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The role of bacterial interference in the respiratory tract was first described in the 1960s. (36) Its role in the development and progression of diseases affecting other organ systems, including [...]

Acute pharyngotonsillitis is one of the most common infections encountered by pediatricians and family physicians. According to the US Vital Health Statistics report, acute pharyngotonsillitis is responsible for more than [...]

Fever with no clear source of infection in children under 3 years old carries a small but important risk of sepsis and meningitis. This review describes the bacterial causes of […]

Objective: To study the aerobic and anaerobic microbiological and clinical characteristics in 15 cases of acute pericarditis treated over a 12-year period. Design: Retrospective review of microbiological and clinical data. Setting: Military hospital in Bethesda, Md. Results: Aerobic or facultative bacteria alone were present in 7 specimens (47%), anaerobic bacteria alone in 6 specimens (40%), and mixed aerobic-anaerobic flora in 2 specimens (13%). In total, there were 21 isolates: 10 aerobic or facultative bacteria and 11 anaerobic bacteria, an average of 1.4 per specimen. Anaerobic bacteria predominated in patients with pericarditis who also had mediastinitis that followed esophageal perforation and in patients whose pericarditis was associated with orofacial and dental infections. The predominant aerobic bacteria were Staphylococcus aureus (3 isolates) and Klebsiella pneumoniae (2 isolates), and the predominant anaerobic bacteria were Prevotella species (4 isolates), Peptostreptococcus species (3 isolates), and Propionibacterium acnes (2 isolates). Conclusion: The findings in our study highlight the potential importance of anaerobic bacteria in acute pericarditis.

Objective: To study the microbiologic and clinical characteristics of patients with mediastinitis. Methods: Retrospective review of clinical and laboratory data of 17 patients treated between 1980 and 1987. Results: Aerobic or facultative bacteria only were present in three patients (18%), anaerobic bacteria only in seven (41%), and mixed aerobic-anaerobic flora in seven (41%). In total, there were 42 isolates, 13 aerobic or facultative and 29 anaerobic bacteria, an average of 2.5 per specimen. Anaerobic bacteria predominated in infections that originated from esophageal perforation and orofacial, odontogenic, and gunshot sources. The predominant aerobes were [alpha]-hemolytic Streptococcus (three isolates), Staphylococcus aurcus (two isolates), and Klebsiella pneumoniae (two isolates). The predominant anaerobes were Prevotella and Porphyromonas species (eight isolates), Peptostreptococcus species (seven isolates), and Bacteroides fragilis group (three isolates). Conclusion: These data highlight the polymicrobial aerobic-anaerobic nature of mediastinitis. (Arch Intern Med. 1996;156:333-336)

Although Propionibacteria are part of the normal bacterial flora colonizing the skin, eyes and eyelids, throat, and digestive tract, they are capable of causing serious infections in human children. Over a 15 year period, 50 Propionibacterium isolates were cultured in 45 patients where the bacterium was the cause of infection. Infections were of many types, including blood, ear, central nervous system, lymph nodes, abscesses, burns, wounds, eye, and bone. Three-quarters of the children had a predisposing or underlying condition such as presence of a foreign body (heart valve, shunt to relieve hydrocephalus), cancer, diabetes, surgery, or steroid therapy. Despite antibiotic therapy, four patients died.

Ionizing radiation is used to treat patients with cancer. Radiation therapy, however, kills not only cancer cells, but the naturally occurring bacteria in the stomach and intestines that play protective roles against infection by preventing other bacteria from growing. Therefore, patients treated with radiation therapy have an increased risk of developing serious infections. Pseudomonas aeruginosa and Klebsiella pneumonia are Gram-negative bacteria that are a common cause of sepsis (the presence of pus-forming bacteria in the blood) in patients undergoing radiation therapy. Antibiotics such as polymyxin, bacitracin and aminoglycosides have been used to reduce the incidence of bacterial infections in patients with neutropenia (low white blood cell count). Therefore, a study was performed to determine if antibiotic drugs could prevent sepsis following radiation therapy. The study was performed in mice that had been infected with Gram-negative bacteria and then exposed to radiation. The mice were treated with oral ofloxacin, oral gentamicin or intramuscular gentamicin at different times after infection. When treatment with either antibiotic was begun within 10 to 24 hours of infection, the growth of Gram-negative bacteria was reduced and survival was improved. It is concluded that treatment with ofloxacin or gentamicin may be useful in reducing Gram-negative bacterial infections following radiation therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

One reason for the failure of penicillin to eradicate acute streptococcal pharyngitis (sore throat due to infection with group A beta-hemolytic streptococci, or GABHS) could be the presence in the throat of other microorganisms that render penicillin ineffective. This could occur as a result of the production by bacteria of beta-lactamase, an enzyme that interferes with penicillin's antimicrobial effect. To evaluate this possibility, patients with acute pharyngitis were treated either with an antibiotic used against both GABHS and beta-lactamase-producing bacteria (amoxicillin-clavulanic acid), or an antibiotic against GABHS only (phenoxymethyl penicillin, also called penicillin V). Forty-three penicillin patients and 46 amoxicillin-clavulanic acid patients completed the study: patients were 7 years old, on average. Effective treatment was defined as elimination of the original streptococcal organism at a follow-up visit within several days of their last use of medication. Results showed that throat culture results remained positive for the same GABHS strain in 6.5 percent of the patients treated with amoxicillin-clavulanic acid and in 2.3 percent of those treated with penicillin; these rates were not significantly different. Moreover, two of the three treatment failures in the amoxicillin-clavulanic acid group were in children who had not produced beta-lactamase at the start of the study, so failure could not be said to be a result of the enzyme. The findings of this admittedly small study indicate that treatment failure against GABHS pharyngitis cannot be corrected by adding an agent against beta-lactamase-producing bacteria. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infections of the skin and soft tissues commonly occur in hospital patients. The choice of initial antibiotic treatment is made before cultures are available which identify the specific organism causing the infection. The selection of this initial antibiotic is based upon knowledge of those organisms which commonly cause such infections. In order to provide more insight into these organisms, a retrospective study was undertaken of 584 wounds and 676 skin or soft tissue abscesses. The anaerobic and aerobic microbiologic characteristics were correlated with the infection site. Aerobic organisms live and grow in the presence of free oxygen, while anaerobic organisms live in the complete or almost total absence of oxygen. The results indicated that anaerobic bacteria play an important role in skin wounds and abscesses. The location of the wound or abscess was useful in determining which organisms were involved in the infection. Infections located around the oral, rectal and vaginal regions tended to have organisms similar to those that are part of the normal flora at the adjacent mucous membrane. Infections occurring far from these areas usually involved organisms found in the skin. Mixed aerobic and anaerobic infections were more often found in the breast area and fingers and nail beds. Cultures for both aerobic and anaerobic organisms should be obtained. Antibiotics play an important role in the prevention of postoperative infections. The best treatment for skin wounds and abscesses is surgical drainage, and some cases may require systemic administration of antibiotics. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objective: To compare the cultures of tonsillar surface aerobic and anaerobic bacterial flora taken during the acute phase of infectious mononucleosis with the repeated cultures taken 2 months later. Patients: Fourteen patients with pharyngotonsillitis associated with infectious mononucleosis. Results: A total of 121 bacterial isolates (ie, 84 anaerobes and 37 facultatives and aerobes) were isolated in the acute stage, and 75 isolates (ie, 42 anaerobes and 33 aerobes) were recovered 2 months later. The reduction in the number of organisms in the second specimen was mostly due to the decrease in the recovery of Prevotella intermedia (13 in the first culture, compared with four in the second) and Fusobacterium nucleatum (12 vs four, respectively). Conclusions: The study illustrates that the surfaces of tonsils of patients with infectious mononucleosis contain more species of anaerobic organisms during the illness than following it. The potential role of these organisms in the inflammation process warrants further study., More anaerobic bacteria seem to inhabit the tonsils of mononucleosis patients during the acute stage of the illness while fewer such organisms may be found as the disease subsides. Anaerobic organisms are able to thrive without oxygen. Between 1978 and 1987, researchers studied 14 patients with mononucleosis. Cultures of the tonsils were taken when the patients were acutely ill and again after 60 to 65 days. Researchers cultivated 121 bacterial organisms from the patients during the acute stage of the disease. Eighty-four of these organisms were anaerobes and 37 were facultatives or aerobes. The second tonsil culture isolated a total of 75 bacterial organisms from patients. Forty-two of these organisms were anaerobes and 33 were facultatives or aerobes. The decrease in the number of organisms found in the second culture was mostly due to a decline in the number of Prevotella intermedia bacteria and Fusobacterium nucleatum bacteria.

I have been an Infectious Disease physician for 36 years, and my main research interest is in head and neck infections. While my work has involved writing, teaching, and patient [...]

An updated review is presented of cases of anaerobic bacterial bacteremia, with specific reference to isolation and identification techniques, and a discussion of applicable new nomenclature. Isolates were obtained from patients at Walter Reed Army Medical Center, in Washington, DC and from the Navy Hospital, Bethesda, MD. A total of 567 patients yielded 634 anaerobic organisms; 296 patients had bacteremia (bacterial infection of the blood). The factors predisposing to anaerobic bacteremia included: malignant neoplasms; blood diseases; recent gastrointestinal, obstetric or gynecologic surgery; organ transplant; intestinal obstruction; decubitus ulcers; dental extraction; corticosteroid or cytotoxic agent therapy; splenectomy; diabetes mellitus; and sickle cell disease. Bacteroides, Fusobacterium, Clostridium and Peptostreptococcus species predominated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Human and animal bites can cause bacterial infections and other complications. Bites which cut or puncture the skin where joints or bones are close to the skin, such as the hand, are especially dangerous. Human and animal saliva contains bacteria which can pass diseases to the bitten body. Since human saliva has more disease-producing microorganisms than animal saliva, human bites can cause more serious infections than animal bites. Human and animal bites require very careful inspection by X-ray or surgery, treatment with broad antimicrobial agents, and, if necessary, immunization against acute infectious diseases such as rabies, which is spread by contamination with virus-laden saliva, and tetanus, which is spread by contaminated punctures such as metal nails, splinters or insect bites., Although often innocuous initially, human and animal bites can cause serious local and systemic infections as well as other complications. Bites to a site where joints or bones are close to the skin are especially prone to severe complications. Bites to the hand, therefore, require meticulous radiographic and surgical evaluation if a puncture or a severe laceration has occurred. Since the normal human oral flora harbors more pathogens than that of animals, human bites have a higher incidence of serious infections and complications. The oral flora of both humans and animals is anaerobic-aerobic, and initial empiric treatment requires the most broad spectrum antimicrobial therapy available, in addition to scrupulous would management and, when required, immunization against rabies and tetanus., Human and Animal Bite Infections The infection potential of animal and human bite wounds is great, especially when the victim is brought to medical attention more than 24 hours after [...]

I am an infectious diseases physician with a special interest in head and neck infections and extensive experience in otolaryngological ailments. Four years ago I was diagnosed with hypopharyngeal carcinoma; [...]

Dear Editor: I would like to report a simple method to prevent and even reverse tracheo-esophageal prosthesis (TEP) fluid leakage through the central tube. I underwent pharyngo-laryngectomy with flap reconstruction [...]