Correlation of virulence genes to clinical manifestations and outcome in patients with Streptococcus dysgalactiae subspecies equisimilis bacteremia

Background/PurposeStreptococcus dysgalactiae subsp. equisimilis (SDSE) is increasingly recognized as a human pathogen responsible for invasive infection and streptococcal toxic shock syndrome (STSS). The pathogen possesses virulence genes that resemble those found in Streptococcus pyogenes (GAS). We analyzed the association between these specific toxic genes, clinical presentations, and outcome in patients with SDSE infections.MethodsPatients (older than 18 years) with community-acquired invasive bacteremia caused by SDSE bacteremia who were undergoing treatment at China Medical University Hospital from June 2007 to December 2010 were included in this study. Multiplex polymerase chain reaction was performed to identify virulence genes of the SDSE isolates. Demographic data, clinical presentations, and outcome in patients with SDSE infections were reviewed and analyzed.ResultsForty patients with 41 episodes of SDSE bacteremia were reviewed. The median age of the patients with SDSE infection was 69.7 years; 55% were female and 78% had underlying diseases. Malignancy (13, 33%) and diabetes mellitus (13, 33%) were the most common comorbidities. The 30-day mortality rate was 12%. Compared with the survivors, the non-survivors had a higher rate of diabetes mellitus (80% vs. 26%), liver cirrhosis (60% vs.11%), shock (60% vs.17%), STSS (60% vs. 8%), and a high Pittsburgh bacteremia score >4 (40% vs. 6%). Most isolates had scpA, ska, saga, and slo genes, whereas speC, speG, speH, speI, speK, smez, and ssa genes were not detected. speA gene was identified only in one patient with STSS (1/6, 17%). All isolates were susceptible to penicillin, cefotaxime, levofloxacin, moxifloxacin, vancomycin, and linezolid.ConclusionIn invasive SDSE infections, most isolates carry putative virulence genes, such as scpA, ska, saga, and slo. Clinical SDSE isolates in Taiwan remain susceptible to penicillin cefotaxime, and levofloxacin

The Relationship between Stasis-Stagnation Constitution and Peripheral Arterial Disease in Patients with Type 2 Diabetes

Objectives. In traditional Chinese medicine, Yu-Zhi (YZ, indicating stasis and stagnation) constitution describes a body that tends to express abnormal circulatory conditions. This study identified the linkage between YZ constitution and peripheral arterial disease (PAD) in patients with type 2 diabetes. Methods. Patients over 20 years of age who had had type 2 diabetes for 5 years or longer were recruited. PAD was diagnosed if the ankle-brachial index score was ≤0.9 in either leg. Level of YZ constitution was accessed by an YZ Constitution Questionnaire. Results. A total of 712 patients (354 men and 358 women) with a mean age of 61.5±10.6 years and diabetes duration of 13.1±6.7 years were recruited. The prevalence of PAD among our patients was 7.2%. Multivariate logistic regression revealed significant correlations between PAD and, respectively, YZ score, age, diabetes duration, current smoking, and hs-CRP. Conclusion. In addition to traditional risk factors, YZ constitution was statistically associated with PAD in patients with type 2 diabetes. This result invites further research into the effectiveness of traditional Chinese medicine to treat YZ constitution

Anesthetic Propofol Reduces Endotoxic Inflammation by Inhibiting Reactive Oxygen Species-regulated Akt/IKKβ/NF-κB Signaling

BACKGROUND: Anesthetic propofol has immunomodulatory effects, particularly in the area of anti-inflammation. Bacterial endotoxin lipopolysaccharide (LPS) induces inflammation through toll-like receptor (TLR) 4 signaling. We investigated the molecular actions of propofol against LPS/TLR4-induced inflammatory activation in murine RAW264.7 macrophages. METHODOLOGY/PRINCIPAL FINDINGS: Non-cytotoxic levels of propofol reduced LPS-induced inducible nitric oxide synthase (iNOS) and NO as determined by western blotting and the Griess reaction, respectively. Propofol also reduced the production of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-10 as detected by enzyme-linked immunosorbent assays. Western blot analysis showed propofol inhibited LPS-induced activation and phosphorylation of IKKβ (Ser180) and nuclear factor (NF)-κB (Ser536); the subsequent nuclear translocation of NF-κB p65 was also reduced. Additionally, propofol inhibited LPS-induced Akt activation and phosphorylation (Ser473) partly by reducing reactive oxygen species (ROS) generation; inter-regulation that ROS regulated Akt followed by NF-κB activation was found to be crucial for LPS-induced inflammatory responses in macrophages. An in vivo study using C57BL/6 mice also demonstrated the anti-inflammatory properties against LPS in peritoneal macrophages. CONCLUSIONS/SIGNIFICANCE: These results suggest that propofol reduces LPS-induced inflammatory responses in macrophages by inhibiting the interconnected ROS/Akt/IKKβ/NF-κB signaling pathways

Analysis of Biofilm Formation and Detachment on Oyster Shells in Low Velocity Flow

礫間接觸是一種利用微生物代謝作用以進行現地的污水處理方法，具有低成本並高效率的優點。藉由提供微生物附著表面，使附著之微生物於介質表面進行污染物吸收與生物降解作用。前人研究指出，牡蠣殼可應用於礫間接觸處理基質，且具有高處理效率；而另一面，牡蠣殼也是沿海養殖漁業的廢棄物，因此不論就環境或經濟考量，皆有利用其材料的價值。本研究嘗試以牡蠣殼為介質，探討其上之生物膜生成與生長環境之流體動力條件之關係，以供進一步應用於牡蠣殼礫間接觸場的操作。 本研究的第一部份旨在探討牡蠣殼上生物膜在不同流體動力條件底下的生成特徵，包括初始附著階段、發展階段、生物膜剝離、生物膜崩落、和再生階段。因此我們進行了為期約三個月的長時間實驗，設定流速範圍為0 到0.13m/ s之間，並以平均生長厚度作為生物膜生長的指標進行分析。結果發現，合理的增加流速有助於生物膜臨界平均厚度的增加，但也因此導致了剝離機率的增加而需較長的發展期。在本研究中，牡蠣殼生物膜的最大臨界平均厚度約900μm，並且至少皆會維持89 到140μm的基礎平均厚度。至於崩落時間也隨流速條件有明顯差異。在無流速環境下，牡蠣殼生物膜在第23 天發生崩落，而在低流速條件下則是分別在第52 和55 天發生。 本研究的第二部份主要專注於牡蠣殼生物膜的剝離現象。我們利用所推導的一個較為簡單的模式分析牡蠣殼生物膜的面積剝離率，以及雷諾數對其的影響力。同時，我們也提出了一種光學方法作為測量生物膜平均密度的非破壞性方法，且利用其於連續培養的生物反應器的測量。 總結來說，我們發現在低流速條件下，環境流速對牡蠣殼生物膜的剝落(erosion)影響為正相關，對生物膜崩落(sloughing)成負相關，其中該生物膜主要由格蘭氏陽性菌所組成，包括芽孢桿菌屬(Bacillus sp.)、短芽孢桿菌屬(Brevibacillus sp.)、和微小桿菌屬(Exiguobacterium sp.)。研究並求得一些低流速環境下牡蠣殼生物膜的生成參數作為未來現地處理的設計與操作參考參數。atment efficiency, in order to understand the relationships between fluid velocities and biofilm formation and detachment, and applicate them into the operation of oyster shells’ contacted beds. In the first part of this study, we observed biofilm formation in a long period (about 3 months), in order to discuss biofilm formation processes including initial cultivation, development, detachment, collapse, and re-growth durning different fluid dynamics. We set fluid velocities from 0 to 0.13 m/ s , and took biofilm mean thickness as the growth index in results analysis. Mainly, we found out that a reasonable increasing of fluid velocity is benefit to critical mean biofilm thickness but also lead to a longer development period because of higher detachment frequency. The maximum critical mean thickness of oyster shells’ biofilm is about 900 μm in our results, and there will remain a basic mean thickness from 89 to 140 μm . The sloughing time is also significantly different in free velocity environment and velocity environment. In a free velocity environment, oyster shells’ biofilm occurred sloughing at day 23, on the other hand, it occurred at day 52 and 55 in slow velocities environment. In the second part of this study we focused on the detachment process of oyster shells’ biofilm. We derived a relatively simple model to analyse the areal detachment rate of oyster shells’ biofilm and discussed the influence of Reynolds number on it. Moreover, we also proposed an optical method to measure biofilm mean density in a non-destructed way and utilized it in the measurement of a continuously cultivated biofilm reactor. Conclusively, we found that fluid velocities are possitive correlation to erosion but negative corelation to sloughing in low velocity flow ( < 0.13 m/ s ), and obtained some reference parameters of oyster shells’ biofilm which is mainly composed of gram-positive bacteria including Bacillus sp., Brevibacillus sp., and Exiguobacterium sp. in the flow condition in order to be a reference of in-situ operation and future design

Congenital Candidiasis

Congenital candidiasis presents with a variety of clinical features. We report two neonates with congenital candidiasis characterized by diffuse erythematous papules associated with pneumonia and respiratory distress. Candida pseudohyphae were identifiable in skin scrapings. Systemic cultures were negative, but urine and sputum cultures grew Candida albicans. After prompt systemic antifungal therapy, the infants were discharged from hospital with no overt complications. This report highlights the presence of characteristic skin lesions associated with candidal infection, occurring within 24 hours of birth. This is an important observation which could help in the early diagnosis of congenital candidal infection

Congenital Central Hypoventilation Syndrome in a Full-Term Baby Presenting With Repeated Extubation Failure

Congenital central hypoventilation syndrome (CCHS) is a rare condition. The main characteristic is respiratory insufficiency during sleep. Patients who have CCHS need varying degrees of ventilation support during sleep, or even all day long, according to its severity. We report a term baby with repeated extubation failure, CCHS and Hirschsprung’s disease diagnosed at 1 month of age. This patient was discharged at 5 months old with a home ventilator and reached normal developmental milestones

Comparative Genomics Reveals Pathogenicity-Related Loci in Shewanella algae

Shewanella algae is an emerging marine zoonotic pathogen and accounts for considerable mortality and morbidity in compromised hosts. However, there is scarce literature related to the understanding of the genetic background of virulence determinants in S. algae. In this study, we aim to determine the occurrence of common virulence genes in S. algae using whole-genome sequence and comparative genomic analysis. Comparative genomics reveals putative-virulence genes related to bile resistance, chemotaxis, hemolysis, and motility. We detected the existence of hlyA, hlyD, and hlyIII involved in hemolysis. We also found chemotaxis gene cluster cheYZA operon and cheW gene. The results provide insights into the genetic basis underlying pathogenicity in S. algae