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Southeast Asian J Trop Med Public Health. 2002 Jun;33(2):355-61.
Clinical features of community-acquired pneumonia treated at Srinagarind Hospital, Khon Kaen, Thailand.

Reechaipichitkul W, Tantiwong P.

Pneumonia is a serious illness associated with significant morbidity and mortality. The interpretation guidelines for pneumonia management requires knowledge of both the clinical presentation of the disease and local epidemiology. We studied the clinical features, initial laboratory results, antibiotic sensitivities, and outcomes of patients diagnosed with acute community-acquired pneumonia between January 1999 and December 2000 at Srinagarind Hospital. The causative organisms were identified in only 52.2% patients; Streptococcus pneumoniae accounted for 23.1% of infections. Other common causes included Klebsiellapneumoniae (19.2%), Burkholderia pseudomallei (15.4%), Hemophilus influenzae (11.5%), Mycoplasma pneumoniae (6.2%), and Staphylococcus aureus (4.6%). Younger patients were more likely to be infected with M. pneumoniae, while the mean age of those with other types of infections was 50. Healthy adults were infected with M. pneumoniae and S. pneumoniae; specific pathogens attacked patients with certain co-morbidity : i) diabetes mellitus and ageing, ii) diabetes mellitus and renal disease, iii) cardiovascular diseases, and iv) connective tissue diseases and steroid-use; these patients were vulnerable to i) K. pneumoniae, ii) B. pseudomallei, iii) H. influenzae, and iv) S. aureus respectively. White blood cell counts were normal in M. pneumoniae infection. Gram-stained sputum had some limitations, especially when determining Gram-negative infections; chest x-rays could not differentiate pathogens. Bactermia was found in one half of patients infected with B. pseudomallei and S. aureus. Antibiotic-resistant organisms were not common in our study. Because morbidity and mortality were high among patients infected with S. aureus and B. pseudomallei, empirical antibiotic treatment should be considered in suspected cases, especially when patients present with acute severe community-acquired pneumonia.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12236437&dopt=Abstract

Infection. 2002 Aug;30(4):198-202.
Occurrence of methicillin-resistant Staphylococcus aureus infections in German intensive care units.

Gastmeier P, Sohr D, Geffers C, Nassauer A, Dettenkofer M, Ruden H.

Division of Hospital Epidemiology and Infection Control, Institute of Medical Microbiology and Hospital Epidemiology, Hanover Medical School, Germany. Gastmeier.Petrh-hannover.de

BACKGROUND: This study aims to describe the occurrence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections and the relation between endemic and epidemic nosocomial MRSA infections in intensive care units (ICUs) in Germany. METHODS: The ICU component within the German national nosocomial infections surveillance system (KISS) was established in January 1997. The number of participating ICUs increased from 25 in 1997 to 178 (June 2000). In every case of nosocomial infection (NI), the pathogens identified were referred to the surveillance system. To identify clusters and outbreaks and distinguish them from mere single events, the following simple definitions were applied: a "cluster" was two nosocomial MRSA infections within 3 months; an "outbreak" was three or more nosocomial MRSA infections within 3 months; all other MRSA infections were classed as "single events." RESULTS: A total of 10,261 NIs were identified during the observation period in the 139 ICUs which had been participating for at least 6 months. Among the 1,535 nosocomial S. aureus infections, 219 MRSA infections were identified (14.3%). Only 51 (36.7%) of the 139 KISS ICUs identified nosocomial MRSA infections. In 12 ICUs (8.6%) however, more than 50% of all nosocomial S. aureus infections were caused by MRSA. The mean incidence density was 0.31 nosocomial MRSA infections/1,000 patient days (range 0-3.6). Outbreaks were registered in 13 ICUs, clusters in 12 further ICUs and only single events in the remaining 26. 64.0% of all MRSA infections were registered during outbreaks and 12.8% in cluster situations. Thus, only 23.2% of MRSA infections were single events. CONCLUSION: These definitions of clusters and outbreaks can only provide an estimate of the real number of cases. However, through the targeted identification of ICUs with endemic and epidemic MRSA problems and subsequent strict measures to prevent the spread of MRSA within these ICUs, it may be possible to retain, or even reduce, the present level of MRSA infections in Germany.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12236560&dopt=Abstract

Infection. 2002 Aug;30(4):203-7.
Respiratory symptoms, asthma, atopy and Chlamydia pneumoniae IgG antibodies in a general population sample of young adults.

Ferrari M, Poli A, Olivieri M, Verlato G, Tardivo S, Nicolis M, Campello C.

Dept. of Science and Surgery, Policlinico Borgo Roma, Verona, Italy. ferraredicinad.univr.it

BACKGROUND: This study was designed to test the association of Chlamydia pneumoniae infection with respiratory symptoms and atopy. METHODS: A general population sample of 369 young adults (aged 20-44 years) completed a questionnaire on respiratory symptoms and underwent skin prick testing. C. pneumoniae IgG and IgM serum titers were measured by microimmunofluorescence. Prior infection was defined by titers of IgG > or = 1:32, acute infection by titers of IgG > or = 1:512 and/or IgM > or = 1:16. RESULTS: The prevalence of cough and phlegm was higher in subjects with (19.0%) than in those without (11.4%) prior C. pneumoniae infection (p = 0.01). A similar difference was found for wheezing (14.3% vs 8.0%; p = 0.05), whereas the percentage of asthmatics was equally distributed between seropositive and seronegative subjects. IgG titers > or = 1:128 were found more frequently in atopic subjects (p = 0.04). After adjusting for any confounding factors, cough and phlegm (but not wheezing) were found significantly associated with C. pneumoniae positivity, both for 1:32 (OR 1.80; 95% CI: 1.01-3.36; p = 0.05) and for 1:128 titers (OR 2.31; 95% CI: 1.20-4.42; p = 0.01). A significant association was also found for atopy, for titers > or = 1:128 (OR 1.73; 95% CI: 1.01-3.20, p = 0.05). Acute infection was not associated with respiratory symptoms or asthma. CONCLUSION: We conclude that C. pneumoniae infection is associated with cough and phlegm and may have a role in the pathogenesis of chronic respiratory diseases. Moreover, our results indicate a relationship between atopy and C. pneumoniae infection.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12236561&dopt=Abstract

Infection. 2002 Aug;30(4):208-11.
Influence of moxifloxacin, comparator drugs and some fractions of pulmonary surfactant on adherence of some respiratory pathogens.

Ferrara A, Dos Santos C, Tellarini MT.

BACKGROUND: This study evaluated the effect of moxifloxacin and comparator drugs with or without some fractions of pulmonary surfactant, as surfactant protein-A (SP-A) and phospholipids, on the adherence of the most common respiratory pathogens. MATERIALS AND METHODS: The adherence of respiratory pathogens to a bronchial epithelial cell line was tested. Antimicrobials were used at 1/2, 1/4 and 1/8 minimum inhibitory concentration (MIC), SP-A at 1 and 5 microg/ml and phospholipids at 50 microg/ml. RESULTS: At 1/2 MIC moxifloxacin, ciprofloxacin, amoxicillin-clavulanate and ceftriaxone reduced the adherence of Staphylococcus aureus and Streptococcus pneumoniae to values of 40-50%. At the same concentration, cotrimoxazole reduced the adherence values of Moraxella catarrhalis and Haemophilus influenzae to about 50%, while beta-lactams showed high efficacy only on H. influenzae, with adherence values of about 40%. The addition of SP-A and/or phospholipids to the tested antibiotics had no effect on bacterial adherence. CONCLUSION: The non-interference of SP-A and/or phospholipids with the suppressive effect that some antibiotics exert on bacterial adherence could represent a favorable event during antibiotic therapy.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12236562&dopt=Abstract

Kidney Int. 2003 Jan;63(1):306-14.
Inhibition of nuclear factor-kappaB activation by pyrrolidine dithiocarbamate prevents chronic FK506 nephropathy.

Tamada S, Nakatani T, Asai T, Tashiro K, Komiya T, Sumi T, Okamura M, Kim S, Iwao H, Kishimoto T, Yamanaka S, Miura K.

Department of Urology, Osaka City University, Osaka, Japan.

BACKGROUND: Chronic tacrolimus (FK506) nephrotoxicity is characterized by renal fibrosis with interstitial inflammation. Since nuclear factor-kappaB (NF-kappaB) plays a key role in chronic inflammatory diseases including renal disease, the present study was conducted to elucidate the role of NF-kappaB in the pathogenesis of chronic FK506-induced nephropathy. METHODS: FK506 (1 mg/kg/day, SC) was administered daily to rats maintained on low sodium diet for 42 days. Some rats were treated with a putative NF-kappaB inhibitor, pyrrolidine dithiocarbamate (PDTC; 100, 200 mg/kg/day, by gavage). The renal function, renal histology, renal NF-kappaB-DNA binding activity and gene expression profile were examined. RESULTS: FK506 caused a decline in glomerular filtration and induced characteristic renal morphologic changes including arteriolopathy, tubular atrophy and interstitial fibrosis. FK506 markedly activated renal cortical NF-kappaB-DNA binding. PDTC administration inhibited NF-kappaB-DNA binding activity in a dose dependent manner. With higher dose, NF-kappaB-DNA binding activity was decreased to a control level. PDTC had little effect on FK506-induced renal dysfunction. Renal cortical monocyte/macrophage infiltration observed in FK506-treated rats was dramatically suppressed by PDTC. FK506 up-regulated renal cortical gene expression of chemoattractant proteins, monocyte chemoattractant protein-1 (MCP-1) and osteopontin. PDTC significantly blocked MCP-1 gene expression but had no effect on osteopontin gene expression. Tubular atrophy and tubulointerstitial fibrosis, but not arteriolopathy, were significantly attenuated by PDTC. FK506 increased renal mRNA expression of fibrogenic molecules and extracellular matrices that also were attenuated by PDTC treatment. CONCLUSIONS: NF-kappaB plays an important role in mediating cortical monocyte/macrophage infiltration and in the pathogenesis of tubular injury and interstitial fibrosis in experimental FK506-induced chronic nephropathy.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12472797&dopt=Abstract [PubMed - in process]

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