effusion. The characteristically slow growth of the organism in vitro could hinder recovery of the organism from clinical specimens and may therefore have prevented its earlier recognition.
Asunto(s)
Bacterias Grampositivas/aislamiento & purificación , Otitis Media con Derrame/microbiología , Preescolar , Enfermedad Crónica , Femenino , Bacterias Grampositivas/crecimiento & desarrollo , Humanos , Lactante , Masculino , Estudios ProspectivosRESUMEN
It is assumed that the causative bacteria in children suffering from otitis media reach the middle ear via the eustachian tube. The purpose of this investigation was to use endonuclease restriction of bacterial chromosomal DNA to compare isolates of nontypable (NT) Haemophilus influenzae obtained from the nasopharynx and from middle ear (ME) effusions of patients with otitis media. Strains of NT H. influenzae were isolated from the nasopharynx (NP) and affected ME from a group of 13 unrelated children with otitis media with effusion (OME). For 12 of these children, identical strains were isolated from the NP and ME in a first episode of OME. Each of these 12 sets differed from the other 11. Six of these children suffered from a second episode of OME with NT H. influenzae. Five of these children with recurrence again had identical NP and ME strains. These results suggest that at the time of an episode of OME, there is one predominant strain of NT H. influenzae that colonizes both the NP and ME. The strains of NT H. influenzae isolated from all six of the second episodes were different from strains from the first episode, indicating turnover of the predominant strain in the NT H. influenzae population between episodes. When we investigated three siblings with concurrent episodes of OME, we found that they shared several similar strains of NT H. influenzae, thereby demonstrating that within a family, transmission of NT H. influenzae from child to child is possible. These results from DNA fingerprinting were essentially identical when compared with results from outer membrane protein subtyping performed on the same set of strains. The analysis of endonuclease restriction patterns of total genomic DNA provides a sensitive measure of genetic dissimilarity between strains and represents an easily applicable method for epidemiological and transmission studies of bacterial infections associated with NT H. influenzae.
Asunto(s)
ADN Bacteriano/aislamiento & purificación , Infecciones por Haemophilus/epidemiología , Otitis Media con Derrame/epidemiología , Mapeo Restrictivo , Proteínas de la Membrana Bacteriana Externa/análisis , Niño , Preescolar , Herencia Extracromosómica , Infecciones por Haemophilus/transmisión , Haemophilus influenzae/clasificación , Haemophilus influenzae/aislamiento & purificación , Humanos , Lactante , Otitis Media con Derrame/transmisión , Reproducibilidad de los Resultados , Serotipificación , Relaciones entre HermanosRESUMEN
Children with catheter-associated bacteremia were evaluated for the type of bacteria recovered and the relationship of the bacteria to the predisposing disease. A previously unrecognized observation was that gram-negative isolates, namely, Escherichia coli and Klebsiella sp., were almost exclusively recovered (11 of 12 isolates [92%]) from children with short bowel syndrome (SBS) compared with those from children with other underlying diseases, such as inflammatory bowel disease, malignancies, and other disorders (P less than 0.001). Furthermore, children with SBS had a higher frequency of repeated infection (3.1 catheter-associated infections compared with 1.3 catheter-associated infections in children with other disorders during the same period). Only gram-positive bacteria were isolated from children with malignancies and other predisposing disorders. The very high frequency of catheter-associated gram-negative bacteremia in children with SBS compared with that in children with other bowel disorders, malignancies, and other predisposing diseases requires attention by the clinician in the management of patients in this group.
Asunto(s)
Cateterismo Venoso Central , Escherichia coli/aislamiento & purificación , Klebsiella/aislamiento & purificación , Síndromes de Malabsorción/complicaciones , Sepsis/etiología , Síndrome del Intestino Corto/complicaciones , Adolescente , Catéteres de Permanencia , Niño , Preescolar , Recuento de Colonia Microbiana , Escherichia coli/crecimiento & desarrollo , Femenino , Humanos , Lactante , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/microbiología , Klebsiella/crecimiento & desarrollo , Masculino , Neoplasias/complicaciones , Neoplasias/microbiología , Recurrencia , Estudios Retrospectivos , Sepsis/microbiología , Síndrome del Intestino Corto/microbiologíaRESUMEN
Isolates of nontypable haemophilus influenzae (NTHI) recovered from paired nasopharyngeal (NP) and middle ear (ME) fluid cultures performed simultaneously on seven children with otitis media with effusion (OME) were studied by analysis of the restriction fragment patterns produced from total genomic DNA. This method provides a sensitive measure of the genetic similarities between strains. In the seven pairs examined, the NP and ME strains were indistinguishable from one another, whereas each pair was distinct from the other, except for two siblings in whom all four strains were identical. This information provides evidence that the pathogenesis of OME caused by NTHI involves spread of the bacteria from NP to the ME. Analysis of paired NP and ME isolates from three children with recurrent OME caused by NTHI indicated that the second episode was caused by the reinfection with a different strain rather than persistence and reemergence of the first strain. Finally, DNA analysis of strains from two siblings with concurrent OME suggested that person-to-person transmission of NTHI can occur among children. These findings suggest that at any one time the NTHI population in the NP is relatively homogenous, at least at the time of acute upper respiratory disease. Our observation that the strains present at the second episode of otitis media were different than the strains present in the first episode is consistent with strain replacement in the NP. Restriction fragment mapping analysis of genomic DNA of NTHI could provide a powerful tool for investigating the rate of turnover of the NTHI population in the NP.