Systemic endotoxaemia is a well recognized feature of inflammatory bowel disease but its pathogenic role remains uncertain. This study examined plasma endotoxin and cytokine concentrations and the acute-phase protein response in a hapten-induced model of experimental colitis. On days 2, 8 and 14 after induction of colitis with trinitrobenzenesulphonic acid in ethanol (TNBS-E), plasma endotoxin, immunoglobulin (Ig) G and IgM endotoxin-core antibody (EndoCAb), tumour necrosis factor (TNF), interleukin (IL) 6 and alpha 2-macroglobulin (alpha 2M) concentrations and colon macroscopic inflammation score were determined. At all time points there was significant colonic inflammation when compared with control values (P < 0.0001). Animals treated with TNBS-E had raised concentrations of endotoxin at all time points (P < 0.04). In TNBS-E-treated animals EndoCAb concentrations were reduced on day 2 (P < 0.0001) and later increased. There were increases in IL-6 and alpha 2M concentrations in TNBS-E-treated animals but no significant change in TNF concentrations. Endotoxin concentrations correlated with macroscopic inflammation score, IL-6 and alpha 2M concentrations. There was a less consistent correlation between EndoCAb concentrations and these parameters. These results suggest that endotoxin is a mediator of the systemic response in this model of experimental colitis.
A prospective study was carried out to analyze the usefulness of blood culture results for adult patients who were discharged from the emergency department with bacteremia. Over a 29-month period, 110 patients with significant bacteremia who were seen in the emergency department and discharged home were studied. The mean age of the patients was 61.8 years. The most frequent initial major diagnosis was urinary tract infection (UTI) (n=63; 57.3%). Gram-negative organisms were isolated in 79 (71.8%) cases. A change in diagnosis (44.5% cases) was more common when the initial diagnosis was something other than UTI or when empiric antimicrobial therapy was ineffective or was not given (P<0.001). The significant predictors of modification of the initial empiric antibiotic therapy were ineffective empiric antimicrobial therapy and transfer of the patient from the emergency department to an infectious diseases outpatient clinic (P=0.01). Blood culture results may be useful for achieving the correct diagnosis in adult patients with bacteremia and for guiding treatment in the subsequent management of outpatients.
A fatal case of Trichosporon inkin prosthetic endocarditis is reported. The isolation sites and susceptibility profiles of 10 other isolates are also reviewed. Four strains were recovered from cutaneous or subcutaneous samples, four were recovered from urine, one was recovered from peritoneal liquid, and one was recovered from bone. Voriconazole and amphotericin B had the most potent activities in vitro against the isolates, with MIC geometric means of 0.11 and 0.30 g/ml, respectively. CASE REPORTA 52-year-old male underwent biological valve replacement for an insufficient aortic valve in October 1987. In May 2001, he developed valvular dysfunction with heart failure, and a second aortic valve replacement was performed. Fifteen months later, the patient presented to the Emergency Department with skin lesions on both hands, swelling of the right wrist, and articular pain. Physical examination revealed a temperature of 37.8°C and a leukocyte count of 12.8 ϫ10 6 per liter. Blood culture samples were taken, and the patient was discharged with the diagnosis of cellulitis and placed on amoxicillin-clavulanate therapy. Two days later, he came to the Infectious Diseases outpatient clinic with new skin lesions. An examination showed Osler's nodes in the fingers of both hands and in the feet and splinter hemorrhages on the nail folds. Transthoracic echocardiography showed a huge vegetation along the rim of the prosthetic aortic valve. After two new sets of blood cultures were performed, antibiotic therapy with vancomycin (1 g/12 h), gentamicin (80 mg/8 h), and rifampin (600 mg/day) was instituted. Forty-two hours later, the patient developed left hemiparesis and was transferred to another hospital for cardiovascular surgery. Unfortunately, after another 30 hours, he suffered a cardiopulmonary arrest and died before the surgery could be performed. An autopsy was not done.No growth was detected in the broth blood cultures after 7 days of incubation, but subcultures on Sabouraud glucose agar with gentamicin and chloramphenicol yielded colonies of a cream-colored organism after 48 h of incubation. Microscopic examination revealed budding cells and arthroconidia. Urease activity was positive. The API ID32C clinical yeast identification system (Biomerieux SA, Marcy-L'Etoile, France) was used to identify the isolate. With this commercial kit, we obtained the code 525764371, which is listed in the API ID32C database as a very good identification of Trichosporon inkin. However, the strain did not show growth on N-acetylglucosamine (the carbon source), a test by which the majority of T. inkin strains included in the API database are positive. Therefore, the isolate was sent to the Mycology Laboratory of the National Center for Microbiology of Spain for definitive identification and susceptibility testing.Identification of the isolate. At the National Center for Microbiology, the strain was labeled as CNM-CL-4811 (Spanish Centro Nacional de Microbiología yeast culture collection). The isolate was identified by routine physiological ...
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