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Here we present a case report of a 41-year-old woman suffering from high fever and bacteremia due to Helicobacter canis, 11 months after kidney transplantation. Identification of H. canis was achieved by 16s rDNA sequence analysis of a positive blood culture. The patient was restored fully to health after antibiotics therapy (cefuroxime and ciprofloxacin). Until now, only 4 human clinical cases have been described with H. canis bacteremia. This study describes for the first time, to our knowledge, an infection with H. canis in a kidney transplant patient.

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This study of the sand goby Pomatoschistus minutus, a nest-holding fish with paternal care, focused on gonadal investment among males of different sizes collected early and late in the breeding season. All males caught at the nest had breeding colour, whereas trawl-caught fish consisted of males both with and without colour. The absence or presence of breeding colour was a good predictor of testes investment. Compared to males with breeding colour, males without colour were smaller in body size but had extraordinarily large testes. In absolute terms, testes mass of males without breeding colour was on average 3.4 times greater than those of males with breeding colour. Since small colourless males are known to reproduce as sneaker males, this heavy investment in testes probably reflects that they are forced to spawn under sperm competition. Contrary to testes size, sperm-duct glands were largest among males with breeding colour. These glands produce mucins used for making sperm-containing mucous trails that males place in the nest before and during spawning. Since both sneakers and nest-holders potentially could benefit from having large glands, this result is intriguing. Yet, high mucus production may be more important for nest-holders, because it also protects developing embryos from infections. There was no significant effect of season on body size, testes or sperm-duct glands size, but colourless males tended to be less common late in the season. Possibly this may indicate that individual small colourless males develop into their more colourful counterparts within the breeding season.

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Campylobacter species are frequently isolated from fecal specimens of patients with diarrheal illness. Several Campylobacter species are commonly isolated from the oral cavity. In contrast, Campylobacter species are rarely isolated from extra-oro-intestinal abscesses. Reported here are four cases of extra-oro-intestinal abscesses due to polymicrobial flora, including Campylobacter species. The first case is a 35-year-old woman who was diagnosed with a brain abscess caused by C. gracilis, Streptococcus constellatus, and anaerobic Gram-positive cocci. The second case is a 65-year-old man with a history of maxillary sinus carcinoma who developed a brain abscess due to polymicrobial flora, including C. concisus. The third case is a 24-year-old male who was diagnosed with a vertebral abscess caused by C. rectus, Eubacterium brachy, and Actinomyces species. The fourth case is a 74-year-old woman who presented with an intraorbital abscess due to C. showae and Micromonas (previously Peptostreptococcus) micros. The first two patients died from a cause directly related to their abscesses. All Campylobacter species involved in the four cases were isolated anaerobically. The isolation of oral Campylobacter species, e.g., C. rectus and C. showae, from abscesses suggests an oral source. A survey of the English literature was undertaken to identify reports of Campylobacter species isolated from extra-oro-intestinal abscesses.

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A 52-year-old man presented 8 months after transplantation with an intrarenal mass, which proved to be caused by an infection with Nocardia farcinica. Because of the potential fatal course of nocardiosis, transplantectomy was performed and long-term antibiotic treatment was instituted. Three-and-a-half years later, this patient underwent successful re-transplantation under co-trimoxazole prophylaxis. At present, more than 1 year after his second transplant has been performed, there are no signs of recurrence of Nocardia infection. To our knowledge, this is the first report of a patient with nocardiosis with an intrarenal abscess as presenting symptom.

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OBJECTIVES: Nasal carriage of Staphylococcus aureus constitutes a risk factor for disease exacerbation in Wegener's granulomatosis (WG). We hypothesized that staphylococcal superantigens (SAg) are a determinant of S. aureus-related risk for disease relapse in WG. METHODS: In a retrospective longitudinal cohort study in 62 WG patients, we investigated the presence of the staphylococcal SAg genes sea, seb, sec, sed, see, tsst-1 and eta in S. aureus strains isolated from WG patients during an observation period of seven years. Subsequently, we assessed whether relapses of WG were associated with the presence of SAg-positive staphylococci. RESULTS: Of 1718 swab cultures analysed, 709 (41.2%) were S. aureus-positive. Fifty-one patients carried S. aureus, of whom 37 (72.5%) patients carried at least one SAg-positive S. aureus strain. Of the 709 S. aureus-positive cultures, 326 (46%) contained at least one SAg gene. Except for see, all assessed SAg genes were detected. sea was found most frequently, followed by sec, tsst-1 and eta and finally, by sed and seb. Using a multivariate, time-dependent Cox regression analysis we found that the presence of S. aureus was associated with relapses of WG (RR 3.2; 95% CI 1.2-8.4). The risk for relapse was modulated by the presence and type of SAg, with tsst-1 being associated with an increased risk for relapse (RR 13.3, 95% CI 4.2-42.6). CONCLUSION: The risk for relapse of WG increases with the presence of tsst-1-positive S. aureus. Eradication of tsst-1-positive S. aureus in WG may show whether disease relapses can be prevented.

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A 47-year-old man from Armenia presented at the emergency department with abdominal pain. He had had a kidney transplant 2 years earlier for renal failure caused by amyloidosis that was secondary to familial Mediterranean fever. He was also known to have chronic hepatitis B with persistent viraemia. He had not received any prophylactic anti-tuberculosis treatment due to impaired liver function, but an extensive work-up was performed prior to transplant, including chest radiography, a Mantoux tuberculin skin test and cultures from 3 consecutive fasting gastric lavage samples, which were all negative for active or latent tuberculosis infection. The patient had presented at the emergency department repeatedly with abdominal pain that was attributed to the familial Mediterranean fever. During his last visit his complaints were accompanied by vomiting, coughing, night sweats and weight loss. He was diagnosed with an intestinal perforation with faecal peritonitis and underwent several laparotomies to treat the faecal peritonitis. Histopathological examination of resected bowel tissue revealed granulomatous inflammation, and acid-fast bacilli were seen with appropriate staining. Later, cultures appeared to be positive for normally sensitive Mycobacterium tuberculosis. The patient died as a result of the disseminated tuberculosis. In immunocompromised patients, tuberculosis often has an atypical course and an increased chance of dissemination that may be difficult to recognize.

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Legionella pneumophila is an intracellularly-growing microorganism and the causative agent of Legionnaires' disease; this disease owes its name to the epidemic among American war veterans in Philadelphia in 1976. The analysis ofthe epidemic in Philadelphia revealed--retrospectively--that unlike beta-lactam antibiotica, erythromycin and tetracyclines provided protection against an unfavourable outcome. Despite the absence of prospective, blinded, randomised clinical trials, a well-founded choice for the antibiotic treatment of patients with a Legionella infection can be made using the evidence from in-vitro and cell culture studies, as well as studies in animal models. Although erythromycin, either or not in combination with rifampicin, is still recommended, there is not enough scientific evidence to support this as a first choice drug treatment. The available evidence suggests that quinolones (the most researched are ciprofloxacin and levofloxacin) are the treatment of choice in the case of severe Legionella pneumonia. Newer macrolides (especially azithromycin) have been shown to have some additional beneficial effect. However, the lack of an intravenous formulation limits the use of newer macrolides in severely ill patients.

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Mucositis is an acute inflammation of the oral mucosa because of radiotherapy and/or chemotherapy. All patients receiving radiotherapy in the head and neck region develop oral mucositis. The aim of this study was to analyse the effects of selective oral flora elimination on radiotherapy-induced oral mucositis, in a double-blind, randomised, placebo-controlled trial. Sixty-five patients with a malignant tumour in the head and neck regions to be treated with primary curative or postoperative radiotherapy participated in this study. The patients received either the active lozenges of 1 g containing polymyxin E 2 mg, tobramycin 1.8 mg and amphotericin B 10 mg (PTA) (33 patients) or the placebo lozenges (32 patients), four times daily during the full course of radiotherapy. Mucositis, changes in the oral flora, quality of feeding and changes of total body weight were assessed. Mucositis score did not differ between the groups during the first 5 weeks of radiotherapy. Nasogastric tube feeding was needed in six patients (19%) of the placebo group and two patients (6%) of the PTA group (P=0.08). Mean weight loss after 5 weeks of radiation was less in the PTA group (1.3 kg) (s.d.: 3.0) than in the placebo group (2.8 kg) (s.d.: 2.9) (P=0.05). Colonisation index of Candida species and Gram-negative bacilli was reduced in the PTA group and not in the placebo group (P<0.05). No effect on other microorganisms was detected. In conclusion, selective oral flora elimination in head and neck irradiation patients does not prevent the development of severe mucositis.

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The majority of patients with Wegener's granulomatosis (WG) are chronic nasal carriers of Staphylococcus aureus. Chronic nasal carriage of S. aureus is associated with an increased risk of developing a relapse of the disease. The mechanism by which this occurs is still unknown. We hypothesized that a cationic protein of S. aureus, staphylococcal acid phosphatase (SAcP), acts as a planted antigen and initiates glomerulonephritis and vasculitis in patients with WG. In order to test the hypothesis that SAcP can act as a planted antigen in WG, we studied the ability of SAcP to bind to human umbilical vein endothelial cells (HUVEC) and human glomerular endothelial cells. We also studied whether this binding can be prevented by preincubation with an anionic protein, and whether binding of SAcP activates endothelial cells. We also evaluated whether antibodies in sera of patients with WG are able to bind to endothelial cell-bound SAcP. The results show that SAcP can act as a planted antigen by binding to both types of endothelial cells in a concentration-dependent manner. Binding of concentrations as low as 4 microg/ml can be detected on HUVEC within 5 min of incubation. Binding of SAcP to endothelial cells was charge-dependent but did not activate endothelial cells. Finally, endothelial cell-bound SAcP was recognized by sera of patients with WG. The data suggest a possible pathogenic role for SAcP by acting as a planted antigen thereby initiating glomerulonephritis and vasculitis in patients with WG.

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AIM: To measure the development of fat digestion in early life, using a stable isotope breath test. METHODS: A combined longitudinal and cross sectional study was performed on 30 term and preterm infants using 13C-labelled mixed triglyceride (MTG). Seventy six tests were performed in all. Results were expressed as cumulative percentage dose recovered over 6 hours (cPDR). RESULTS: Eighteen of 34 tests performed on infants under 30 days of age showed cPDRs below the normal range for adults and older children. The remainder of tests, performed on infants over 57 days of age, all showed cPDRs within the normal range. Peak PDR correlated significantly (r = 0. 928, p<0.01) with cPDR. CONCLUSION: The capacity to digest fat is incomplete at birth, but quickly develops to normal levels during the first months of life. The MTG breath test is a useful non-invasive method to measure the development of fat digestion in early life.

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OBJECTIVE: To evaluate features of general immune function, in particular the restoration of the humoral immune response to pneumococcal capsular polysaccharides, in humans undergoing a spleen autotransplantation after splenectomy because of trauma. SUMMARY BACKGROUND DATA: After splenectomy, patients have an increased risk of overwhelming infection or sepsis involving encapsulated bacteria such as pneumococci. The value of human spleen autotransplantation after splenectomy because of trauma has long been questioned. Mononuclear phagocyte system function appeared to be similar to that in splenectomized persons. The presence of specific antipneumococcal antibodies would allow other parts of the mononuclear phagocyte system, such as those in the liver, to phagocytose opsonized bacteria. METHODS: Ten consecutive patients undergoing splenectomy followed by autotransplantation were compared with the next 14 consecutive patients undergoing splenectomy alone. After a minimum of 6 months, the patients were vaccinated with 23-valent pneumococcal vaccine. Blood samples were taken at the time of vaccination and after 3 and 6 weeks for antipneumococcal capsular polysaccharides IgM and IgG enzyme-linked immunosorbent assay against types 3, 4, 6, 9, 14, and 23. Splenic regrowth was evaluated by scintigraphy. RESULTS: Surprisingly, several of the nonautotransplanted patients showed scintigraphic activity, indicating the presence of either accessory spleens or traumatic seeding (splenosis). Significant antibody titer increases (more than twofold) were found for both IgM and IgG in the autotransplanted patients. Splenectomized-only patients showed no significant increase in Ig levels in patients without splenic regrowth and partial improvement in patients with splenosis/accessory spleens. CONCLUSIONS: Considering this significant antipneumococcal antibody increase, spleen autotransplants can be expected to permit an adequate humoral response to pneumococcal infections and presumably also to other TI-2 antigens, and to protect against overwhelming postsplenectomy infection or sepsis.

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Seven laboratories, including a reference laboratory, tested the susceptibility of Moraxella catarrhalis, Streptococcus pneumoniae and Haemophilus influenzae strains to ciprofloxacin, clarithromycin, co-amoxiclav and sparfloxacin with the Etest. A total of 976 strains were collected. The results with ciprofloxacin and sparfloxacin were consistent for all laboratories, while those with clarithromycin and co-amoxiclav were not. The agreement between Etest MICs and broth microdilution was: ciprofloxacin and sparfloxacin, >95%; clarithromycin for all species, 71-85%; co-amoxiclav for H. influenzae, 31%. MIC90 values (broth dilution, mg/L) for M. catarrhalis, S. pneumoniae and H. influenzae were: sparfloxacin, 0.06, 0.5, 0.03; ciprofloxacin, 0.12, 2.0, 0.03; co-amoxiclav, 0.25, 0.25, 0.25; clarithromycin 0.25, 0.25 and 16.

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An International Study Group on New Antimicrobial Strategies (ISGNAS) has been formed in response to the recognition that development of microbial resistance to antibiotics is becoming a serious, world-wide problem. The group met in 1993 for the first time to discuss the feasibility of developing rational alternatives to the use of antibiotics and prepared, as a result, a comprehensive overview of normal (physiological) mechanisms involved in the control of potentially pathogenic (oppotunistic) microorganisms. One objective of ISGNAS is to understand the conditions which allow opportunistic microbes present among the symbionts to cause an infection. There is a need for more coherent information concerning the habitat, growth requirements and host and pathogen properties which allow opportunistic pathogens to cause life-threatening infections. In particular, information is urgently being sought to understand the complexity of the interactions between the vast number of microbial species, and the interactions between the microbes and their host. Another goal is to inspire and enable basic and clinical research that will lead to the development of new therapies for regulating colonization, translocation and infection by opportunistic micro-organisms in patients during periods of decreased resistance. With a sufficient amount of knowledge of how healthy individuals keep opportunistic micro-organisms under control, it may become feasible for physicians to maintain host resistance and inter-microbial factors involved in the containment of opportunistic microbes. Therapies aimed at boostering natural resistance mechanisms will be of critical importance to individuals whose resistance has been compromised as a result of another clinical condition.

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Bacteria and endotoxins can pass through the gut barrier under certain conditions. This process of bacterial translocation (BT) may occur after thermal injury in animals and is thought to play a role in the pathogenesis of septic complications in severely burned patients. The current study was performed to determine the role of endotoxin-related cytokines in the pathogenesis of burn-induced BT. Wistar rats were used in which enhanced sensitivity to TNF/LPS reactions was achieved by treatment with galactosamine (GalN). The GI tracts of these rats were antibiotic decontaminated with oral bacitracin and neomycin and were colonized with a neomycin resistant (NR)-Escherichia coli strain. The rats were divided into four groups, 30 per cent TBSA scald with GalN (Burn+GalN) pretreatment; 30 per cent TBSA scald without GalN (Burn); or sham injury with (GalN) and without GalN (Sham) pretreatment. On day 2, the animals were killed and liver, spleen, lung, heart and the peritoneal cavity were cultured. Blood samples were taken and the concentrations of LPS, TNF, IL-6 and ALAT were determined. Mortality was significantly increased in the Burn+GalN group compared to the other groups. In all groups, the incidences of BT were increased compared to the sham-treated group, although BT was most pronounced in the Burn+GalN group. In the latter group it was accompanied by highly elevated IL-6 and ALAT levels. The results of this study suggest that endotoxin mediators like TNF and IL-6 could play a role in the phenomenon of BT and that the function of the liver is an important clearing mechanism.

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There is a well-known association between colon carcinoma and bacteraemia with Streptococcus bovis biotype I. There are also associations, less well known, with other streptococci of the viridans group. In three patients, a man of 44, a woman of 53 and one of 52 years old, colorectal carcinomas were diagnosed in association with bacteraemia with S. salivarius, S. milleri, and S. salivarius respectively.

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