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Multiply high-level-aminoglycoside-resistant enterococci isolated from patients at a university hospital
87 Infectious Diseases Newsletter 7(11) November 1988 CMV does not result in symptomatic reinfection after transplantation.
Comment This work raises questions about the ability of CMV vaccines to control infection in aUograft recipients. Specific anti-CMV antibody failed to prevent re-infection in this group of patients. RML []
Vaira D, Holton J, Cairns SR, et al: Antibody titers to Campylobacter pylori after treatment for gastritis. Br Med J 297:397, 1988. Sixty-six dyspeptic patients underwent gastroscopy and biopsy from their gastric antrum and duodenal bulb. Campylobacter pylori was identified by Giemsa stain and culture. Antibody to C. pylori was measured by an ELISA method. Thirty-two patients had acute or chronic gastritis in both regions, and all were infected with C. pylori. Thirty-one were treated with a 4-week course of colloidal bismuth subcitrate (only 19 patients complied with the full course of therapy). A second endoscopy and serum specimen were obtained 1 week after completion of therapy. There was complete resolution of gastritis in 13/19 and the remaining six showed improvement. In another seven patients treated with ranitidine or metronidazole there was no change in four, mild improvement in one, and worsening of the gastritis in two. IgG and IgA titers against C. pylori were significantly higher in patients positive for C. pylori, and decreased significantly following treatment with bismuth subcitrate. There were no changes in titers in patients treated with ranitidine or metronidazole.
Comment This appears to be the first report of correlating antibody titer and response to treatment. Antibody titration could
be used to screen patients prior to endoscopy and to follow response to therapy. An easy, rapid test to guide therapy without the requirement for endoscopy would be welcome. RML []
nificant antimicrobial-resistant, nosocomial pathogen of the '90s. This study and the experience at the University of Michigan emphasizes the need to screen enterococci for high-level resistance to aminocyclitols and for production of beta-lactamase. CWS []
Nachamldn I, Axelrod P, Talbot GH, et al: Multiply high.level-aminoglycoside-resistant enterococci isolated from patients at a university hospital. J Clin Microbiol 26: 12871291, 1988. Over 250 clinical enterococcal isolates were screened against aminocyclitols, and approximately 15% were found to exhibit high-level resistance to gentamicin and kamamycin. Most isolates (80%) also exhibited high-level resistance to streptomycin; 79% of the isolates were from definite or likely sites of infection, but serious infections were not observed. In cases not involving endocarditis or meningitis, the infections were neither refractory to therapy nor plagued by relapse.
Comment The findings of Nachamkin et al differ from the clinical experience with enterococci exhibiting high-level resistance to aminocyclitols at the University of Michigan Medical Center. There, enterococci with high-level resistance to enterococci are a major problem; they cause - 2 7 % of all nosocomial infections and are responsible for infections that are refractory to therapy or that relapse after treatment. Moreover, serious infections with a high morbidity and mortality such as sternai osteomyelitis, have occurred. Therapy with newer agents, e.g., imipenen, ciprofloxacin, and deptamycin, has not been successful. Finally, a number of beta-lactamase-producing strains of enterococci have been reported. It is possible that Enterococcus feacalis will be the most sig© 1988 Elsevier Science Publishing Co., Inc. 0278-2316/88/50.00 + 2.20
Croxson S, Mildran D, Mathews H, et al: Entamoeba histolytica antigenspecific induction of human immunodeficiency virus replication. J Clin Microbiol 26:1304-1308, 1988. A soluble protein derived from an invasive strain of Entamoeba histolytica was used to study the lymphoblastic responses of T lymphocytes derived from patients who were seronegative or seropositive for antibodies to HIV. Of 15 HIV-seropositive patients, five (33%) produced HIV p24 in response to the soluble protein from Entamoeba histolytica. In addition, HIV p24 was expressed in three of seven patients in response to the E. histolytica protein, but not to the T-lymphocyte mitogen phytohemagglutinin.
Comment In this study, yet another antigen is reported that may initiate replication of HIV. Of interest is the observation that in some patients activation of lymphocytes does not stimulate HIV p24 production, while activation of the macrophage T-cell system may result in demonstrable replication of HIV. Such findings are consistent with theories that suggest that the macrophage is an important reservoir of HIV in vivo. CWS []
The National Committee For Clinical Laboratory Standards Working Group
Comment This work raises questions about the ability of CMV vaccines to control infection in aUograft recipients. Specific anti-CMV antibody failed to prevent re-infection in this group of patients. RML []
Vaira D, Holton J, Cairns SR, et al: Antibody titers to Campylobacter pylori after treatment for gastritis. Br Med J 297:397, 1988. Sixty-six dyspeptic patients underwent gastroscopy and biopsy from their gastric antrum and duodenal bulb. Campylobacter pylori was identified by Giemsa stain and culture. Antibody to C. pylori was measured by an ELISA method. Thirty-two patients had acute or chronic gastritis in both regions, and all were infected with C. pylori. Thirty-one were treated with a 4-week course of colloidal bismuth subcitrate (only 19 patients complied with the full course of therapy). A second endoscopy and serum specimen were obtained 1 week after completion of therapy. There was complete resolution of gastritis in 13/19 and the remaining six showed improvement. In another seven patients treated with ranitidine or metronidazole there was no change in four, mild improvement in one, and worsening of the gastritis in two. IgG and IgA titers against C. pylori were significantly higher in patients positive for C. pylori, and decreased significantly following treatment with bismuth subcitrate. There were no changes in titers in patients treated with ranitidine or metronidazole.
Comment This appears to be the first report of correlating antibody titer and response to treatment. Antibody titration could
be used to screen patients prior to endoscopy and to follow response to therapy. An easy, rapid test to guide therapy without the requirement for endoscopy would be welcome. RML []
nificant antimicrobial-resistant, nosocomial pathogen of the '90s. This study and the experience at the University of Michigan emphasizes the need to screen enterococci for high-level resistance to aminocyclitols and for production of beta-lactamase. CWS []
Nachamldn I, Axelrod P, Talbot GH, et al: Multiply high.level-aminoglycoside-resistant enterococci isolated from patients at a university hospital. J Clin Microbiol 26: 12871291, 1988. Over 250 clinical enterococcal isolates were screened against aminocyclitols, and approximately 15% were found to exhibit high-level resistance to gentamicin and kamamycin. Most isolates (80%) also exhibited high-level resistance to streptomycin; 79% of the isolates were from definite or likely sites of infection, but serious infections were not observed. In cases not involving endocarditis or meningitis, the infections were neither refractory to therapy nor plagued by relapse.
Comment The findings of Nachamkin et al differ from the clinical experience with enterococci exhibiting high-level resistance to aminocyclitols at the University of Michigan Medical Center. There, enterococci with high-level resistance to enterococci are a major problem; they cause - 2 7 % of all nosocomial infections and are responsible for infections that are refractory to therapy or that relapse after treatment. Moreover, serious infections with a high morbidity and mortality such as sternai osteomyelitis, have occurred. Therapy with newer agents, e.g., imipenen, ciprofloxacin, and deptamycin, has not been successful. Finally, a number of beta-lactamase-producing strains of enterococci have been reported. It is possible that Enterococcus feacalis will be the most sig© 1988 Elsevier Science Publishing Co., Inc. 0278-2316/88/50.00 + 2.20
Croxson S, Mildran D, Mathews H, et al: Entamoeba histolytica antigenspecific induction of human immunodeficiency virus replication. J Clin Microbiol 26:1304-1308, 1988. A soluble protein derived from an invasive strain of Entamoeba histolytica was used to study the lymphoblastic responses of T lymphocytes derived from patients who were seronegative or seropositive for antibodies to HIV. Of 15 HIV-seropositive patients, five (33%) produced HIV p24 in response to the soluble protein from Entamoeba histolytica. In addition, HIV p24 was expressed in three of seven patients in response to the E. histolytica protein, but not to the T-lymphocyte mitogen phytohemagglutinin.
Comment In this study, yet another antigen is reported that may initiate replication of HIV. Of interest is the observation that in some patients activation of lymphocytes does not stimulate HIV p24 production, while activation of the macrophage T-cell system may result in demonstrable replication of HIV. Such findings are consistent with theories that suggest that the macrophage is an important reservoir of HIV in vivo. CWS []
The National Committee For Clinical Laboratory Standards Working Group