KMP047 Determination of the inflammatory potential of organic dust by using human whole blood cytokine response

Wissenschaftliches Programm 55. DGHM-Tagung 29. September-l. Oktober 2003 in Dresden Abstracts - Poster

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Tuberculous peritonitis Ditzen, A.1; Theissig,

F.2;

Barretton,

G,2;

Jacobs, E.1

1TU Dresden; Institut fElr Medizinische Mikrobiologie und Hygiene 2Uniklinikum Dresden; Institut fEtr Pathologie A 53-year-old patient was admitted to a surgical ward of the University Hospital, Dresden, with an abdominal wound dehiscence emptying small intestinal stool. The patient had a history of an intraabdominal seminoma with resection of the right testicule, small intestinal resection and revision due to an anastomotic insufficiency, tumor of retroperitoneal lymph nodes and bilateral renal cysts. He was treated with three cycles of chemotherapy (Cisplatine, Etoposide, Bleomycine) 6 months prior to current hospital admission. On physical examination, he showed fever, shivering and localized tenderness of the abdomen. Hematological analysis revealed leucocytosis and elevated C-reactive protein. UItrasonographical examination showed thickening of the peritoneal wall, infiltration of the omentum classified as "omental cake" and absence of ascites. The patient underwent relaparotomy, a localized peritonitis with a small intestinal fistula was detected. Microbiological analysis of clinical samples revealed Mycobacterium tuberculosis in intraabdominal swabs and urine samples. In addition, abdominal tuberculosis and tuberculous peritonitis was demonstrated by histopathological examination. Tuberculostatic therapy was started with a 4-fold combination including Isoniazid, Rifampicin, Ethambutol and Pyrizinamide. Radiological examination did not show any primary pulmonary tuberculous focus neither any other active primary site. This result was unexpected since most cases of tuberculous peritonitis in industrialized countries result either from reactivation of latent tuberculous foci in the lung or the peritoneum or follow a hematogenous spread from active primary sites or discharge of caseous degenerated lymph nodes.

Determination of the inflammatory potential of organic dust by using human whole blood cytokine response Zucker, B.A.1; Linsel, G.1; M011er, W. 1

IFreie Universit~t Berlin; Institut fDr Tier- und Um welthygiene Exposure to organic dust can induce pulmonary diseases in humans and animals. Some of these diseases are of inflammatory origin, such as toxic pneumonitis or chronic bronchitis. Currently risk assessment to organic dust exposure is based mainly on the determination of airborne endotoxin concentrations by using the Limulus amebocyte lysate (LAL) test. However, this is under discussion for various reasons: 1. the LAL test is based on the coagulation reaction of amebocytes of a crab and may not reflect the inflammation reaction in mammals, 2. the LAL test is limited to the detection of endotoxins. In this study we compared the activity of typical components of organic dust and dust samples from

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Wissenschaftliches Programm 55. DGHM-Tagung 29. September-l. Oktober 2003 in Dresden Abstracts - Poster

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animal houses to induce cytokines in human whole blood and to coagulate Limulus amebocytes to gain information about the problems described above. We found considerable differences between the ability of endotoxins from different gram-negative bacteria to induce Limulus amebocyte coagulation and monocyte activation. For instance, the LAL test overrated the inflammatory activity of Pseudomonadaceae compared to Enterobacteriaceae. Further our results indicated that also "Non-LAL reactive material", such as components of gram-positive bacteria, contribute to the inflammatory reaction in the respiratory tract by activation of various cells especially macrophages. Since the activation of macrophages initiates and modulates the inflammatory process in the respiratory tract it is likely that the coagulation of Limulus amebocytes reflects this process only in part. The determination of the potential of organic dust to activate macrophages by using whole blood or cell culture models could offer new perspectives in exposure and risk assessment. These currently have two major potential advantages over the LAL test: Detection of a broad spectrum of inflammation-inducing substances and detection of these substances by using a system that is relevant to the exposed species.

Five Percent of Enterobacter cloacae strains produce Extended Spectrum ~-Iactamases (ESBLs) in Germany Hoffmann, H. 1, St~renburg, E.2; Roggenkamp, A. 1

1Ludwig-Maximilian-Universit~t MOnchen; Max-vonPettenkofer-Institut, Medizinische Mikrobiologie Klinikum GroBhadern 2Universit~tsklinikum Harnburg-Eppendorf; Institut for Med. Mikrobiologie Introduction: In E. coli and Klebsiella species, ESBL-expression is considered associated with increased virulence. Four groups of Extended-spectrum 13-1actamases (ESBLs) can be distinguished by their genetic relatedness: OXA, CTX, TEM, SHV. Diagnosis of ESBLs is based on their inhibition by Clavulanic Acid (CA). In species, where the chromosomally coded cephalosporinase AmpC is coexpressed, detection of ESBLs is difficult by phenotypic methods, since AmpC is induced but not inhibited by CA. A couple of local outbreaks with ESBL-expressing Enterobacter strains have recently been reported. National rates of ESBL-strains of the E. cloacae complex have not yet been elicited. This was the purpose of the present study. Methods: In 2002, eleven laboratories of different German counties have randomly collected 120 E. cloacae isolates. 4 isolates were sent on account of their specific resistance patterns. Antibiotic susceptibility, ESBL- and MTC-testings were performed following the NCCLS guidelines. Universal PCR-assays were designed for each ESBL-group. PCR-products were sequenced. Isoelectric Focusing (IEF) proved expression of ESBLs.

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