Carbuncle and Homoeopathy

Staph Infection Secrets By Dr. Walinski

Discover a Simple 3-Step Program to Permanently Eradicate Mrsa & Staph Infections Without Using Antibiotics. Here is what's provided in Staph Infection Secrets. Get Rid of Your Staph / Mrsa Infection. Best ways to quickly get rid of the most common conditions caused by Mrsa and Staph, such as: Impetigo, Cellulitis, Folliculitis, Boils / Carbuncles and more. An easy remedy for nasal infections than can completely eradicate the presence of the bacteria in less than 7 days. How to treat internal infections using a naturally occurring powerful antibiotic with a proven success rate. Learn how to get the most out of Western medicine learn what kinds of treatment is available and how to work with your doctor for best results.

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Activity of Quinupristin Dalfopristin RP 59500 Versus Methicillin Resistant Staphylococcus aureus and other

The results of testing the susceptibility of staphylococci to RP 59500 are shown in Table 1, In a study of 247 clinical isolates of staphylococci belonging to 10 species, RP 59500 displayed MICs (minimal inhibitory concentrations) generally lower than those of ciprofloxacin (6). The range of MICs was 0,25-1 xg ml and the MICM was s 1 g ml for all strains tested, except for certain species of coagulase-negative staphylococci (CNS), for which the range was 0.25-2 p,g ml and the MIC,,, was 2 xg ml. The susceptibility of Staphylococcus aureus to RP 59500 was not affected by methicillin resistance. Shonekan et al. reported that the MIC range of RP 59500 was 0.1250.5 pgjm for oxacillin-sensitive strains of staphylococci and 0.125-2 ig ml for oxacillin-resistant strains (100 strains studied) (5). Table 1 In Vitro Activity of RP 59500 Against Staphylococci bCNS Coagulase-negative staphylococci. bCNS Coagulase-negative staphylococci. The activity of RP 59500 against staphylococci adherent to a...

Carbuncle

An ancient cure for the condition used KNAPWEED. The Welsh medical text known as the Physicians of Myddfai has For a carbuncle . take the flowers of the Knapweed or the leaves, pounding with the yolk of an egg and fine salt, then applying thereto, and this will disperse it . They have been dealt with too, by using a TOBACCO leaf as a poultice (Thomas & Thomas). Another American remedy was by the use of SWEET FLAG - the roots would be mashed to a similar consistency as mashed potatoes, and that would be spread on a bandage, and used as a poultice (Indiana) (Tyler). One can assume the use of TUTSAN for a carbuncle by one of its Welsh names, Dail fyddigad, carbuncle leaves (Awbery). Its close relative, ST JOHN'S WORT, could also be used, by direct application (Physicians of Myddfai). A poultice of CHICKWEED is still prescribed by herbalists (Warren-Davis).

Staphylokinase

Staphylokinase is a protein secreted by certain Staphylococcus aureus strains. Its ability to dissolve fibrin clots has been recognized since the 1940s 58 . In contrast to streptokinase, staphylokinase exhibits fibrin-specific activation of plasminogen. This provides staphylo-kinase with a theoretical advantage for use in the treatment of thrombosis 59 . Recombinant forms of staphylokinase have been evaluated in recent years for the treatment of myocardial infarction and peripheral arterial occlusion.

Molecular Resistance Testing

Assays for resistance testing will not replace conventional culture-based antibiotic susceptibility testing in the immediate future, and additional technical developments in the field of multiplex amplification and DNA chips will be needed (64). Nevertheless, rapid PCR-based assays for resistance testing have been introduced in the laboratory and are excellent complementary tools, as has been shown for MRSA (65).

Andrea J Grisold and Harald H Kessler

The rapid and accurate identification of methicillin-resistant Staphylococcus aureus (MRSA) is of great importance for the affected patient, the involved ward, and the microbiological laboratory. Resistance to methicillin is encoded by the mecA gene in S. aureus. Because routine laboratory diagnostics may be time consuming and because species differentiation encounters a variety of difficulties, molecular techniques detecting both the mecA and a S. aureus-specific gene are used for rapid and accurate detection and identification of MRSA. Various protocols, including the manual extraction of DNA have been established. In this chapter, the identification of MRSA based on simultaneous detection of the mecA gene and the S. aureus-specific Sa442 DNA fragment using automated DNA extraction and real-time polymerase chain reaction is described. This method is an attractive alternative to labor-intensive manual protocols and can easily be incorporated into the diagnostic microbiology...

Nwadiuto Esiobu

Environmental monitoring and public health risk assessments require methods that are rapid and quantitative with defined sensitivity and specificity thresholds. Although several molecular techniques have been developed to rapidly detect bacteria in complex matrices, the challenge to simultaneously detect and enumerate only viable cells remains a limiting factor to their routine application. This chapter describes the use of peroxi-dase-labeled peptide nucleic acid (PNA) probes to simultaneously detect and count live Staphylococcus aureus, a human pathogen in sea water and beach sand. Mixed bacteria from the environmental sample were immobilized on polyvinylidene difluoride membrane filters and allowed to form microcolonies during a 5-h incubation on Tryptic soy agar plates. PNA probes targeting species-specific regions of the 16S rRNA sequences of S. aureus were then used to hybridize the target bacteria in situ. Probes were detected by capturing chemiluminiscence on instant (e.g.,...

In Vitro Postantibiotic Effects

Persistent suppression of growth after intermittent drug exposure appears to be a feature of all macrolides, azalides, and streptogramins and has been observed with a variety of respiratory tract pathogens (2-15). In general, the duration of the in vitro postantibiotic effect has varied between 1.5 and 9 h. Much of the variation is likely related to differences in media, environmental conditions, and bacterial strains. However, higher concentrations and longer exposure times produced more prolonged in vitro postantibiotic effects. The in vitro PA Es observed at my laboratory for erythromycin, clarithromycin, azithromycin, and the streptogramins (quinupristin dalfopristin and RP 74501 74502) against multiple strains of Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae are shown in Table 1. The duration of the in vitro PAEs were similar for erythromycin, clarithromycin, and azithromycin against the two gram-positive organisms. The streptogramins produced much...

Antimicrobial Drug Resistance

Antimicrobial resistance is an inevitable consequence of the misuse, underuse, and abuse of antibiotics in animals and humans, exacerbating the natural selection pressures for decreased susceptibility to pharmacothera-pies. Recent articles by Tenover 30 and Rice 31 covered the mechanisms of resistance to antimicrobial agents with case studies on E. coli's resistance to third-generation cephalosporins, Staphylococcus aureus' resistance to highlevel vancomycin, Pseudomonas aeruginosa's resistance to multidrugs, and in depth account of methicillin-resistant Staphylococcus aureus (MRSA). As they pointed out, the prudent use of antibacterial drugs using the appropriate drug at the appropriate dosage and for the appropriate duration is one of the important means of reducing the selective pressure that helps resistant organisms emerge. Interested readers are referred to articles of Tenover 30 , Rice 31 , and Martinez 32 and the references cited therein. Antimicrobial drug misuse in both...

Genetic Support of Resistance

Streptococcus donors in this species (47,48). Resistance to the macrolide-lincosamide-streptogramin (MLS) in gram-positive cocci from animals is generally constitutive and can be plasmid mediated (29,49,50). Some of these plasmids from Staphylococcus hyicus are close to plasmids from strains of human origin (49). However, interspecific conjugal transfer of the resistance is often not obtained from staphylococcal strains isolated from bovine mastitis (51). Medical concerns arise here mostly from results suggesting that resistant Enterococci from animal sources could colonize humans (52,53) and thereby exchange transferable determinants of resistance in this occasional host.

Bacterial Strains 517

All tested strains were clinical isolates identified by the methods outlined in the Manual of Clinical Microbiology, 1991 gram-positive cocci 237, most of which were multiresistant hospital strains S. aureus (87 strains), coagulase-negative staphylococci (92 strains), and enterococci (58 strains) Campylobacter sp. (156 strains) C. jejuni (112 strains), C. coli (40 strains), and C. fetus (4 strains) obligately anaerobic bacteria (134 strains, chosen among those species with greater tendency of erythromycin resistance Bacteroides fragilis group (86 strains) Prevotella sp. (26 strains), including P. oralis, P. oris, P. intermedia, P. melaninogenica Fusobacterium sp. (10 strains) Bilophila wadsworthia (2 strains), and Clostridium sp. (10 strains).

Cicatricial Pemphigoid

TREATMENT Diagnosis can sometimes be established with a biopsy of an oral mucosal bulla, with histopatho-logic examination showing a sub-epidermal locus. Immunofluorescent antibodies fixed to conjunctiva basement membrane can be demonstrated in up to 80 of cases. Assays for circulating auto-antibodies also exist, but are positive in only about 10 of affected patients. During exacerbations, topical steroids will reduce the severity and perhaps diminish scarring. Because up to half of patients will harbor staphylococci, the lids and conjunctivae should be periodically cultured, and a course of appropriate antibiotics started if necessary. Artificial tears often help the signs and symptoms of aqueous tear deficiency. In severe cases combined therapy using systemic steroids and immunosuppressive agents is usually of benefit. Dapsone

Phylum Firmicutes The low GC Grampositive bacteria

The cells of staphylococci occur in irregular bunches rather than ordered chains. They also produce lactic acid but can additionally carry out aerobic respiration involving cytochromes, and lack the complex nutritional requirements of the lactic acid bacteria. They are resistant to drying and able to tolerate relatively high concentrations of salt. These properties allow Staphylococcus aureus to be a normal inhabitant of the human skin, where it can sometimes give rise to dermatological conditions such as acne, boils and impetigo. It is also found in the respiratory tract of many healthy individuals, to whom it poses no threat, but in people whose immune system has been in some way compromised, it can cause serious respiratory infections. S. aureus can also cause a type of food poisoning and is the causative agent of toxic shock syndrome. Widespread antibiotic use has been largely responsible for the development of resistant forms of S. aureus, which have become ubiquitous inhabitants...

The Pathogenic Potential Of S Aureus

Staph Aureus Quorum Sensing

Despite the progress in the disciplines of infectious medicine and pharmacology, S. aureus continues to be a major human pathogen. Infections caused by this micro-organism range from superficial lesions, such as wound infections and abscesses, to life-threatening syndromes, including bacteremia, endocarditis, meningitis and osteomyelitis. The increasing prevalence of antibiotic-resistant strains, especially methicillin resistant S. aureus (MRSA) and the emergence of vancomycin resistant S. aureus (VRSA), has rendered staphylococcal infections a serious public health concern. Figure 1. A schematic representation of the Staphylococcus aureus quorum sensing system. Figure 1. A schematic representation of the Staphylococcus aureus quorum sensing system. is a transmembrane transport protein with endopeptidase activity and facilitates AgrD cleavage, followed by secretion of the resulting octapeptide,6 subsequently termed the auto-inducing peptide (AIP). AgrC forms a membrane-bound histidine...

Differential Regulation of Key Signaling Molecules in Innate Immunity and Human Diseases

Egg Sinker Leader Combo

Because of the central role IRAK-4 plays in mediating NFkB activation and innate immunity signaling, humans carrying IRAK-4 gene variation may be prone to microbial infections. Indeed, a study by Picard et al. revealed that IRAK-4 mutations are present in three children suffering from persistent pyogenic bacteria infection and poor inflammatory responses (Picard, Puel, Bonnet, Ku, Bustamante, Yang, Soudais, Dupuis, Feinberg, Fieschi, Elbim, Hitchcock, Lammas, Davies, Al-Ghonaium, Al-Rayes, Al-Jumaah, Al-Hajjar, Al-Mohsen, Frayha, Rucker, Hawn, Aderem, Tufenkeji, Haraguchi, Day, Good, Gougerot-Pocidalo, Ozinsky and Casanova 2003). These patients did not respond to IL-1P, IL-18, or any of the TLR1-6 or 9 ligands, as assessed by activation of NF-kB and p38-MAPK, and induction of IL-1P, IL-6, IL-12, TNFa, and IFN-y. It is intriguing that the spectrum of infections was relatively narrow, with most infections caused by Gram-positive bacteria Staphylococcus aureus and Streptococcus...

Necrotizing Fasciitis

Frostbite Histopathology

INTRODUCTION Necrotizing fasciitis is an uncommon and severe invasive soft tissue infection characterized by cutaneous gangrene, suppurative fasciitis, and vascular thrombosis. The disease is usually preceded by penetrating trauma in patients that have systemic problems, most commonly diabetes, alcoholism, and immunosupression, but may occur after blepharoplasty or other eyelid surgery. Necrotizing fasciitis represents a synergistic polymicrobial soft tissue infection with the release of endogenous cytokines and bacterial toxins. The disease is most frequently attributed to group A Streptococcus and Staphylococcus aureus. The mortality rate overall is 34 , and for those cases with periorbital involvement it is 12.5 . Death usually results from a fulminant course that may lead to septic shock, respiratory distress syndrome, and renal failure. The average age at time of infection is 57 years, but it may be seen in all age groups.

Vinas Sabu Production

Berdague. Production of flavor esters by lipases of Staphylococcus warneri and S. xylosus. Enzyme Microbiol. Technol. 19(8) 620-622, 1996. Rivera-Munoz, G., J.R. Tinoco-Valencia, S. Sanchez, A. Farres. Production of microbial lipases in a solid-state fermentation system. Biotechnol. Lett. 13 277-280, 1991. Villegas, E., S. Aubague, L. Alcantara, R. Auria, S. Revah. Solid-state fermentation acid protease production in controlled CO2 and O2 environments. Biotechnol. Adv. 11 387-397, 1993. Ikasari, L., D.A. Mitchell. Leaching and characterization of Rhizopus oligosporus acid protease from solid-state fermentation. Enzyme Microb. Technol. 19 171-175, 1996. Ikasari, L., D.A. Mitchell. Mimicking gas and temperature changes during enzyme production by Rhizopus oligosporus in solid-state fermentation. Biotechnol. Lett. 20 349-353, 1998. George, S., V. Raju, T.V. Subramanian, K. Jayaraman. Comparative study of protease production in solid substrate fermentation...

Chronic Exit Site Care of Healed Exit Site

Mupirocin Study Group Nasal mupirocin prevents Staphylococcus aureus exit-site infection during peritoneal dialysis. J Am Soc Nephrol 1996 7 2403-2408. Tacconelli E, Carmeli Y, Aizer A, Ferreira G, Foreman MG, D'Agata EM Mupirocin prophylaxis to prevent Staphylococcus aureus infection in patients undergoing dialysis a meta-analysis. Clin Infec Dis 2003 37 1629-1638. Piraino B, Bernardini J, Florio T, Fried L Staphylococcus aureus prophylaxis and trends in gramnegative infections in peritoneal dialysis patients. Adv Perit Dial 2003 19 198-201. Bernardini J, Bender B, Florio T, Sloand J, PalmMontalbano L, Fried L, et al Randomized, double-blind trial of antibiotic exit site cream for prevention of exit site infection inperitoneal dialysis patients. J Am Soc Nephrol 2005 16 539-545.

Activation of Ignorant Autoreactive T Cells The Transition from Autoreactive to Autoaggressive

Bacteria and viruses can be spotted by the innate and adaptive immune systems, either via pattern receptors or specific T and B cell receptors. But some of the organisms can fight back. One way is via superantigens, secreted proteins that activate large groups of T cells and thus make them produce pro-inflammatory cytokines in amounts big enough to flood a patient's body and cause severe disease. Toxic shock syndrome was widely publicized some years ago as an example ofsuperantigen-mediated pathogenesis. One version is caused in people by the toxic shock syndrome toxin-1 (TSST-1), a superantigen released from Staphylococcus aureus (Llewelyn and Cohen 2003). Apart from producing acute disease, superantigens were credited with shaping the immune repertoire, and, most important in our context, with triggering autoimmune disease.

Clinical Examination And Screening Techniques To Identify The Patient At Risk Of Foot Ulceration

Treatment of infection involves debridement of all necrotic tissue with aggressive, adequate drainage along with antibiotic therapy. Antibiotic selection should take into account the likely causative organisms, whereas bearing in mind the potential toxicity of the agents. In the diabetic foot, the bacteria most likely responsible for minor, non-limb threatening infections such as a cellulitis are Staphylococcus and Streptococci. Whereas more severe, deeper, and limb-threatening infections are generally the consequence of a polymicrobial infection (90). Empirical antibiotic selection should be based on the suspected bacterial pathogens along with modifications to address anticipated resistant pathogens that might have been present during earlier episodes of infection. Antibiotic selection should minimize toxicity and be cost effective. Broad spectrum antimicrobial therapy should be initiated empirically with reassessment following the results of culture data. The main antibiotic...

The Perugia YSet with Disinfectant

However, the efficacy of the simple flush before fill was not absolute, i.e. the system permits a significant reduction of the bacterial count but does not guarantee the certainty of a constant complete removal of all micro-organisms 10-13 . This is particularly true for bacteria, like Staphylococcus aureus and Pseudomonas aeruginosa, which are removed only 50 or less of the time with the flush alone, because of their high capability to adhere to the tubes thanks to their pili and flagella, and to produce a biofilm in which the bacteria are retained, thus escaping the action of the flush 12, 15-16 . But a certain rate of failure occurs also for the Staphylococcus epidermidis, even if at a lower rate. The rate of failure, however, 'increases significantly with all bacteria and especially for

Exit Site Care Pre Implantation of PD Catheter

The exit-site should be identified and marked on the skin. This should be done in collaboration with the patient, the surgeon, the nephrologist, and the experienced PD nurse. The exit-site should be placed laterally either above or below the belt line, and it should not lie on a scar or in abdominal folds. It should be determined with the patient in an upright (seated or standing) position. Local trauma and hematoma during catheter placement should be avoided. The exit-site should be round and the tissue should fit snugly around the catheter. Sutures around the exit-site increase the risk of infection and should be avoided. The downward-directed exit-site is associated with significantly lower catheter related peritonitis 3 . Prophylactic antibiotics given at the time of catheter placement decreases the risk of infection 4, 5 . Vancomycin (1 g IV, single dose) at the time of catheter insertion is found to be superior to cephalosporin (1 g IV single dose) in preventing early...

Osteomyelitis Introduction

Osteomyelitis is an infection of the bone caused by any infectious agent, but most commonly by Staphylococcus aureus, hemolytic streptococci, E. coli, or Haemophilus influenzae. In children, the metaphyses of long bones (tibia, femur) are the sites most frequently involved. The infectious agent usually enters the bone through the blood (hematogenous) after trauma or an upper respiratory infection. Less commonly, the infection can spread to the bone secondary to a contiguous focus of infection. The disease can be acute, with a rapidly destructive pyogenic infection of the bone and marrow and signs of systemic infection as well as local pain, swelling, and redness of the involved area. In subacute osteomyelitis, the disease is insidious in onset and the child has pain and dysfunction without systemic infection. The subacute form may be caused by children receiving antibiotics during a presymptomatic period. Osteomyelitis most commonly occurs in children 5 to 14 years of age. The disease...

Transmissible Elements

Staphylococcus Mercuric reductase genes have been identified as plasmid based on a wide variety of bacteria, including Staphylococcus aureus 69 . Other enzymes (e.g., lysases) can also be present on the same plasmid that allows for the conversion of various organomercuric compounds into mercury ions as subsequent substrates for reductase activity. Further examples of plasmid-associated degradative enzyme expression include formaldehyde dehydro-genase (as a mechanism of formaldehyde tolerance 70 ) and enzymes involved in the degradation of toluene phenols (e.g., as expressed on the TOL or TOM plasmids in various pseudomonads 6,71 ). Plasmid-encoded factors have been shown to cause changes in the structure, and therefore the biocide penetration capabilities of the cell wall membrane, with associated resistance to some QACs (e.g., in E. coli) and aldehydes (in some gramnegative bacteria species). Sequestration, by binding of a plasmid-encoded molecule, can also be an effective protective...

Regulatory Framework for Disinfectants

In the United States, liquid chemical disinfectants are regulated by the U.S. Environmental Protection Agency (EPA) and U.S. FDA. EPA regulates disinfectants used in environmental surfaces in healthcare settings. EPA requires manufacturers to test formulations by using accepted methods for microbicidal activity, stability, and toxicity to animals and humans. To be labeled as an EPA hospital disinfectant, the product must pass the Association of Official Analytical Chemists' (AOAC) effectiveness test against three target organisms Salmonella choleraesuis for effectiveness against gram-negative bacteria, Staphylococcus aureus for effectiveness against gram-positive bacteria, and Pseudomonas aeruginosa for effectiveness against a primarily nosocomial pathogen. Manufacturers might also test specifically against organisms of known concern in healthcare practice (e.g., HIV, HBV, hepatitis C virus, and herpes). However, potency against Mycobacterium tuberculosis is used only as a bench mark...

Antibiotics and Antitoxins

Alexander Fleming in 1928 made a serendipitous discovery that Staphylococcus bacteria would not grow in the presence of the fungus Penicillium notatum. Eventually, the active ingredient, penicillin, was isolated and since 1941 it has been of great value in the control of certain bacterial diseases, especially syphilis, pneumococcal pneumonia, and some staphylococcal and streptococcal infections. Shortly thereafter, in 1943, Selman Waksman and Albert Shatz found streptomycin, produced by the actinomycete Streptomyces gri-seus, which was effective against tuberculosis and many gram-negative bacteria. In addition to many other antibacterials, compounds active against some fungi and protozoa have since been developed, and most recently there has been success with antiviral compounds. The term antibiotic dates from 1889, when Paul Vuillemin used it for a chemical compound produced by Pseudomonas aeruginosa that was inhibitory to other bacteria.

Immunodeficiency states

Pneumococ-cus is the predominant organism, presumably due to its common presence in the upper airway Other streptococci (10 ) Haemophilus influenzae (9 ) Neisseria meningitidis (5 ) Staphylococcus aureus (5 ) Enteric Gram-negative bacilli (4 ) Staphylococcus epidermidis (2 ) Listeria monocytogenes Streptococcus pneumoniae (56 ) Aerobic Gram-negative bacilli (26 ) Enterobacter aerogenes, Serratia marcescens, Escheri-chia coli, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella species Haemophilus influenzae (8 ) Streptococcus species (6 ) Neisseria meningitidis (2 ) Staphylococcus aureus (2 ) Aerobic Gram-negative bacilli (46 ) Escheri-chia coli, Proteus mirabilis, Proteus vulgaris, Pseudomonas aeruginosa Anaerobes (13 ) Gram-positive (peptostrepto-cocci, Clostridia, etc.) Bacteroides fragilis Gram-negative, other than B. fragilis Streptococcus species (13 ) Staphylococcus epidermidis (7 ) Staphylococcus aureus (7 ) Haemophilus parainfluenzae (7 )...

Structure and assembly of GAS pili

The crystal structure of the sortase SrtCl, solved at 2.3 A resolution (H. Kang, unpublished), showed that it has the archetypal sortase fold seen in Staphylococcus aureus SrtB,23 and shares the same catalytic residues. On the other hand, it has large insertions in portions of the structure that help form the substrate-binding region. This is consistent with the idea that SrtCl is a specialized sortase required specifically for pilus assembly, and correlates with the different sortase motif in the backbone pilin subunit EVPTG, compared with the generic LPxTG.

Resistance to antibiotics

Not long after penicillin was put into general use, strains of Staphylococcus aureus were found which did not respond to treatment, and by 1950 penicillin-resistant S. aureus was a common cause of infections in hospitals. A decade later, a semi-synthetic form of penicillin, methicillin, was introduced this was not affected by the j-lactamase enzymes that inactivated Penicillin G, and was used to treat resistant forms. Within years, however, came the first reports of strains of S. aureus that did not respond to methicillin. The incidence of methicillin-resistant S. aureus (MRSA) has increased greatly since, and it represents the major source of nosocomial infections. In 1980, synthetic fluoroquinolones were introduced to counter the threat of MRSA, but within a year 80 percent of isolated strains had developed resistance to these too. Vancomycin is regarded as a last-resort treatment for MRSA, for a number of reasons it has a number of serious side-effects, its widespread use would...

Most Frequent Pathogens by Age Group

Pseudomonas aeruginosa Staphylococcus aureus Haemophilus influenzae Citrobacter Escherichia coli Group B Streptococcus Listeria monocytogenes Streptococcus pneumoniae Salmonella species Haemophilus influenzae, type b Haemophilus influenzae, type b Streptococcus pneumoniae Neisseria meningitidis Staphylococcus aureus Streptococcus pneumoniae Neisseria meningitidis Listeria monocytogenes

In Vitro Diagnostic Applications

Fig. 2 Application of PNA-FISH tests for direct identification of positive blood culture bottles. The result of the Gram stain provides a basis for the selection of appropriate PNA-FISH test. GPCC S. aureus PNA-FISH is used to identify S. aureus. Negative test results are indicative of coagulase-negative staphylococci. GPCPC Enterococcus faecalis PNA-FISH is used to distinguish E. faecalis from other enterococci. Negative test results (not shown) are indicative of streptococci. Yeast C. albicans PNA-FISH is used to identify C. albicans. Negative test results are indicative of non-C. albicans species. (View this art in color at www.dekker.com.) Fig. 2 Application of PNA-FISH tests for direct identification of positive blood culture bottles. The result of the Gram stain provides a basis for the selection of appropriate PNA-FISH test. GPCC S. aureus PNA-FISH is used to identify S. aureus. Negative test results are indicative of coagulase-negative staphylococci. GPCPC Enterococcus...

Materials And Methods

This open randomized study was conducted with two groups of patients. The first group consisted of 68 patients with history of inflammatory diseases of the lower urinary tract and the male urogenital system caused by gram-positive bacteria. Staphylococcus plus gram-negative flora E.coli and Pseudomonas aeruginosa caused infection in eight patients who underwent invasive measures including cystoscopy and bladder catheterization. AH included patients had no renal or liver insufficiency. The differentiation of patients by age, diagnosis, and bacterial agents is shown in Table 1. In the second group, 23 patients with histories of inflammatory diseases Staphylococcus epidermidis 18 Staphylococcus aureus 13 r Staphylococcus epidermidis f Staphylococcus epidermidis

Resistance Induced By Ribosomal Mutations

Resistance in bacteria with multiple rrn operons is generally conferred by Erm methylation or active efflux. However, there are recent reports of macrolide resistance in laboratory and clinical strains of Streptococcus pneumoniae and Staphylococcus aureus which harbor four and six rrn operons, respectively.1-5,6-1 Susceptibility of erythromycin decreases as the number of the mutated copies increases,1-7-1 and high-level erythromycin resistance can be achieved only when at least half of the copies are mutated.

Description Medical Nonmalignant Breast

Mastitis is usually caused by the introduction of bacteria from a crack, fissure, or abrasion through the nipple that allows the organism entry into the breast. The source of organisms is almost always the nursing infant's nose and throat other sources include the hands of the mother or birthing personnel and maternal circulating blood. The most common bacterial organism to cause mastitis is Staphylococcus aureus others include beta-hemolytic streptococcus, Escherichia coli, Candida albicans, and rarely, streptococcus. Community-acquired and nosocomial methicillin-resistant S. aureus have also been found to cause mastitis. The actual organism can be cultured from the milk. Common predisposing factors relate to milk stasis and include incomplete or inadequate drainage of a breast duct and alveolus that occurs as a result of missed feedings prolonged delay in infant feeding abrupt weaning of the infant and blocked ducts caused by tight clothing or poor support of pendulous breasts....

Clinical Significance Natural Habitat and Reservoir

S. aureus is widely distributed in the environment, although it may also be found as part of the normal bacterial flora of humans or other mammals. Strains may colonize various anatomic sites including the skin, mucous membranes, and the upper respiratory, gastrointestinal, and genitourinary tracts. 24 Nevertheless, S. aureus has a particular predilection for colonizing the anterior nares of humans. 15,24 A constellation of host factors is believed to play a role in the ability of an individual to asymptomatically carry this organism. It is estimated that 20 of humans are persistent S. aureus carriers, 60 are intermittent carriers, whereas the remaining 20 are noncarriers. 24 Carriage of MRSA has similar anatomic predilections but occurs less commonly, being more prominent in hospitalized patients and health-care work-ers. 15,24 Some patients who become colonized with MRSA eventually develop an MRSA infection. MRSA are easily spread from a colonized patient or health-care worker to...

Template DNA Preparation

Isolates should be pure and phenotypically identified as S. aureus prior to testing. Control strains of MRSA (ATCC 33591), MSSA (ATCC 25923), and mecA-negative Staphylococcus epidermidis (ATCC 14990), in addition to a no-template (water) control, should be included with each run. Prepare a 1.0 McFarland standard suspension of the organism in 0.85 NaCl. Extract DNA using either commercial nucleic acid extraction kits or Chelex-100 resin. For the latter, Chelex-100 is added to 800 pL of bacterial suspension to a 1.5-mL final volume, followed by vortexing, heating to 80 C for 10 min, and centrifugation for 15 min at 16,000 xg, resulting in a supernatant containing template DNA. Preferred specimens include nasal swabs or blood from positive blood cultures. For the latter, a single morphotype of gram-positive cocci in clusters resembling staphylo-cocci should be confirmed prior to testing. Obtain a 0.5-mL aliquot of blood and centrifuge for 2 min at 900 xg to remove particulate matter...

Abnormal Microbial Infection

Acinetobacter Corynebacterium Propionibacterium acnes Staphylococcus aureus Staphylococcus epidermidis Streptococcus Haemophilus Neisseria Staphylococcus aureus Staphylococcus epidermidis Streptococcus pneumoniae Streptococcus pyogenes Corynebacterium Fusobacterium Neisseria Staphylococcus epidermidis Streptococcus mitis S. salivarius Treponema

Storage Sites Plasma Proteins

Diarrhea is an unpleasant physiological effect of toxicant ingestion. It is important to understand the factors and mechanisms responsible for the effect in order to better understand the toxic response and how treatment can be devised. Diarrhea is the frequent evacuation of watery feces. The term is derived from Late Latin diarrhoea and Greek diarrhoia, from diarrhein, which means to flow through. Food poisoning, laxatives, and alcohol ingestion can cause acute diarrhea, but it is usually caused by an acute infection with bacteria such as Salmonella, Staphylococcus aureus, and Escherichia coli. Acute diarrhea is usually self-limiting in infants and the major concern to influence the prognosis is prevention of dehydration. Travelers' diarrhea is very common and affects up to half of those traveling to developing areas of the world.

Keep foods at safe temperatures

Mead et al. (1999) reported that 100 of the cases of Staphylococcus aureus, Clostridium perfringens, and Bacillus cereus illness are foodborne, but FoodNet does not conduct active surveillance of foodborne pathogens that are primarily controlled by storage temperature. Reported incidence of illnesses associated with improperly stored foods currently is low, perhaps because illnesses caused by these pathogens are largely self-limiting and medical treatment is infrequent (Mead et al., 1999), or because of the emphasis consumer education programs have traditionally placed on food handling behaviors that control these pathogens (Medeiros et al., 2001b). However, consumers frequently practice behaviors that could lead to illnesses from these pathogens. For example, a food safety survey of consumers found that almost half of the respondents were likely

Factors Affecting Detection Level

Been calculated to contain such numbers. Food, clinical, and environmental samples commonly reduce sensitivity through a wide range of inhibiting substances. Complete failure and false-negative amplification reactions are reported in many cases (45,46), but often sensitivity is merely reduced (47), sometimes considerably (48). Typically, a variety of mechanisms reduce sensitivity by several orders of magnitude. Wernars et al. (37) found the sensitivity of detection was at least 10-fold poorer than the theoretical minimum, varying between 103 and 108 CFU 0.5 g in different brands of soft cheeses. Sensitivity was reduced 1000-fold in milk powder (38) where 105 CFU mL were required for detection of Staphylococcus aureus despite fewer than 10 cells being detectable in diluent. Protein-breakdown products in aged cheeses caused sensitivity problems in the detection of lactic acid bacteria (49). Ten plaque-forming units (PFU) per gram of enteroviruses in diluent were detectable directly in...

Future consumer trends

Consumers must rely on the training and diligence of commercial food workers who have assumed the role of assuring the safety of foods during preparation. Safe storage of foods prepared away from home then transported to the point of consumption raises concerns that temperature abuse could lead to re-emergence of some types of low-incidence foodborne illnesses, such as Staphylococcus aureus or Bacillus cereus (Little et al., 2002). These researchers concluded that establishments where the manager had participated in food safety training have less food contamination than those without trained managers. Cohen et al. (2001) evaluated the efficacy of an in-house food safety training program and learned that success was dependent on the motivation of the workers to practice safe food handling behaviors. Workers in food establishments in England, most of whom (95 ) had received some type of food safety training, were surveyed regarding their food handling practices (Clayton et al., 2002)....

Antibiotic resistance

Largely to the increasing use of antibiotics. Ironically, antimicrobial resistance has been recognized since the introduction of penicillin nearly 50 years ago, when penicillin-resistant infections caused by Staphylococcus aureus rapidly appeared. The 1990s has become known as the era of multidrug resistance. Bacteria causing several kinds of human infectious diseases have become resistant to multiple antibiotics and the different types continue to increase. Infections challenge and impede the treatment of some patients in hospitals and the community. In hospitals, organisms found include Staphylococcus aureus, Escherichia coli, Pseudomonas, and Acinetobacter. In the community, multidrug-resistant bacteria causing acquired infections include pneumococci, gonococci, streptococci, E. coli, and Mycobacte-rium tuberculosis. There is ample evidence that the antibiotic-resistance problem is global, confronting many communities worldwide. Also, it is known that resistant organisms are...

In Vivo Postantibiotic Effects

Table I In Vitro Postantibiotic Effects with Erythromycin, Clarithromycin, Azithromycin, and Streptogramins Against Staphylococcus aureus ATCC 25923 and Streptococcus pneumoniae ATCC 10813 Table 3 In Vivo Postantibiotic Effects and the Time Serum Levels Exceed the MIC (T MIC) for Various Doses of Erythromycin, Clarithromycin, Azithromycin, and Quinupristin Dalfopristin Against Staphylococcus aureus ATCC 25923 and Streptococcus pneumoniae ATCC 10813 Table 3 In Vivo Postantibiotic Effects and the Time Serum Levels Exceed the MIC (T MIC) for Various Doses of Erythromycin, Clarithromycin, Azithromycin, and Quinupristin Dalfopristin Against Staphylococcus aureus ATCC 25923 and Streptococcus pneumoniae ATCC 10813

Haemophilus influenzae

RPR 106972 has potent in vitro bacteriostatic activity against aerobic grampositive cocci, including staphylococci resistant to oxacillin and macrolides-lincosamides-streptograminB (MLSB), gram-positive anaerobes, certain gram-negative bacteria responsible for respiratory tract infections (Neisseria spp., Moraxella catarrhalis, Haemophilus influenzae), and fastidious bacteria as Legionella spp. and Mycoplasma spp. This activity is due to the synergism of its two components, RPR 112808 (containing PIB as the major component) and RPR 106950 (containing PIIB as the major component). This synergistic activity occurred over a wide range of RPR 112808 to RPR 106950 ratios and was affected only slightly by variations in culture conditions. RPR 106972 demonstrated in vitro bactericidal activity at concentrations ranging from to to four times the MIC against Staphylococcus aureus sensitive or resistant to oxacillin and MLSB (five of six strains tested), Streptococcus pneumoniae (six of nine...

Natural Products Derivatives and the Search for New Antibiotics

Bacterial resistance to antibiotic drugs is a growing problem in antibacterial therapy and new classes of anti-infectives are desperately needed 21 . Predictions suggested that by 2005 nearly 40 of all Streptococcus strains will be resistant to both penicillin and macrolide antibiotics in the United States 22 . Of special concern is the drug resistance of Gram-positive pathogens such as Streptococcus pneumoniae to penicillin, Staphylococcus aureus (MRSA) to methicillin and in particular Enterococcus faecium (VRE) to vancomycin. The biological activity of natural products is often mediated by their carbohydrate epitopes, which influence the phar-macokinetic properties, targeting and mechanism of action in general. Consequently, diversification of the carbohydrate groups may lead to new therapeutics 23 . With the aid of the Cu(I)-catalyzed process, 15 triazole-linked monoglycosy-lated derivatives of vancomycin were synthesized (Fig. 15.2) 24 . Antibacterial screens of this library...

CF The Archetypal Mucosal Disease

Most of the morbidity and mortality of cystic fibrosis (CF) is the result of progressive respiratory damage due to uncontrolled airways infection and inflammation. The genetic cause of CF has been localized to a defective CF transmembrane regulator (CFTR) resulting in a failure of epithelial chloride channel function (1). The biological consequences of the genetic defect include abnormal epithelial sodium chloride and fluid transport in epithelia, intracellular pH dysregulation with widespread reductions in sialylation of secreted proteins, and an increase in sulfation and fucosylation of mucus glycoproteins. These biochemical alterations have detectable consequences, including salty sweat and thick mucus. However, the pathogenetic link to the clinically most important aspect of CF, the colonization of respiratory epithelia by bacteria including Staphylococcus aureus, Hemophilus influenzae, and most characteristically, mucoid Pseudomonas aeruginosa, has not been elucidated. The search...

Molecular Characterization

Methicillin resistance in S. aureus and other staphylococci is caused by the production of penicillin-binding protein 2a (PBP2a, also known as PBP2'), a novel 78-kilo Dalton penicillin-binding protein encoded by the mecA gene. 10 PBP2a, along with PBPs normally produced by S. aureus, are enzymes that catalyze peptidoglycan cross-linking reactions in the bacterial cell wall, resulting in a rigid structure that protects the bacterium against osmotic cell lysis and death. 10 However, PBP2a is distinct from putative S. aureus PBPs in that it has a low binding affinity for -lactam antibiotics, resulting in continued cell wall synthesis, albeit not as efficiently, at -lactam concen trations that would otherwise be lethal. 10 Nevertheless, mecA expression and hence PBP2a production is variable, being regulated by at least 20 additional genes of known or unknown function. 10,17,18 Two particularly important regulatory genes are located adjacent to the mecA locus, namely, mecRl (encoding a...

Operating Room Procedures with CC

The most common cause is infection with Escherichia coli, but streptococci, staphylococci, and pneumococci may also cause the inflammation. The main sources of inflammation are the gastrointestinal (GI) tract, external environment, and bloodstream. Entry of a foreign body such as a bullet, knife, or indwelling abdominal catheter and contaminated peritoneal dialysate may precipitate peritonitis. Acute pancreatitis may also cause peritonitis.

Fluoroquinolone Cellular Targets

It was initially believed that the primary target for fluoroquinolones in all gram-negatives, such as Esche-richia coli, was DNA gyrase, whereas the primary target in all gram-positives, such as Staphylococcus aureus, was topoisomerase IV. 1,4 However, it has now been demonstrated that in certain bacterial species, such as S. pneumoniae, the primary bacterial target is dependent on the specific fluoroquinolone structure. 1,4,7

Development Of Streptogramins And Macrolides

The streptogramins belong to the peptide group of antibiotics and include the mikamycins, ostreomycins, virginiamycins, and pristinamycins. The latter naturally occurring antibiotics derived from Slreptomyces pristinae-spira. Pristinamycin and virginiamycin have been used in continental Europe as oral agents for the treatment of staphylococcal and streptococcal infections. The importance of these developments can be viewed from several perspectives. First, they provide an expansion of the macrolide-lincosamide-streptogramin (MLS) group of antibiotics at a time when the development of new anti-infective agents, and in particular new classes of drug, has shown a considerable slowing in comparison with former years. Second, we are currently faced with a number of new infectious challenges such as the emergence of multidrug-resistant enterococci and mycobacteria, and serious staphylococcal infections, particularly those caused by multidrug-resistant Staphylococcus aureus and...

Commentary Background Information

Recently, the application of membrane potential-sensitive dyes to antimicrobial susceptibility testing has become a popular approach. Ordonez and Wehman (1993) successfully used dipentyloxacarbocyanine iodide to detect sensitivity of Staphylococcus aureus to penicillin. Oxacarbocyanine dyes are cationic lipophilic ions that fluoresce in viable bacterial cells but lose intensity if the magnitude of the cytoplas-mic membrane potential is reduced. Use of these dyes with gram-negative organisms requires pretreatment with EDTA to permeabilize the outer membrane. Therefore, any result may depend on the susceptibility of organisms to the action of either EDTA, the antibiotic, or both. In addition, uptake of these dyes may affect the viability of cells regardless of antibiotic action. Figure 11.8.1 A single-parameter histogram showing the different fluorescent responses of DiBAC4(3) to gramicidin-treated (broken line) and untreated (solid line) Staphylococcus aureus NCTC 6571. Figure 11.8.1 A...

Resistance to Quinupristin Dalfopristin Biochemical Mechanisms and Detection

The rapidity with which resistance genes are disseminated through a bacterial population, especially in the hospital setting, is unpredictable. Both the frequency at which genes encoding proteins involved in resistance appear and the hardiness and transfer capacity of the genetic element carrying such genes are involved. The gene erm encodes a methylase that modifies a base in 23S ribosomal RNA, reducing the affinity of the ribosome for macrolides, lincosamides, and group B streptogramins, such that these antibiotics cannot bind to their target (the MLS0 resistance phenotype) (21). Other genes, frequently carried by plasmids, have been identified in staphylococci these encode enzymes that can inactivate streptogramin components (22), as well as an efflux mechanism. An inactivating enzyme has also been found in Enterococcus (23).

Material And Methods

A total of 247 staphylococcal strains freshly isolated from clinical material was tested. Only one isolate per patient was included. In addition, because methicillin-resistant Staphylococcus aureus strains can cause epidemics, we used several criteria to avoid multiple copies of the same strain (i) strains were from different geographic locations (both within hospitals and from different hospitals), which would reduce the chance of obtaining a single clone, (ii) collecting strains over a period of years would also make a single clone unlikely, and (iii) when strains with similar antibiograms and pheno-types were obtained, we performed pulsed-field gel electrophoresis and selected only one clone. The 5. aureus strains included 29 penicillin-susceptible S. aureus (PSSA), 40 methicillin- susceptible S.aureus (MSSA), and 61 methicillin-resistant S. aureus (MRSA), The coagulase-negative staphylococci (CoNS) comprised 24 methicillin-susceptible S. epidermidis (MSSE), 28...

Regulatory Constraints

Infection control professionals are facing an unprecedented wave of legislative and regulatory activity as individual states and federal agencies in the United States demand the public disclosure of infection rates. For example, legislation introduced in early part of 2006 in Illinois requires hospitals to screen all patients for MRSA in accordance with guidelines published by CDC. In addition to MRSA, emerging as a distinctly different community-acquired strain, VRE and Clostridium difficile may get the needed regulatory attention. As noted in the Web site for the Association for Professionals in Infection Control and Epidemiology (APIC), 14 states including Colorado, Connecticut, New Hampshire, South Carolina, Tennessee, and Vermont have adopted laws requiring mandatory reporting of hospital infection rates and many others are in some state of legislative study or discussion. At present, the impact of public reporting of infection data on the quality of patient care, consumers, or...

Danger Transmission Through Tlrs

Many exogenous or endogenous molecular patterns, either derived from pathogens such as LPS, glycolipds, and teichoic acid, or from tissues such as modified LDL or necrotic cells, can be recognized by complement-derived danger sensors and TLRs, suggesting that complement receptor pathways may intersect with TLR pathways. The first evidence of a regulatory link between the complement system and TLR-mediated immune responses was provided by reports demonstrating that activation of CR354 and the complement regulator molecule CD4658 by C3 cleavage products promote efficient control of TLR-induced synthesis of IL-12 from human monocytes. Further, the C5 cleavage fragment C5a was found to downregulate LPS or Staphylococcus Cowan strain 1 (SAC)-induced synthesis of IL-12 in human monocytes but not in monocyte-derived DCs121,122. In contrast, ablation of C5 in murine macrophages led to reduced IL-12 production in response to IFN-y + SAC stimulation, suggesting that C5a enhances IL-12...

Airborne transmission influenza

Influenza is a disease of the respiratory tract caused by members of the Orthomyx-oviridae. Transmission occurs as a result of inhaling airborne respiratory droplets from an infected individual. Infection by the influenza virus results in the destruction of epithelial cells of the respiratory tract, leaving the host open to secondary infections from bacteria such as Haemophilus influenzae and Staphylococcus aureus. It is these secondary infections that are responsible for the great majority of fatalities caused by influenza. Generally, sufferers from influenza recover completely within 10-14 days, but some people, notably the elderly and those with chronic health problems, may develop complications such as pneumonia.

Ex Vivo Cytokine Production by Monocytes

Monocyte reactivity to LPS stimulation has been particularly studied in isolated monocytes and in whole-blood assays. Monocytes from septic patients have a diminished capacity to release TNFa, IL-1a, IL-1P, IL-6, IL-10, and IL-12 (227,228,243,250,251), whereas this is not the case for IL-1ra (251) and G-CSF (252). Reduced cytokine production has also been observed with other stimuli such as silica, staphylococcal enterotoxin B, and killed Streptococcus and Staphylococcus (98,243, 253,254). In human volunteers, intravenous endotoxin suppresses the cytokine response of PBMCs when activated in vitro by LPS (255). The anergy of leukocytes observed in septic patients has been associated with endotoxin tolerance (246,256). We have shown that upon LPS activation, PBMC of systemic inflammatory response syndrome patients show patterns of necrosis factor (NF)-kB expression that resemble those reported during LPS tolerance i.e., a global downregulation of NF-kB in survivors of sepsis and trauma...

Indicated Supporting Diagnostic Data

This simple test is positive in staphylococcal bullous impetigo, and shows clumps of Gram-positive cocci. In nonbullous impetigo, smears can be of value if early vesicles are still present. Chains of Gram-positive cocci may be seen. Topical 2 mupirocin ointment applied in a thin layer TID is effective in eradicating mild nonbullous impetigo and is active against streptococci and most of the staphylococcus organisms encountered. Mupirocin or bacitracin ointments can also be used to reduce communicability during the early stages of systemic treatment. This will add to the imme diate cost, but may be cost-effective if other cases within a family or social unit are prevented. Because of the thickness and persistence of the blister roof, topical treatment of bullous impetigo is not recommended. Some mupirocin-resistant staphylococcus organisms have already been reported. Secondary impetiginization of a primary skin disorder usually involves an antibiotic-sensitive Staphylococcus organism...

Activation and Hydroxylation are Required for Oxidation

Knowing that damaging the integrity of cells impaired the a-oxidation process,20 a search for possible cofactors was initiated in rat hepatocytes permeabilized with Staphylococcus aureus toxin. In such systems, the intracellular environment can be varied experimentally but the integrity of the intracellular membranes is conserved.34

Identification of C albicans in Yeast Positive Blood Culture Bottles

S. aureus bacteremia is both a serious and frequent nosocomial and community-acquired infection that is further complicated by the emergence of methicillin-resistant S. aureus and, recently, vancomycin-resistant S. aureus 12 which are ascribed to the widespread use of these antibiotics in healthcare settings. S. aureus is preliminary identified as gram-positive cocci in clusters (GPCC) along with other staphylococci however, whereas S. aureus is often clinically significant, other staphy-lococci, such as Staphylococcus epidermidis, are often contaminants and not clinically significant. Therefore, rapid identification of S. aureus and differentiation from other staphylococci directly from positive blood culture bottles are important for patient diagnosis and selection of appropriate therapy to reduce empirical therapy with broad-spectrum antibiotics, such as ampicillin and vancomycin.

Microorganisms and Media

L. lactis subsp. lactis ATCC 11454 (American Type Culture Collection, Rockville, MD) was used as a nisin-producing microorganism. Kluyveromyces marxianus MS1 was isolated from kefir grains in our laboratory and identified according to tests for morphological and biochemical properties (16). Staphylococcus aureus IFO 12732, which was obtained from the collection at the Institute for Fermentation Osaka (IFO), Japan, was used as a indicator microorganism in the bioassay measurement of nisin concentration. The compositions of media for growth of microorganisms are summarized as follows. Medium A, used for seed culture and preculture of L. lactis (pH7.0), contained 5 g L of maltose, 5g L of polypeptone (Nihonseiyaku) and 5 g L of yeast extract (Difco Laboratories, Detroit MI). Medium B, used for seed culture and preculture of K. marxianus (pH 7.0), contained 10 g L of L-lactate, 10 g L of polypeptone, and 10 g L of yeast extract. Medium C, used for primary culture of L. lactis, contained...

Bacterial Food Poisoning

Staphylococcus Staphylococcus aureus is the most common cause of food poisoning. It is often present on the skin, so that it is easily introduced into food during preparation and handling. If dishes containing mayonnaise, meat, poultry, or creamy sauces or fillings are not properly refrigerated (e.g., at a picnic), the organism can grow and produce enterotox-ins. These can provoke severe vomiting and diarrhea within 1 to 6 hours.

How does antibiotic resistance work

Mutations may occur which modify bacterial proteins in such a way that they are not affected by antimicrobial agents. You will recall that streptomycin normally acts by binding to part of the 30S subunit on the bacterial ribosome the actual binding site is a protein called S12. Mutant forms of the S12 gene can lead to a product which still functions in protein synthesis, but loses its ability to bind to streptomycin. Similarly, mutations in transpeptidase genes in staphylococci means they do not bind to penicillin any more, so cross-linking of the cell wall is not inhibited.

Induction Experiments In S Aureus

In contrast to most other 16-membered-ring macrolides which show poor activity (e.g., josamycin), all inducibly erythromycin (ERY)-resistant strains are remarkably susceptible to RU 004 (staphylococci, enterococci, pneumococci). Induction experiments in liquid medium with RU 004 compared to its corresponding cladinose derivative (RU 252), clearly demonstrated that RU 004 has no inducing properties (Fig. 1), The observations made here with ketolides will certainly revive interest in the role of L-cladinose on the induction of resistance.

Viral Heparin Binding Complement Inhibitors A Recurring Theme

Viruses are well known to subvert host complement inhibitors for their own protection. Enveloped viruses such as cytomegalovirus, vaccinia, HIV and T-cell lymphotrophic retroviruses are known to acquire cell-bound inhibitors (Spear et al. 1995 Spiller et al 1997 Vanderplasschen et al. 1998) cytomegalovirus further upregulates the expression of decay-accelerating factor (DAF CD55) and membrane cofactor protein (MCP CD46) to maximize the protection of progeny virions and infected cells (Spiller, Morgan, Tufaro and Devine 1996). Some viruses also actively recruit soluble complement inhibitors (in addition to those that bind acquired host GAGs) through binding by surface expressed viral glycoproteins (eg. HIV gp120 binding of factor H Pinter, Beltrami, Stoiber, Negri, Titti and Clivio 2000) although this strategy is more associated with bacterial strains of Staphylococcus, Streptococcus and Borrelia (Rooijakkers and van Strijp 2007). However, two viral families (herpesviridae and...

Labeling of Bacterial Pathogens for Flow Cytometric Detection and Enumeration

With the advent of new cytometric technologies and the development of an increasing number of available pathogen-specific antibodies, as well as the accumulation of a large body of microbial sequence information, there have been a rising number of reports in the literature pertaining to pathogen detection by flow cytometry. The food and pharmaceutical industries each have a Big Four, i.e., the four primary pathogens of concern to the particular industry. The food industry tests for the presence of Escherichia coli O157 H7, Salmonella, Listeria, and Campylobacter, while the pharmaceutical industry focuses on Staphylococcus aureus, Pseudomonas aeruginosa, Salmonella, and E. coli. Environmental water-related testing targets fecal-contamination indicators like E. coli or Enterococcus and parasites such as Cryptosporidium and Giardia oocysts. All these tests focus on the prevention of disease.

Nosocomial Infection and Related Issues

Nosocomial infection is deadly and prevalent. Organisms causing nosocomial infection are found virtually everywhere. Approximately 6 of all patients admitted to U.S. hospitals acquire nosocomial infections of which 4 prove fatal 36 . This issue is getting more complicated when the infection results due to drug-resistant organisms. According to the National Nosocomial Infection Surveillance (NNIS) statistics for infections acquired among ICU patients in the United States in 1999, 52 of infections resulting from S. aureus were identified as MRSA infections, and 25 of nosocomial infections were attributed to vancomycin-resistant enterococci (VRE). It reflects 37 and 43 increase from 1994 to 1998 2 , respectively. Nosocomial pneumonia, surgical wound infections, and vascular access-related bacteremia have caused the most illness and death in hospitalized patients with intensive care units (ICUs) identified as epicenters of antibiotic resistance 37 . Dettenkofer and Block provide a...

New Method Of Detection In Grampositive Cocci

A denaturing high-performance liquid chromatography (DHPLC) technique was recently evaluated in streptococci and staphylococci.1-25-1 This rapid screening method allows automated detection of single base substitution as well as small insertions or deletions employing a combination of temperature-dependant denaturation of DNA and ion pair chromatography. In this method, after PCR amplification of regions of interest in 23S rRNA, L4, or L22 genes, wild-type and mutant PCR products are mixed in an equimolar ratio, heated to denature each strand, and then allowed to reanneal until they form a mixed population of homoduplexes plus hetero-duplexes containing the mismatched bases. Under conditions of partial denaturation temperature, the heteroduplexes elute from the column earlier than the homoduplexes because of their reduced melting temperature. Denaturing high-performance liquid chromatog-raphy data analysis is then based on a qualitative comparison of peak number and or shape of a...

Application for Other Organisms

Somal RNA makes it applicable as a universal bacterial probe. Many important pathogens, including Enterobac-teriaceae, Listeria, Pseudomonas spp., and staphylococci have more than five ribosomal operons and thus produce ribotype patterns of 5 to 15 bands. 17 Ribotyping is a robust method that exhibits excellent reproducibility and stability, during the course of the outbreaks. It is commercially available and fully automated and well standardized. However, its discriminatory power is only moderate, and this is related to the fact that ribosomal operons cover less than 0.1 of chromosomal length and tend to cluster in one particular region of the genome. Discrimination of ribotyping depends on the species and on the choice and number of restriction endonucleases used. No consensus has been achieved on optimal procedure and no general rules are available for interpretation of technically problematic results, such as weakly hybridizing fragments.

Mechanisms and Determinants of Resistance

Several mechanisms of resistance to the MRAs are known in various species of bacteria (54-56). All have been initially described from medical microorganisms of human origin. Whereas intrinsic resistance due to outer membrane impermeability is a general characteristic of gram-negative bacteria, three main mechanisms of acquired resistance have been reported posttranscriptional methylation of ribosomal RNA (target protection), modification inactivating the drug(s), and active efflux. All have been documented in bacteria of animal origin, by hybridization with gene or oligonucleotide probes, obtention of PCR products with specific primers, or biochemical identification of the mechanism. Here again, one can deplore the absence of systematic studies in veterinary medicine. The distribution of r-RNA methylase genes in bacteria causing disease in animals has received the attention of several groups most determinants identified in gram-positive cocci correspond to genes belonging to...

Viral recombination lateral exchange and the evolution of bacteriophages

From the above, it is apparent that bacteriophages have a profound effect on the evolution of their bacterial hosts (as facilitators of gene-transfer events). However, viral recombination and horizontal transfer affect the evolution of bacteriophages as well. The dynamic nature of their evolution was first indicated by the extremely labile nature of the globally distributed bacteriophage lineages. For example, when considered as a single 'population', the replacement of the global bacteriophage pool was estimated to occur every few weeks (Wilhelm et al. 2002 Breitbart et al. 2004). However, deciphering the role of various processes, including viral recombination and lateral exchange, in the evolution of these organisms requires specific information on the genetic variability in bacteriophage lineages. To accomplish this, Kwan et al. (2005) carried out an analysis of the entire genomes of 27 bacteriophages that infect Staphylococcus aureus. By comparing the sequence information from...

Signal Transduction Pathways In Infection Inducing Cytokines

The presence of a functional TLR4 gene and gene product appears to be one of several determinants of outcome in Gram-negative infection. A first preliminary report suggests that a rare Arg753Gln mutation might render patients with sepsis susceptible to staphylococcal infection (64). Another rare Arg677Trp variation of TLR2 has been linked to susceptibility to lepromatous leprosy (65). Studies to test the association of the rare TLR4 variations with incidence and course of infectious disease are ongoing (66,67).

Microbiological Description

S. aureus and other members of the genus Staphylococcus are gram-positive, catalase-positive, predominantly facultatively anaerobic, nonmotile, nonspore-forming, spherical-shaped bacteria, approximately 0.5-1.0 mm in diameter, which typically form irregular ''grapelike'' clusters and or occasional configurations of single cells, pairs, tetrads, and short chains, and are differentiated from other closely related genera by their cell wall teichoic acids, susceptibility to lysostaphin, intrinsic bacitracin resistance, lack of cytochrome c (as determined by the modified oxidase test), and relatively low guanine plus cytosine DNA base composition.1-23-1 Approximately 35 species of staphylococci have been described to date. Based on the production of the enzyme and virulence factor coagulase (encoded by the coa gene), the staphylococci are classified as either coagulase-positive (S. aureus, and the veterinary pathogens Staphylococcus schleiferi subspecies coagulans, Staphylococcus lutrae,...

Nosocomial Infections

An important application of PFGE is the comparative analysis of nosocomial pathogens. It is clear that specific etiological agents can be transferred between patients in hospital settings and cause nosocomial infections. Rapidly assessing the clonal relatedness of these isolates is critical in determining the extent of outbreak spread and the strategies for containment. Pulsed field gel electrophoresis is most often considered the typing technique of choice to examine the true genetic identity of the bacterial isolates in an outbreak investigation.1-11-1 Figure 1 shows a variety of PFGE patterns that were generated when methicillin-resistant S. aureus (MRSA) chromosomal DNA was digested with Smal restriction enzyme. These results were obtained from a published study describing an outbreak investigation in our hospital, which involved four cases of postpartum mastitis caused by nosocomial spread of a virulent strain of community-acquired MRSA. 19 The outbreak strains were found to be...

Pathophysiology

Sepsis is caused by the invasion of intact pathogenic or commensal bacteria or bacterial cell wall constituents, especially lipopolysaccharides (LPS), in particular li-poid A endotoxin of the outer membrane of Gramnegative bacteria, or peptidoglycan, teichoic and lipo-teichoic acids of Gram-positive bacteria, or toxins, e.g., toxic-shock-syndrome-toxin 1 and Staphylococcus au-reus toxin A. They bind to cellular receptors and co-receptors, e.g., CD14, toll-like receptors TLR2 and TLR4, CD18 ( 32 integrins), and selectins, on the surfaces of monocytes macrophages, neutrophils, and endothelial cells. Via intracellular signaling molecules, e.g., NF-kB and protein kinase C, they activate the transcription of mediator genes to induce the synthesis and release of numerous endogenous mediators, i.e., cytokines such as interleukin (IL)-1, IL-2, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor (TNF), and platelet-activating factor (PAF). These pro-inflammatory and anti-inflammatory mediators...

Xihydrolysis

The catalytic activity of lipases is reversible and depends on the water content in the reaction mixture. At high water content, the hydrolytic reaction prevails, whereas at low water content, the synthetic reaction is favored. The lipases that have received attention for their ability to synthesize ester bonds have been obtained from yeasts, bacteria, and fungi. Lipases can be classified into three groups based on their specificity (Macrae, 1983). The first group contains nonspecific lipases these show no specificity regarding the position of the ester bond in the glycerol molecule or the nature of the fatty acid. Examples of enzymes in this group are lipases of Candida cylindracea, Corynebacterium acnes, and Staphylococcus aureus. The second group contains lipases with position specificity for the 1- and 3-positions of the glycerides. 1,3 Specificity is common among microbial lipases. This positional specificity is the result of the inability of the sterically hindered ester bond of...

Figure 132

Three-dimensional structure of Staphylokinase (Sakstar variant). (From Berman, H., et al., The protein data bank PDB , Nucleic Acids Res., 28, 235-242, 2000. PDB ID 2SAK. With permission.) other plasminogen molecules. Staphylokinase and streptokinase display very little homology despite their similar plasminogen activation mechanism 1 . When staphylokinase is added to human plasma containing fibrin clot, it binds to plasminogen, creating the plas-minogen-staphylokinase complex. This complex reacts poorly with free plasminogen. However, the staphylokinase-plasminogen complex reacts with traces of plasmin at the clot surface with high affinity, converting it into the plasmin-staphylokinase complex. This complex activates free plasminogen at the clot surface, forming plasmin (process outlined in Figure 13.3). Free plasmin is inhibited from cleaving the plasminogen-staphy-lokinase complex in plasma by the inhibitor a2-antiplasmin. The plasmin-staphylokinase complex and plasmin are...

Therapeutic Uses

Staphylokinase is highly fibrin-specific, avoids systemic plasminemia, and is therefore fibrinogen sparing. These properties, along with reduced risk of side effects such as bleeding, and the relatively low product cost, suggest that recombinant staphylokinase has the potential to be widely used in treating thrombosis 69 . Early recombinant forms of staph-ylokinase were found to be less immunogenic and more active toward platelet-rich arterial blood clots than streptokinase in experimental animal models. However, later trials with human patients revealed that it was as immunogenic as streptokinase 70 . Polyethylene glycol (PEG)-derivitization of staphylokinase increases its circulating half-life in both animals and humans, the extent of which appears to be proportional to the molecular weight of the PEG conjugate. The extended half-life leads to more rapid lysis of the thrombus and better patient outcome. A reduction in immunogenicity has been achieved by site-directed mutagenesis of...

Exfoliative Toxins

Two classical, immunologically different ETs of S. aureus are recognized, ETA, which is chromosomally encoded and heat stable, and ETB, which is carried on a p-lactamase plasmid and is heat inactivated. 9 A serolog-ically different heat-labile ET isolated from a horse strain of S. aureus was termed ETC. Recently, ETD, a novel ET integrated on a pathogenicity island, has been pub-lished. 10 Other SEs causing exfoliation in piglets were named SHETA and SHETB and have been purified from culture supernatants of Staphylococcus hyicus (Table 1).

Ecthyma Gangrenosum

Ecthyma Gangrenosum Histology

A clinical presentation of necrotizing papules and plaques in apocrine areas of an immunosuppressed patient strongly suggests ecthyma gangrenosum, but the differential diagnosis for a plaque or plaques with eschar is much wider, including true ecthyma caused by Staphylococcus or Streptococcus species, arachnid or arthropod bite reactions, anthrax, tularemia, diphtheria, syphilitic chancre, herpes simplex virus infection, and orf. Similar lesions may develop in patients with septicemic plaque (Yersinia pestis) (20). Also in the differential diagnosis is Fournier's gangrene, a polymicrobial acute necrotizing infection of the genitalia. Causes include Streptococcus and Staphylo-coccus species, usually in combination with various gramnegative and anaerobic bacteria. This infection differs from ecthyma gangrenosum in its frequent occurrence in diabetics, severe pain, and tissue crepitus.

Abscess

Difference Abscess Cellulitis Skin Layer

An elevated soft, fluctuant mass is palpable with overlying injected skin that may be ulcerated and scaling. The abscess may rupture spontaneously and exude a purulent material sometimes mixed with blood. This site often seals over with dried blood and a mucoid crust. Any tissues of the eyelid can be involved. There is often a history of recent local infection, such as a chalazion, or trauma, surgery, or other treatment such as laser or cryosurgery. The infection can spread into the adjacent skin producing a spreading cellulitis. Organisms are often skin bacteria such as staphylococci, but occasionally can be parasites or fungi. Bacteremia can result with systemic manifestations.

Cellulitis

Mucormycosis

TREATMENT Initial antibiotic selection is based on the history, clinical findings, and initial laboratory studies. With positive culture, prompt sensitivity studies are indicated so that the antibiotic selection can be revised, if necessary. Staphylococcus aureus is the most common pathogen in patients with preseptal cellulitis from trauma. The infection usually responds quickly to penicllinase-resistant penicillin. Imaging studies should be performed to rule out underlying sinusitis if no direct inoculation site is identified. If the patient does not respond quickly to oral antibiotics or if orbital involvement becomes evident, prompt hospital admission, CT scanning and intravenous antibiotics are usually indicated. Surgical drainage may be necessary if the preseptal cellulitis progresses to a localized abscess. Incision and drainage can usually be performed directly over the abscess. The orbital septum should not be opened to avoid contaminating the orbital soft tissue. Affected...

Impetigo

Bullous Impetigo Eyelid

INTRODUCTION Impetigo represents a superficial invasion of the skin by pathogenic streptococci, staphylococci, or sometimes a mixture of both. Infections tend to occur in areas of previously compromised or diseased skin, such as skin affected by dermatitis, especially eczema, or in a recently lasered resurfaced skin. Owing to the superficial location there is rarely any systemic reaction of consequence. However, in rare instances the bacterial infection may result in the formation of antigen-antibody complexes that can lead to a life-threatening nephritis. CLINICAL PRESENTATION Impetigo can begin in either a bullous or vesicular form, with both types eventuating in pustule formation and then in ulceration. Invasion of the superficial regions of the skin by pathogenic streptococci or staphylococci produces small erythe-matous macules followed by dissolution of the basal epithelial layers and the formation of superficial vesicles or bullae ranging from 2 to 20 mm in diameter and...

Blepharitis

Atrophic Vagina Histology

INTRODUCTION Blepharitis is a general term referring to eyelid margin inflammation. The two most prevalent factors appear to be a dysfunction of the sebaceous glands (meibomian glands), and colonization by pathogenic staphylococci. Additional common features include a diminished or abnormal tear production, chronic conjunctivitis, and structural changes in the lid margin due to chronic inflammation. Several organisms have at times been implicated in the etiology of blepharitis, including Moraxalla, Demodex folliculorum, and Malassezia furfur (Pityrosporum ovale), however, it now appears the most likely organism is Staphylococcus. Once the bacteria colonize the lid margin and meibomian glands they are virtually impossible to eradicate. Through their production of aggravating exotoxins and enzymes that convert lipids to fee fatty acids, they are responsible for many of the ongoing tissue changes and chronic inflammation seen in blepharitis. They remain sequestered deep in the meibomian...

Infections

The majority of sticky eyes are not infected but are due to a blocked nasolacrimal duct. In the absence of conjunc-tival redness or swelling investigation for infection and treatment with topical antibiotics is not required. Simple measures such as cleaning with boiled water and lacrimal duct massage suffice with symptoms usually resolving in 3-6 months. Neonatal conjunctivitis can be caused by such organisms as Staphylococcus aureus, Chlamydia trachomatis, Haemophlus influenzae, Streptococcus pneumoniae and Neisseria gonorrhoeae. Gonococcal ophthalmia usually presents within 24 h of delivery with profuse purulent conjunctival discharge and immediate diagnosis and treatment (systemic and topical) is required to prevent damage to the cornea. Simple hygienic methods such as bathing, hand washing and routine umbilical cord care can prevent many skin infections. The infant's skin is vulnerable to infection by Staphylococci, which usually leads to small pustules or lesions but can also...

Atopic Dermatitis

Clogged Tear Photos

Pruritis aggravated by heat, sweat, or wool often leads to chronic rubbing and as a result, the eyelid skin becomes violaceous early on and hyperpigmented with time. Coalescent papules, fissures, and fine scaling may occur. If the condition becomes chronic, thickening and accentuation of normal skin lines (lichenification) can occur on the periocular skin, and scaling plaques occur predominantly on the upper eyelids. With time eversion or stenosis of the lacrimal puncta may occur and frank ectropion may be seen in severe cases. Loss of eyelashes can occur. Darkening of periorbital skin suggests the diagnosis of atopy and is frequently of cosmetic concern to patients. Secondary staphylococcal infection or colonization of the eczematous skin is common leading to chronic anterior blepharitis. Associated ocular changes include keratoconjunctivitis, chemosis, sympblepharon, corneal pannus, Tranta's dots, anterior and posterior subcapsular cataracts, and keratoconus. TREATMENT The...

Hyaluronidase

There are three principal groups of enzymes that degrade hyaluronan, all three having different reaction mechanisms 142,143 . The testicular-type hyaluronidase (EC 3.2.1.35) group (also known as hyaluronoglucosaminidase hyaluronate 4-glycanohydrolase) contains three subdivisions that include testicular hyaluronidase, tissue lysosomal hyal-uronidase, and venom hyaluronidase. This group hydrolyzes the P(1-4) linkages between N-acetyl D-glucosamine and D-glucuronic acid 140 . Transglycosylation activity has also been displayed by this group of enzymes. The leech hyaluronidase group is also known as hyaluronate glycanohydrolase (EC 3.2.1.36) and principally hydrolyzes the P(1-3) linkage between the repeating disaccharide units of hyaluronan. The third group is bacterial hyal-uronidase, which is also known as hyaluronate lyase (EC 4.2.2.1 or 4.2.99.1). This group acts like endo-N-acetylhexosaminidases by cleaving the P(1-4) linkages of the hyaluronan polysaccharide 144 (Figure 13.5). This...

Mugwort

Still connected with Midsummer, there was a widespread delusion about the roots of mugwort - see Lupton It is certainly and constantly affirmed that on Midsummer Eve there is found, under the root of Mugwort, a coal which saves or keeps them safe from plague, carbuncle, lightning, the quartan-ague, and from burning, that bear the same about them . From the Practice of Paul Barbette, 1676, a more rational view is taken - for the falling sicknesse some ascribe much to coals pulled out (on St John Baptist's Eve) from under the roots of mugwort but those authors are deceived, for they are not coals, but old acid roots, consisting of much volatile salts, and are almost always to be found under mugwort so that it is only a certain superstition that those old dead roots ought to be pulled upon the eve of St John Baptist, about twelve at night .

Thornapple

Thorn-apple has always been valued for medicinal as well as narcotic purposes. The active principle seems to be identical with atropine, and has been used commercially as a substitute for it (Lloyd). It has long been valued as a pain-reliever in American domestic medicine, in the form of a poultice or ointment made from the pulp of the bruised green leaves, and it was used for the same purpose in Essex at one time. The method there was to cut the top of the fruit off, and pulp the inside, adding vinegar. Inhalation of the fumes brought relief, so they claimed (V G Hatfield. 1994). It was used for rheumatism and headache, bee stings and bruises, and for carbuncle, or any minor skin irritation (R B Browne) warts too can be treated by rubbing the leaves over them, whether the leaves are buried afterwards as a charm, or not (H M Hyatt). Sores used to be treated in Kentucky with jimsonweed and fat meat on a penny applied. It would stop the pain (Thomas & Thomas). Gerard talks about the...

St Johns Wort

Gypsies use the St John's Wort as a hair dressing, to make it grow (Vesey-Fitzgerald), a usage that is known too in Somerset, where the leaf infusion was used not only to make the hair grow, but to heal cuts, and to make a poultice for sprains (Tongue. 1965), and that same ointment is also good for burns, and for throat and lung complaints (Wickham). In Scotland, the plant is used in a herb mixture for coughs (Simpkins). The infusion had further uses, one being for children's bed-wetting (Fernie) in Russian folk medicine, centaury and St John's Wort were mixed in equal amounts for this (Kourennoff). The juice is sometimes used for warts, and carbuncles were also treated by direct application of the plant (Physicians of Myddfai). It is still used for bed sores, too, in an ointment prepared from the flowers and leaves, and mixed with olive oil (Genders. 1971), and that same ointment is also good for burns (Tongue. 1965). There is even an ointment for fractures involving this plant,...

Madonna Lily

The bulbs are edible, though very bitter, and are cooked and eaten in parts of Asia, Japan, for instance (Le Strange). They are used medicinally, too pulped, they are used as a poultice, for boils, carbuncles, etc., (Gutch & Peacock Maloney). There is a long list of historical references to this type of medicament. Hill, for example, declared that such a poultice is excellent to apply to swellings . Boiled with milk and water, it was used as an emollient cataplasm to broken breasts (Thornton) (cracked nipples, did he mean ). Gerard, of course, had a number of examples in which lily roots were declared to be efficacious, and recorded too far more ambitious claims for it, such as it expelleth the poison of the pestilence and causeth it to breake forth in blisters in the outward part of the skin , and took note of a learned gentleman who hath cured many of the dropsie with

Assay Procedure

Staphylococcus aureus strain Wood 45 cultures (Protein A-negative Code NCo7121 Central Public Health Laboratory, National Collection of Type Cultures, London) are maintained on agar slopes and plated on blood agar, and the colonies picked off into peptone water. Cultures are agitated at 37 C overnight. The cells are washed three times in HBSS without phenol red (Invitrogen, Carlsbad, CA, formerly Gibco) and fixed with 70 ethanol at 4 C for 30 min. The fixed cells are then washed twice in PBS containing 1 gelatine and 1 glucose (Sigma-Aldrich, St. Louis, MO) (PBSg) pH 7.2 and resuspended to a final concentration of 1 X 108 organisms per mL as determined by optical density measurement at 580 nm in a spectrophotometer.

Putrefaction

The primary source for the opportunistic microbiological colonization in the decomposing body is the microbially rich environment of the gastrointestinal tract. These enteric micro-organisms can cross the failing membrane barriers, a process that is facilitated by the autolytic degradation of body tissues, and migrate and proliferate throughout the body. Hence, the pronounced impact of autolytic processes on the structural integrity of the cellular membranes and the end of the viability of regular defensive or protective cells (e.g. macrophages and neutrophils) as a function of pH changes and the loss of available oxygen, provides the basis for the population explosion the putrefactive period represents. Characteristic microbial species observed during putrefaction include various Bacilli and Pseudomonas, Bacterioides fragilis, Eschericia coli, Clostridium perfringens, Proteus mirabilis, Staphylococcus epidermidis, and Staphylococcus faecalis (8).

Chickweed

Chickweed was used extensively in the medicinal field. It contains copper and iron, and so it is useful for anaemia, and kidney and skin disorders can be treated with it. The last-named was known to Gerard, too - the leaves boiled in vinegar and salt are good against manginesse of the hands and legs, if they be bathed therewith . Chickweed was used to make poultices for boils in Irish folk medicine (Barbour), and the treatment was known in Newfoundland, too (Bergen. 1899). In Somerset, the poultice is used for abscesses and ulcers, too (Tongue. 1965), and it was a common Dorset remedy for gatherings and boils (Dacombe), and in Norfolk for quite severe cases of dermatitis or eczema (V G Hatfield. 1994). The practice in Hampshire was to mix groundsel with chick-weed in making this poultice (Hampshire FWI), but this kind of use was well-known in the Highlands of Scotland, too, for carbuncles and abscesses. The traditional way of preparing it there was to bruise the plant between a flat...

Abstract

All dialysis treatments include a certain risk of infection because of the decreased immune defenses of the patients and because of dialytic techniques that increase the potential of microbial contamination. Peritoneal dialysis, and in particular continuous ambulatory peritoneal dialysis (CAPD), has a higher risk of infections of the peritoneum, but even of the subcutaneous tunnel. These infections are caused by environmental microorganisms principally gram-positives (Staphylococcus epidermidis and Staphylococcus aureus). We tested three active ingredients, electrolytic chloroxidizer, iodine and chlorhexidine gluconate. It is evident that because of the large spectrum of activity, the good effectiveness even at the lowest concentration, coupled with good tolerability (and to the fact of not causing allergic reactions) the electrolytic chloroxidizer appears to be an ideal antiseptic in CAPD. Peritoneal dialysis, and in particular continuous ambulatory peritoneal dialysis (CAPD), has a...

Microbiology

Staphylococcus aureus Beta-hemolytic streptococci Streptococcus faecalis Staphylococcus epidermidis isms are Escherichia coli, Bacteroides, beta-hemolytic streptococci, Staphylococcus spp., and Proteus. Besides being found in the lumen of the gastrointestinal tract, these bacteria are also normal commensal flora of the skin folds and hair follicles of the perineum (Benizri et al. 1996 Smith et al. 1998). This mixed spectrum of bacteria acts in a synergistic fashion to produce and promote a fulminant necrotizing fasciitis.

Iodine and lodophors

Iodine and iodophors have a wide range of activity against gram-positive and gram-negative bacteria, tubercle bacillus, fungi, and viruses. Their activity is based on the oxidizing potential of iodine. Some new studies have shown that povidone-iodine is effective against MRSA, Chlamydia, Herpes simplex, adenoviruses, and enteroviruses 62 . Today, iodophors are widely used for antisepsis of skin, mucous membranes, and wounds. Iodine-based creams may also be used to treat nasal colonization with MRSA 63 . As a result of poor manufacturing processes, iodophor antiseptics have become contaminated and have caused outbreaks or pseudo-outbreaks of infections 64,65 .

Antiseptic Agents

Normal human skin is colonized with microorganisms, which Price, an American surgeon, divided into two types resident and transient flora 47 . Resident flora live and grow on normal skin. Predominant flora is normally harmless and consists of coagulase-negative staphylococci, mainly Staphylo-coccus epidermidis, micrococci, and a smaller number of diphtheroids. In some areas of the body, such as moist areas (e.g., axillae), gram-negative bacteria are more common (e.g., Acinetobacter, Klebsiella) 48 . However, composition of skin flora depends on location, sex, age, health condition, hospitalization, season of the year, and frequency of hand washing 49 . Resident flora are protective to skin because they prevent invasion by other harmful species. They are difficult to remove, because they are attached to deeper layers of the skin. These microorganisms can cause infections during surgery and other invasive procedures. Also, skin bacteria can create problems when transferred from...

Antibiotics

The most common antibiotics given perioperatively are penicillins, cephalosporins, gentamicin, and vancomy-cin (in patients with methicillin-resistant Staphylococcus aureus) (Thong and Yeow-Chan 2004). (3-Lactam antibiotics are estimated to cause 400-800 fatal anaphylactic episodes per year. The skin test is the most reliable method for evaluating suspected anaphylaxis to penicillin 97 of patients with a negative skin test reaction will tolerate penicillin administration. Thus the skin test has a high negative predictive value. With the presence of a positive history and a positive skin test reaction, the patient has at least a 50 risk of an immediate reaction to penicillin (Bernstein et al. 1999). Positive drug-specific IgE test results may suggest a diagnosis of penicillin allergy however, negative tests are unreliable. Thus, skin tests are preferred.

In Vitro Activity

The growing importance of drug resistance to other classes of antibiotic further emphasizes their growing importance. These resistance problems include penicillin-resistant pneumococci, multiresistant enterococci, and, in particular, vanocmycin-resistant strains, methicillin-resistant staphylococci, and multiresistant coagulase-negative staphylococci, as well as drug-resistant Mycobacteria spp. The in vitro activity of erythromycin encompasses most streptococci, including Streptococcus pneumoniae, Streptococcus pyogenes, and the viridans streptococci, but excludes the enterococci. Staphylococcus aureus is also susceptible with the exception of methicillin-resistant strains (MRSA) which are often multiresistant. Other sensitive gram-positive pathogens include corynebacterium and Listeria monocytogenes. Susceptible gram-negative pathogens include Neisseria gonorrhoeae, Moraxella catarrhalis, Legionella pneumophila, and Bordetella pertussis. Activity against Haemophilus...

Peritoneal Dialysis

Thanks to the third lateral way of the 'Y' set, through which the disinfectant could be washed to the outside with a double flush (with the fresh dialysate from the new bag and with the spent dialysate from the abdominal cavity). The disinfectant which resulted as the most suitable for this use, due to the best combination of antimicrobial efficacy and low general and local toxicity, was a chloroxidizer which not only exhibited a toxicity significantly lower than the povidone-iodine, but also with respect to other chloroxidizers, thanks to a particular production system. Our initial choice focused, ever since the late 70s, on this disinfectant because of its reported histophilic properties. Already in 1980, we published the results of our first 'in vitro' studies 1-2 , which confirmed both the high antimicrobial activity and the very good tolerance. Tolerance which was confirmed clearly superior to that of the other disinfectants, as largely confirmed by other subsequent studies 3-9 ....