Diseases and pathogenes



Legionellosis: the Role In Human Infectious Pathologies

I.S. Tartakovski1, A.I. Sinopalnikov2

1Research Institute of Epidemiology and Microbiology Named Under N.F. Gamaleya, Russian Academy of Medical Science, Moscow, Russia
2State Institute of Postgraduate Medical Education of Ministry of Defense, Moscow, Russia

In spite of the fact that legionellosis is known as a human infectious disease for more than 25 years there is still quite a few difficulties and open problems. At the present article the following topics are described in detail: taxonomy, general description, biology and pathogenic factors of legionellae, epidemiology and clinical aspects of "Legionnaires' disease" and "Pontiac fever". Current approaches to the therapy of legionellosis as well as to diagnostic procedures, including express-tests, and prophylaxis are also discussed.

Key words: legionellosis, Legionnaires' disease, epidemiology, diagnosis, chemotherapy, prophylaxis.

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Clinical and Epidemiological Characteristics of Outbreak of West Nile Fever in 1999 in Volgograd Region

V.A. Petrov, A.M. Alushin, A.N. Zjukov, A.G. Filippov, E.I. Ioannidi, V.V. Lazorenko, E.V. Leshinskaja, A.M. Butenko, E.B. Belan

Volgograd State Medical Academy, Public Health Committee of Volgograd Regional Administration, Russia

West Nile fever is an infectious disease caused by West Nile virus, a flavivirus commonly found in Africa, South Europe and Asia. People get it by the bite of a mosquito that is infected with West Nile virus. Several sporadic cases and outbreaks of West Nile fever have been observed recently in the regions of temperate climate. The latest large outbreak of this disease occurred in Volgograd and Volgograd region in 1999 is described in this article.

Key words: West Nile fever, West Nile virus, flaviviruses, arboviruses.

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Clinical Significance and Therapy of Candiduria

V.V. Rafalsky

Institute of Antimicrobial Chemotherapy of Smolensk State Medical Academy, Smolensk, Russia

Candiduria is relatively infrequent condition that occurs in less than 5% hospitalised patients and accounts for difficulties in diagnosis and patient's investigation. The main problem is a difficulty in a differentiation of the true fungal infection and colonization. Development of candiduria is a result of one of the following: contamination of urine samples, urinary tract colonisation, local UTI, caused by Candida spp. or disseminated candidosis with urinary tract involvement. In the case of candiduria specific antifungal therapy (fluconazole, amphotericin  and flucytosine) indicated only in patients with disseminated fungal infection, proven fungal invasion of urinary tract, risk factors for disseminated fungal infection, instrumental manipulation on urinary tract and in renal transplant patients.

Key words: urinary tract infections, candiduria, fungal infections, chemotherapy.

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Antimicrobial Resistance



Enterococcal Carriage and Antimicrobial Resistance in Premature Born Unit

A.V. Dekhnitch1, O.I. Kretchikova2, L.I. Turkova3, L.S. Stratchounski1

1Institute of Antimicrobial Chemotherapy, Smolensk State Medical Academy, Russia
2Smolensk Regional Center for Epidemiology and Hygiene, Russia
3Paediatric Hospital No.1, Smolensk, Russia

Sensitivity of 100 enterococcal strains isolated from faeces in premature born unit to 15 antimicrobial agents has been studied. 33 strains of Enterococcus faecalis, 61 strains of Enterococcus faecium, 4 strains of Enterococcus casseliflavus and 2 strains of Enterococcus durans were included in this study. MICs to ampicillin, gentamicin, streptomycin, vancomycin, teicoplanin, chloramphenicol, tetracycline, rifampicin, ciprofloxacin, ofloxacin, levofloxacin, sparfloxacin, quinupristin, dalfopristin and quinupristin/dalfopristin were detected by agar dilution method. 53% of strains were resistant to ampicillin, 44 and 39% – to gentamicin and streptomycin, 50, 71 and 93% were resistant to chloramphenicol, tetracycline and rifampicin, respectively. There were no strains fully resistant to vancomycin and teicoplanin. Generally E. faecium was more resistant than other enterococci to most of tested antibiotics with exception of quinupristin/dalfopristin where E. faecalis was more resistant.

Key words: enterococci, antimicrobial resistance, carriage, premature born.

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Ecological Aspects of Antimicrobial Susceptibility of Anaerobic Bacteria

M. Caceres1,2, C.E. Nord1, A. Weintraub1

1 Division of Clinical Bacteriology, Department of Immunology, Microbiology, Pathology and Infectious Diseases, Karolinska institute, Huddinge University Hospital, Stockholm, Sweden
2 Department of Microbiology, Medicine Faculty, National Autonomous University of Leon, Nicaragua

The treatment options for the therapy of anaerobic infections, the most typical anaerobic pathogens and their mechanisms of resistance to antimicrobials are given in the article. The data on the susceptibility testing of Bacteroides spp., Clostridium spp. and Fusobacterium spp. isolated form hospitalized adults from Sweden and Nicaragua who were receiving antimicrobial therapy and from Nicaraguan antimicrobial treated children and healthy children under 2 years of age. Benzylpenicillin, cephalotin and piperacillin were the antimicrobials less effective against Bacteroides species, followed by clindamycin and cefoxitin. Fusobacterium species resistant to benzylpenicillin were also found. A significant difference was observed between the Nicaraguan and Swedish patients. Most Clostridium species from both groups of patients were sensetive to the antimicrobial agents tested. Bacteroides strains were the only bacterial species resistant to ampicillin and cefoxitin isolated from children; the percentage of resistant strains increased with age. These resistant strains were isolated mainly from antimicrobial treated children. However, Bacteroides strains resistant to ampicillin were also isolated from the intestinal microflora of healthy children. No resistant strains to imipenem, metronidazole and chloramphenicol were found. The antimicrobial susceptibility pattern of anaerobic and aerobic bacteria isolated from 219 Nicaraguan patients was determined against the most common antimicrobials used in Nicaragua. B.fragilis group strains were the most common anaerobic isolates and the most resistant to ampicillin (56%), cefoxitin (28%) and clindamycin (25%). Fusobacterium strains resistant to ampicillin and cefoxitin (44% and 12% resistance, respectively) were also isolated. All the gram-positive anaerobic strains isolated were sensitive to the antimicrobials tested.

Key words: anaerobs, antibacterial therapy, antibacterial resistance.

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Laboratory Diagnostics



Genus Leuconostoc: Clinical Significance, Identification, Susceptibility to Antimicrobials

L.I. Ahmetova, E.J. Perevalova, S.M. Rozanova

Microbiological Laboratory of Center of Laboratory Diagnostics, Ekaterinburg, Russia

In many cases vancomycin is a drug of choice for the treatment of serious gram-positive infections and what is more important vancomycin is often the only antimicrobial agent that active against multiresistant strains. In this connection the correct identification of intrinsically vancomycin-resistant bacteria that quite uncommon in clinical practice, in particular Leuconostoc spp., is important. Prompt identification of this bacterium will lead not only to administration of adequate antibiotic therapy but also to avoid the mistaken reports about vancomycin resistance in streptococci, enterococci and other streptococcus-like bacteria.

Approaches to identification of Leuconostoc are presented. One case of Leuconostoc bacteremia is described.

Key words: Leuconostoc, vancomycin, laboratory diagnosis, identification, bacteremia.

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Guidelines for clinicians



Criteria Used When Initiating Antifungal Therapy Against Candida spp. in the Intensive Care Unit

Patricia Munoz, Almudena Burillo, Emilio Bouza

Department of the Clinical Microbiology and Infectious Diseases, Hospital General "Gregorio Maranon", Madrid, Spain

Translated and reprinted with permission from "International Journal of Antimicrobial Agents" 2000; 15:83-90.

Invasive candidiasis is a life threatening complication for intensive care unit (ICU) patients. The infection is difficult to recognise so that treatment may be delayed or even not given. Risk factors for candidiasis include the use of antimicrobial agents, central intravascular devices (mainly Hickmann catheters), recurrent gastrointestinal perforations, surgery for acute pancreatitis or splenectomy and renal dysfunction or haemodialysis. Therapy against Candida spp. is recommended in ICU patients with endophthalmitis or chorioretinitis possibly caused by Candida spp., in symptomatic patients with risk factors for invasive candidiasis especially if two or more anatomical sites are colonised and for asymptomatic high-risk surgical patients (with recent abdominal surgery or recurrent gastrointestinal perforations or anastomotic leakages).

The isolation of Candida from any site poses an increased risk but there are a few microbiological data that might help to establish the predictive value of a particular isolate. These include the site of isolation, the number of culture positive, noncontiguous sites, the density of colonisation and the species isolated. Antifungals should be started when Candida spp. are recovered from blood cultures or from usually sterile body fluids, abscesses or wounds in burns patients. They should also be considered in patients with a colonisation index > 0,5 or a corrected colonization index > 0,4 or when the isolate is identified as Candida tropicalis.

Key words: antifungal therapy, Candida spp., intensive care unit.

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