Hypertension and LAD are independent pre-procedural predictors of AF recurrence after CPVA to treat AF. These data may help in patient selection for AF ablation.

Background: Intranasal inoculation of Streptococcus pneumoniae D39 serotype 2 causes fatal pneumonia in mice. The cytotoxic and inflammatory properties of pneumolysin (PLY) have been implicated in the pathogenesis of pneumococcal pneumonia.

No abstract

Multiple-antibiotic-resistant strains of Serratia marcescens isolated from hospitalized patients were examined for their ability to transfer antibiotic resistance to Escherichia coli by conjugation. Two different patterns of linked transferable resistance were found among the transconjugants. The first comprised resistance to carbenicillin, streptomycin, and fosfomycin; the second, and more common, pattern included resistance to carbenicillin, streptomycin, kanamycin, gentamicin, tetracycline, chloramphenicol, sulfonamide, and fosfomycin. The two types of transconjugant strains carried a single plasmid of either 57 or 97 megadaltons in size. Both of these plasmids are present in parental S. marcescens strains resistant to fosfomycin. The 57-megadalton plasmid was transformed into E. coli.

Molecular epidemiology studies have allowed the identification of the methicillin (meticillin)-resistant (MRSA) and methicillin-susceptible (MSSA) clonal complexes (CCs) and clones of, and CC59 were also detected. Many exotoxin genes were present in each of the 81 isolates, independent of whether they were involved in sepsis (11 to 22) or other types of infections (13 to 21), and they appeared in 73 combinations. The relevant data are that (i) all isolates were positive for hemolysin and leukotoxin genes (98.8% for lukED and 25.9% for lukPV); (ii) all contained an enterotoxin gene cluster (egc with or without seu), frequently with one or more genes encoding classical enterotoxins; (iii) about half were positive for tst and 95% were positive for exfoliatin-encoding genes (eta, etb, and/or etd); and (iv) the four agr groups were detected, with agrII (55.6%) and agrIII (23.5%) being the most frequent. Taken together, results of the present study suggest a frequent acquisition and/or loss of exotoxin genes, which may be mediated by efficient intralineage transfer of mobile genetic elements and exotoxin genes therein and by eventual breakage of interlineage barriers.Staphylococcus aureus is both a commensal bacterium and an extremely versatile pathogen that causes a wide range of diseases in humans, including superficial, deep-seated, and systemic infections, as well as a variety of toxemic syndromes, such as toxic shock syndrome (TSS), staphylococcal scaldedskin syndrome (SSSS), and staphylococcal food poisoning (36). S. aureus produces a wide range of virulence factors that mediate host colonization, invasion of damaged skin and mucosa, dissemination through the body, and evasion of host defense mechanisms (8,12). Relevant among them are a variety of exotoxins that comprise ␣-, ␤-, ␥-, and ␦-hemolysins, leukotoxins (the classical LukS-PV-LukF-PV Panton-Valentine leukocidin [LukPV], LukE-LukD [LukED] and LukM-LukFЈ-PV [LukM]), exfoliative toxins, and pyrogenic toxin superantigens, such as the staphylococcal TSS toxin (TSST-1, first referred to as SEF) and staphylococcal enterotoxins (SEs) (14,29,43). Five major serological types of SEs, SEA through SEE (known as classical enterotoxins, encoded by the sea to see genes, respectively) have been initially identified. However, new types of SEs and their coding genes (seg through seu) were later reported. Several SE genes (seg, sei, sem, sen, and seo) are part of an operon termed the enterotoxin gene cluster (egc

Pneumolysin (PLY) is an important virulence factor of Streptococcus pneumoniae. We examined the ability of three murine monoclonal antibodies (MAbs) to PLY (PLY-4, PLY-5, and PLY-7) to affect the course of pneumococcal pneumonia in mice. The intravenous administration of antibodies PLY-4 and PLY-7 protected the mice from the lethal effect of the purified toxin. Mice treated with PLY-4 before intranasal inoculation of S. pneumoniae type 2 survived longer (median survival time, 100 h) than did untreated animals (median survival time, 60 h) (P < 0.0001). The median survival time for mice treated with a combination of PLY-4 and PLY-7 was 130 h, significantly longer than that for mice given isotype-matched indifferent MAbs (P ‫؍‬ 0.0288) or nontreated mice (P ‫؍‬ 0.0002). The median survival time for mice treated with a combination of three MAbs was significantly longer (>480 h) than that for mice treated with PLY-5 (48 h; P < 0.0001), PLY-7 (78 h; P ‫؍‬ 0.0007), or PLY-4 (100 h; P ‫؍‬ 0.0443) alone. Similarly, the survival rate for mice treated with three MAbs (10 of 20 mice) was significantly higher than the survival rate obtained with PLY-5 (1 of 20; P ‫؍‬ 0.0033), PLY-4 (2 of 20; P ‫؍‬ 0.0138), or PLY-7 (3 of 20; P ‫؍‬ 0.0407) alone. These results suggest that anti-PLY MAbs act with a synergistic effect. Furthermore, MAb administration was associated with a significant decrease in bacterial lung colonization and lower frequencies of bacteremia and tissue injury with respect to the results for the control groups.

Thiol-activated cytolysins share a conserved hydrophobic, Trp-rich undecapeptide that is suggested to be involved in membrane binding and intercalation. The neutralizing monoclonal antibody PLY-5 recognizes all members of this toxin family and peptide mapping assigned its epitope to the undecapeptide motif. This antibody inhibited binding of the toxins to host cell membranes and the epitope was no longer available for binding when a preformed toxin/membrane complex was tested. These results confirm the model of cytolysin binding suggested by structural data.z 1999 Federation of European Biochemical Societies.

Septicaemia due to Corynebacterium striatum occurs infrequently. A case of C. striatum septicaemia with a known skin focus is reported in a 69-year-old male with ischaemia, refractory anaemia and treated for thyroid cancer. The characterization and typing of blood and cutaneous isolates was carried out using biochemical and DNA molecular typing methods to analyse the isolates. This is the first reported case with a documented source. IntroductionCorynebacterium striatum infections are scarcely documented in the English and Spanish literature. The case of septicaemia we describe is the first reported with a known skin focus in which the identity of the strains has been established. Case reportA 69-year-old man was admitted to the geriatric ward in the Hospital Monte Naranco (Oviedo, Spain) with the diagnosis of chronic ischaemia of the lower extremities (grade IV) and lesions in the first and second toe and the heel of the right foot. The patient had a 10-year history of thyroidectomy and iodine radiotherapy for thyroid carcinoma. Two years ago he had a lung metastasis of the tumour treated with iodine radiotherapy and since then he has presented a refractory anaemia and has undergone periodic blood transfusions.During hospitalization, in poor general condition he suffered a sudden febrile episode (39·5 8C) and cellulitis in his right lower limb. Laboratory tests revealed anaemia with a red blood cell count of 2·8 million mm À3 , haemoglobin (g dl À1 ) 9, an increased erythrocyte sedimentation rate (45 mm for the first hour) and a count of 7·6 3 10 3 leukocytes ìl À1 with 82 % polymorphonuclear cells.The chest X-ray showed a consolidation of the left lung with pleural effusion, and nosocomial pneumonia was diagnosed, in this case improving without further interventions.Blood, urine and skin cultures (from the ischaemic areas) were taken. C. striatum was isolated from blood cultures (three out of four bottles, the growth was in the two different venipunctures) with a previous povidone iodine skin preparation, and isolated from two skin swab cultures (together with Enterococcus faecalis in the last one). The Gram stain showed the presence of more than 25 neutrophils under the 310 objective, comprising three morphotypes and the skin cultures showed a semi-quantitative growth of 4+ for C. striatum and 2+ for E. faecalis. Treatment with IV amoxicillin/clavulanic acid, 2 g three times a day, was started and continued for 14 days until the resolution of the infection. During this time, the patient required the placement of a femoral bypass and received two transfusions of red cell concentrate.The strains of C. striatum, isolated from blood and skin, were simultaneously identified. Smooth colonies, about 1 mm in diameter and white-cream in colour, grew on blood agar plates. A Gram stain showed Gram-positive short rods. They were catalase-positive and oxidase-negative, fermented glucose and sucrose in 24 h, reduced nitrate, hydrolysed pyrazinamide and tyrosine but did not produce urease or hydrolyse gelatin in the API Cor...