Diphtheria is now rare in most European countries but, when cases do arise, the case fatality rate is high (5-10%). Because few countries continue to routinely screen for the causative organisms of diphtheria, the extent to which they are circulating amongst different European populations is largely unknown. During 2007-2008, ten European countries each screened between 968 and 8551 throat swabs from patients with upper respiratory tract infections. Six toxigenic strains of Corynebacterium diphtheriae were identified: two from symptomatic patients in Latvia (the country with the highest reported incidence of diphtheria in the European Union) and four from Lithuania (two cases, two carriers); the last reported case of diphtheria in Lithuania was in 2002. Carriage rates of non-toxigenic organisms ranged from 0 (Bulgaria, Finland, Greece, Ireland, Italy) to 4.0 per 1000 (95% CI 2.0-7.1) in Turkey. A total of 28 non-toxigenic strains were identified during the study (26 C. diphtheriae, one Corynebacterium ulcerans, one Corynebacterium pseudotuberculosis). The non-toxigenic C. ulcerans strain was isolated from the UK, the country with the highest reported incidence of cases due to C. ulcerans. Of the eleven ribotypes detected, Cluj was seen most frequently in the non-toxigenic isolates and, amongst toxigenic isolates, the major epidemic clone, Sankt-Petersburg, is still in circulation. Isolation of toxigenic C. diphtheriae and non-toxigenic C. diphtheriae and C. ulcerans in highly-vaccinated populations highlights the need to maintain microbiological surveillance, laboratory expertise and an awareness of these organisms amongst public health specialists, microbiologists and clinicians.
Legionella pneumophila has been found to be a common cause of community-acquired pneumonia in patients who required intensive care unit (ICU) admission. In many studies, the clinical manifestations for Legionnaires' disease were more severe and the mortality was higher when compared with pneumonias of other etiology. However, this may be due to delay in diagnosis and suboptimal antibiotic therapy, rather than enhanced virulence of L. pneumophila. A syndromic approach using high fever, diarrhea, mental status changes, hyponatremia, etc., may be useful in suggesting the correct diagnosis in patients with severe pneumonia, but this remains to be validated. The availability of Legionella diagnostic microbiology testing in-house (rather than being sent to an outside reference laboratory) maximizes the ability to correctly diagnose Legionnaires' disease. All patients with community-acquired pneumonia admitted to an ICU should undergo Legionella testing using the urinary antigen and culture on selective media. Moreover, we recommend routine cultures of the hospital water supply once a year (regardless of whether a case of nosocomial Legionnaires' disease has ever been diagnosed). If Legionella is found in the water supply, all patients with nosocomial pneumonia should undergo diagnostic tests for Legionella; empiric anti-Legionella antibiotics should be administered pending definitive diagnosis.
This study was performed to define the relation between colonization of genital skin flora and bacteriuria in spinal cord injured patients with neurogenic bladder dysfunction. Twenty-seven female and 23 male spinal cord injured patients were included in the study. Patients were evaluated regarding their type of bladder management, educational status, level and degree of the spinal cord lesion. Quantitative cultures were obtained from the perineum labium/dorsum of penis, external meatus of urethra, and urine. We investigated whether the organisms isolated from urine were also present in one or more skin sites in every patient. In total 54 identical bacterial isolates were observed both from urine and one or more skin sites in 43 of the patients. Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and Proteus stuartii were the most common bacterial isolates. The distribution of identical colonization of genital skin flora with urine were as follows: 30 in urethra, one in perineum, four in urethra and perineum, nine in urethra and labium/dorsum of penis, and 10 in both three skin sites. Identical colonization of both perineum and labium/dorsum of penis with urine were significantly higher in female patients than those of males (P = 0.037, P = 0.003, respectively). No significant difference was found in the presence/distribution of colonization with respect to type of bladder management, educational status, and neurologic status. These results demonstrate the importance of the urethra, perineum, and labium/dorsum of penis as a source of bacteria causing urinary infection in spinal cord injured patients.
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