Diseases and pathogenes
The Anthrax
Yu.V. Lobzin, V.M. Volzhanin, S.M. Zakharenko
Academy of Military Medicine, Saint-Petersburg, Russia
Anthrax, along with smallpox and plague, is considered one of the most potential biological warfare agents. It has been proved during the recent bioterroristic events in the USA in the fall last year. This article presents the questions of etiology, epidemiology and pathogenesis of Bacillus anthracis infection. Clinical features of the different forms and major criteria for diagnosis of anthrax are described in details. Different microbiological diagnostics for confirmation of anthrax infection are analyzed. Management of the naturally occurring anthrax as well as patients with anthrax in mass casualty setting is emphasized. Routine preexposure and postexposure vaccination are also discussed. Recommendations for postexposure prophylaxis following an aerosol exposure to B.anthracis spores are presented.
Key words: anthrax, Bacillus anthracis, bioweapon, bioterrorism, fluoroquinolones, anthrax vaccine.
Role of Helicobacter pylori in human pathology
V.A. Schkitin, A.I. Schpirna, G.N. Starovoytov
Smolensk State Medical Academy, Smolensk, Russia
Helicobacter pylori is one of the most common pathogens in humans. H.pylori associated gastric diseases include chronic gastritis, gastric and duodenal peptic ulcer; moreover, role of this microorganism as a causative factor in the development of MALT-lymphoma and gastric cancer is also under consideration. This article presents microbiological properties of H.pylori and specific interactions between host and microorganism; molecular basis of pathogenicity are described. Local and systemic immune responses to the H.pylori infection are emphasized. Mechanisms of the development of gastric and duodenal peptic ulcer are discussed. The data, regarding the role of H.pylori as a risk factor for gastric cancer are reviewed.
Key words: Helicobacter pylori, microbiology, pathogenicity, immunity, chronic gastritis, peptic ulcer, gastric cancer.
Randomized, Double-Blind Study Comparing 5- and 7-Day Regimens of Oral Levofloxacin in Patients with Acute Exacerbation of Chronic Bronchitis
R.G. Masterton1, C.J. Burley2, Study Group
1 The Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh EH3 9YW, UK
2 Carol Burley Associates, 4 Franklin Court, Bourne End. Bucks SL8 5AT, UK
Translated and Reprinted with permission from "International Journal of Antimicrobial Agents" 2001;18:503-13.
A randomized, double-blind, multicentre study was conducted in adult patients with acute exacerbation of chronic bronchitis (AECB), to compare the efficacy of a 5-day course of levofloxacin 500 mg once daily, with the standard 7-day regimen at the same dose. Five hundred and thirty-two patients from 48 centers in 10 countries were randomized to receive levofloxacin: 268 and 264 received the 5- and 7-day courses, respectively. The primary efficacy analysis was the clinical response at 7–10 days post-treatment in the per-protocol (PP) population. Clinical success rates in the primary PP analysis of 482 patients were 82,8% (197/238) for the 5-day group and 84,8% (207/244) for the 7-day group. The difference in success rates was – 2,1% with 95% CI (of – 9,1 to 4,9%). The bacteriological response showed eradication rates of 82,1% (92/112) and 83,2% (84/101) in the 5- and 7-day groups, respectively. Both treatments were well tolerated.
These results show that for patients with AECB levofloxacin 500 mg once daily for 5 days provides equivalent clinical and bacteriological success to the same dose given for 7 days irrespective of the patients age, the frequency of exacerbations or the presence of co-existing cardiopulmonary or chronic obstructive airways disease.
Key words: chronic bronchitis, acute exacerbation of chronic bronchitis, levofloxacin, 5-day treatment, equivalence.
Antimicrobial Resistance
Susceptibility of Staphylococcus aureus from Hospitalised Patients Topical Antimicrobials in Russia
L.S. Stratchounski, A.V. Dekhnitch, Ju.A. Belkova, The StEnt Study Group
Institute of Antimicrobial Chemotherapy, Smolensk, Russia
Objective. To determine in vitro activity of fusidic acid and other antimicrobials available for topical use against S.aureus isolated from hospitalised patients.
Materials and methods. A total of 879 clinical strains of S.aureus isolated in 2000–2001 from patients hospitalised in 17 medical institutions in different parts of Russia – 4 in Central region, 2 in North-West region, 3 in South region, 2 in Volga region, 3 in Ural region, 3 in Siberian region, were included in the study. Susceptibility to fusidic acid and 8 other antimicrobials available for topical use (gentamicin, mupirocin, erythromycin, clindamycin, lincomycin, tetracycline, chloramphenicol, ciprofloxacin) was determined by agar dilution method in accordance with the NCCLS recommendations.
Results. The most potent antimicrobial was fusidic acid to which no resistance was found. The only other antimicrobial with low frequency of resistance was mupirocin (0,3% of the lower-level resistance). The prevalence of MRSA among tested strains was 33,6%. The high rates of resistance were found to erythromycin (39,6%), tetracycline (37,1%), gentamicin (30,7%), clindamycin (27,1%), ciprofloxacin (13,1%) and chloramphenicol (43,1%).
Conclusions. Fusidic acid and mupirocin can by used as the drugs of choice for the treatment of S.aureus infections in Russia. High rate of resistance to chloramphenicol, macrolides, tetracyclines, aminoglycosides and lincosamydes advise not to use these antimicrobials for empiric therapy of S.aureus infections.
Key words: Staphylococcus aureus, topical antimicrobials, antimicrobial resistance, fusidic acid, mupirocin.