Bacteremia caused by staphylococci with inducible vancomycin heteroresistance

The clinical significance of bacteremia due to vancomycin- heteroresistant staphylococci and a rapid laboratory screening method were examined; 203 strains of staphylococci isolated from patients with clinically significant bacteremia were screened by the disk-agar method with use of vancomycin-salt agar to demonstrate satellitism around an aztreonam disk as well as by conventional population screening. Eighteen isolates (three Staphylococcus aureus and 15 coagulase-negative staphylococci) were shown to be heteroresistant to vancomycin. A case-control clinical study showed that the interval between admission and bacteremia, admission to the intensive care unit, prior use of vancomycin and/or β-lactams, and isolation of methicillin-resistant staphylococci were significantly more common among patients with bacteremia due to staphylococci with heteroresistance to vancomycin; these patients had an overall mortality of 44.4%. The use of vancomycin and admission to the intensive care unit were independently significant risk factors on multivariate analysis. Vancomycin heteroresistance is inducible by salt and β-lactams. Indiscriminate sequential use of β-lactams and glycopeptides may facilitate the emergence of glycopeptide resistance.published_or_final_versio

Acupuncture mycobacteriosis [6]

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Viral loads in clinical specimens and SARS manifestations.

1. A high viral load in nasopharyngeal aspirate (with or without a high viral load in serum) is a useful prognostic indicator of respiratory failure or mortality. The presence of viral RNA in multiple body sites is also indicative of poor prognosis. 2. Early treatment with an effective antiviral agent before day 10 may decrease the peak viral load, and thus ameliorate the clinical symptoms and mortality, and reduce viral shedding and the risk of transmissionpublished_or_final_versio

Nucleic acid technology and infectious diseases

The past decade has witnessed an explosion in the knowledge of microbial genetics, pathogenesis, and antimicrobial resistance as a result of advances in molecular technology. This has brought important breakthroughs in the management of patients with infectious diseases, as organisms that had previously been difficult to demonstrate in vitro can now be detected by molecular techniques such as the polymerase chain reaction. Not only is rapid diagnosis now possible, but old diseases of uncertain aetiology have been found to have an infective origin, for instance, Whipple's disease. Molecular technology has also contributed greatly to epidemiological studies of outbreaks, understanding antimicrobial resistance, developing new antimicrobial agents, the in vitro synthesis of immunomodulators, production of vaccines, and gene therapy. The limitations of these latest technologies, however, need to be remembered so that they yield meaningful information for patient care.published_or_final_versio

Human enterovirus 71 epidemics: what's next?

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Acupuncture transmitted infections.

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Comparative genomic analysis of pre-epidemic and epidemic Zika virus strains for virological factors potentially associated with the rapidly expanding epidemic

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A significant number of reported Absidia corymbifera (Lichtheimia corymbifera) infections are caused by Lictheimia ramosa (syn. Lichtheimia hongkongensis): an emerging cause of mucormycosis

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Acinetobacter bacteremia in Hong Kong: Prospective study and review

The epidemiological characteristics of 18 patients with acinetobacter bacteremia were analyzed. Patients (mean age, 55.5 years) developed bacteremia after an average of 14.1 days of hospitalization. Fifteen of 16 patients survived bacteremia caused by Acinetobacter baumannii. Cultures of blood from the remaining two patients yielded Acinetobacter Iwoffii. Most patients (78%) resided in the general ward, while four patients (22%) were under intensive care. Genotyping by arbitrarily primed polymerase chain reaction analysis and the temporal sequence of isolation were more useful than phenotyping by antimicrobial susceptibility in the determination of the source of bacteremia, and the intravascular catheter was the leading infection source (39% of cases). The possibility of an association of glucose with the pathogenesis of acinetobacter infection was raised.published_or_final_versio

TonEBP/NFAT5 stimulates transcription of HSP70 in response to hypertonicity

While hyperosmolality of the kidney medulla is essential for urinary concentration, it imposes a great deal of stress. Cells in the renal medulla adapt to the stress of hypertonicity (hyperosmotic salt) by accumulating organic osmolytes. Tonicity-responsive enhancer (TonE) binding protein (TonEBP) (or NFAT5) stimulates transcription of transporters and a synthetic enzyme for the cellular accumulation of organic osmolytes. We found that dominant-negative TonEBP reduced expression of HSP70 as well as the transporters and enzyme. Near the major histocompatibility complex class III locus, there are three HSP70 genes named HSP70-1, HSP70-2, and HSC70t. While HSP70-1 and HSP70-2 were heat inducible, only HSP70-2 was induced by hypertonicity. In the 5' flanking region of the HSP70-2 gene, there are three sites for TonEBP binding. In cells transfected with a reporter plasmid containing this region, expression of luciferase was markedly stimulated in response to hypertonicity. Coexpression of the dominant-negative TonEBP reduced the luciferase expression. Mutating all three sites in the reporter plasmid led to a complete loss of induction by hypertonicity. Thus, TonEBP rather than heat shock factor stimulates transcription of the HSP70-2 gene in response to hypertonicity. We conclude that TonEBP is a master regulator of the renal medulla for cellular protection against high osmolality via organic osmolytes and molecular chaperones.open12