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Löfgren’s syndrome is an acute form of sarcoidosis that is characterized by the activation of CD4+ T helper cells. In this issue of JEM, Greaves et al. (2021. J. Exp. Med.https://doi.org/10.1084/jem.20210785) identified a peptide derived from an airborne mold species that stimulates T cells of Löfgren’s syndrome patients in an HLA-DR3–restricted manner. An increased serum IgG antibody response to the full-length protein was also observed in those patients, indicating that the fungus Aspergillus nidulans might be the elusive microbial agent that drives acute sarcoidosis.

Open-pit mining causes soil damage and affects the health of the ecosystem. In the arid grassland mining areas, the soil is severely sanded, water-starved, and saline, thus making it difficult for plants and microorganisms to survive. Water-jet loom sludge can be used to improve the quality as it contains a lot of clay and is rich in organic matter, which provides a material basis for microorganism activity. To explore the effects of microbial agent-modified water-jet loom sludge on the restoration of degraded soil in grassland mining areas, four pot trials were set up, i.e., for untreated soil, the application of a microbial agent alone, the application of water-jet loom sludge alone, and the combined application of water-jet loom sludge and the microbial agent. The results show that (1) microbial agent-modified sludge can improve soil water-holding capacity and aggregate stability, (2) the nutrient content of the restored soil fraction increased significantly, and the pH of the original saline soil decreased from 9.06 to 7.84, (3) this method significantly increased plant biomass and microbial biomass carbon and enhanced the abundance and diversity of fungi and bacteria. The three treatments had different results in different soil properties, and the effect of the combined water-jet loom sludge and microbial agent treatment on soil remediation was significantly better than the individual application of either.

Purpose The aim of this study was to perform a systematic review and meta-analysis of studies performed in primary care centers and hospital facilities that evaluated the effectiveness of computerized clinical decision support systems (CDSSs) in decision making on the prescription of any given antibiotic. Methods We conducted a search of the MEDLINE and EMBASE databases. A meta-analysis was then conducted of all variables with results reported in >2 studies. Findings A total of 42 of the 46 studies included in the review identified a statistically significant advantage for CDSSs in ≥1 study variables. The effect of CDSSs on the percentage accuracy of the antibiotic spectrum prescribed empirically with respect to the microbial agent's susceptibility, which is one of the most frequently studied outcome variables, was examined in 7 studies, all undertaken in hospital settings. In all these studies but one, CDSSs resulted in a statistically significant increase in percentage accuracy. The other study variables present in >2 studies had more inconsistent results. Although the results of the meta-analysis of the variables percentage accuracy, antibiotic prescription rate in hospital, percentage adherence to antibiotic prescription guidelines in primary care or hospital, and percentage of inappropriate prescriptions for antibiotics in primary care were statistically significantly favorable to CDSSs; in the case of hospital length of stay and mortality, they were favorable although not statistically significantly. Implications CDSSs appear to be useful for variables such as the percentage of appropriate empirical treatment in the hospital setting or to induce changes in antibiotics prescription rate. Even so, more better quality studies are required to draw clearer conclusions in respect of morbidity and mortality outcome variables and other settings.

Food poisoning is still the first cause of hospitalization worldwide and the most common microbial agent, Campylobacter jejuni, is the most commonly reported gastrointestinal disease in humans in the EU (European Union) as is reported by the European Union One Health 2018 Zoonoses Report styled by the EFSA (European Food Safety Authority) and ECDC (European Center for Disease Prevention and Control). One of the vehicles of transmission of this disease is milk. Nanostructured MOS (Metal Oxide Semiconductor) sensors have extensively demonstrated their ability to reveal the presence and follow the development of microbial species. The main objective of this work was to find a set up for the detection and development follow up of C. jejuni in milk samples. The work was structured in two different studies, the first one was a feasibility survey and the second one was to follow up the development of the bacteria inside milk samples. The obtained results of the first study demonstrate the ability of the sensor array to differentiate the contaminated samples from the control ones. Thanks to the second study, it has been possible to find the limit of microbial safety of the contaminated milk samples.

Food poisoning microbial agent can cause diarrhoel disease and ill-health in infant. Staphylococcal organisms constitute a very important group of pathogens which is the great significance because these are the most common bacteria causing food poisoning. Being Iquitos in nature, staphylococci are usually present in raw milk and some strains may turn out to be exterotoxigonic S.aureus . The current investigation revealed significance variations in the staphylococcal counts of infant food. A total eight brands of infant milk food and three brands of weaning food samples were collected around from Meerut city in U.P. in the year 2009-10. The collected samples were analysed for staphylococcal counts and their characterization. Staphylococci were recovered from almost all brands of infant foods. Among positive samples, approximately, 3.28 per cent contained more than 5000 staphylococci per gram, while, 11.47 per cent had a count between 501 and 5000 and further observed that 26.23 per cent were considered to be of good quality as they contained less than 10 staphylococci per gram of samples. During the present study, 142 isolates of staphylococci were recovered from infant food samples. All these isolates produced catalase and fermented glucose anaerobically based on additional characters of production of coagulase, phosphatase and anaerobic fermentation of mannitol, 53 strains were identified as S.aureus . Therefore, there is a likelihood of incidence of these organisims in the finished products. The chance contamination during processing cannot also be ignored, because these are the most common bacteria causing food poisoning.

Proper preservation of microbial activity over long periods poses a considerable challenge for pollutant biopurification. A composite microbial agent, mainly composed of bacteria and fungi isolated by the current research team, was constructed in this study and its performance in the removal of mixed waste gases (containing α-pinene, n-butyl acetate and o-xylene) was investigated. According to the removal efficiency in the first 24h and the response to starvation, the optimal ratio of selected carriers (activated carbon, wheat bran and sawdust) was found to be 1:2:1. In some cases of storages, the removal capability of the microbial agent was more than twice that of the suspension. Microbial analysis showed that the inoculated bacterial and fungal strains dominated the agent preparation and utilization. These results indicated that the agent has potential for use in biopurification of mixed waste gas, favoring the reduction of environmental passives and longer retention of microbial activity.

espanolLa fascitis necrotizante es una patologia infrecuene y grave, definida por la rapida progresion de un proceso inflamatorio y de necrosis tisular que incluye normalmente piel, tejido subcutaneo y fascia. Suele ser de etiologia polimicrobiana, aunque se han descrito casos derivados de un unico agente microbiano, siendo las formas mas frecuentes la E. Coli o Pseudomonas spp. La naturaleza de esta enfermedad es muy agresiva, por lo que el diagnostico precoz y la inmediata intervencion terapeutica son de vital importancia, y la cirugia, el principal pilar terapeutico. El pronostico varia en funcion del momento del diagnostico y del tratamiento. Presenta tasas elevadas de morbimortalidad, llegando, incluso, al 76% en algunas series. EnglishNecrotizing Fasciitis is an uncommon and serious disease, defined by the rapid progression of an inflammatory process and tissue necrosis which usually includes skin, subcutaneous tissue and fascia. Usually polymicrobial etiology, although cases arising from a unique microbial agent, have been described being the most frequent forms the E. Coli or Pseudomonas spp. The nature of this disease is very aggressive, by which early diagnosis and immediate therapeutic intervention are of vital importance, being the main surgery the most important therapeutic. The prognosis varies depending on the time of diagnosis and treatment, showing high rates of morbidity and mortality, even reaching, 76% in some series.

Background: Microbial keratitis in children can cause visual loss and amblyopia. In this study, epidemiological features of microbial keratitis in children was examined at a tertiary care center in Iran. Methods: Sixty-three cases of microbial keratitis under the age of 15 admitted at Khalili hospital, Shiraz, Iran, during five years, were reviewed. Patients’ age, gender, residential area, ulcer size, causative organism, surgical, and medical treatment were investigated. Results: Mean age of patients was 5.2 ± 4.8 years and 68.2% were under five years old. The prevalence of microbial keratitis was significantly higher in males than females (P = 0.003), especially in children coming from rural areas. Ulcers larger than 5 mm were observed more than smaller ones (P ≤ 0.0001) in hospitalized children. Ocular trauma was the most common risk factor (present in 56.9%), while in 22.4%, no risk factor was detected. The most causative microbial agent was Staphylococcus (42.8%). Fungus was detected in two cases and herpes simplex was suspected in eight cases. In 54% recovery was observed with medical therapy; mainly by combination of cefazolin-gentamicin and ceftazidime-vancomycin drops. Penetrating keratoplasty was needed in 16.9% and conjunctival flap in 14.7% of recalcitrant cases. Overall recovery from microbial keratitis was observed in 72% of cases, who showed complete healing of ulcer or significant decrease in size at the time of discharge from the hospital. Conclusions: Pediatric microbial keratitis was more common under the age of five years old and trauma was the main predisposing factor. Staphylococcus was the main causative microorganism and recovery was observed with topical treatment in the majority of cases. Trauma prevention and timely treatment is recommended.

Septic arthritis has to be suspected in children with joint effusion and fever so as to perform joint aspiration, which will confirm the diagnosis by bacteriological methods, and to perform surgical treatment by joint lavage. Since development of current molecular methods, such as real-time PCR, Kingella kingae has become the first microbial agent of osteoarticular infections in young children, whereas Staphylococcus aureus is second. C-reactive protein (CRP) is an aid used to diagnose septic arthritis, but its elevation could be moderate. In a previous study, conducted at our hospital, 10% of children hospitalized for S. aureus or K. kingae septic arthritis had a CRP level 10 mg/L during septic arthritis in children, it could be negative in up to 20% of patients in different studies. However, a mild inflammatory syndrome or even a CRP

PURPOSE To report an unusual case of postcataract endophthalmitis secondary to Bosea thiooxidans. METHODS Case report. RESULTS An 86-year-old man presented with postoperative endophthalmitis 3 weeks after uncomplicated cataract surgery. He complained of a headache and blurry vision but denied having eye pain. Slit-lamp examination demonstrated leukocytes with a fibrinous membrane in the anterior segment and vitritis. A diagnosis of acute postoperative endophthalmitis was made, and the patient was treated with intravitreal antibiotics. Culture of vitreous tap revealed Bosea thiooxidans, a gram-negative rod found in soil and water systems. CONCLUSION To our knowledge, this report is the first to describe Bosea thiooxidans endophthalmitis and one of a few reports of human infection with this microbial agent.

Objectives: This study aimed to assess clinical, microbial changes in IUD users and other contraceptive methods in referent to urban health centers in Hamadan city, Iran. Methods: Detailed history and gynecological examination were conducted on women (IUD users, n = 100) or other contraceptive methods (controls, n = 160) in the health centers. Results: Frequencies of the different vaginal pathogens, high indices of infection by bacterial vaginosis (12.0%) candida albicance (7.0%) and low indices of trichomoniasis (5.0%) were found in present study, but none of them in both groups was significant. Menorrhagia was more frequent among women with IUD than that among women without IUD (P < 0.05). A trend of erosion cervix and dysmenorrhea being more frequent among women with IUD was also found (P < 0.05). Conclusions: IUD is the safety in general; however, an increase occurred in the frequency of vaginitis.

In vivo experiments were carried out to investigate the effect of microbial agents on tomato disease occurrences in a sustainable tomato farm in Gong-ju, Chung-nam during 2 years (2010-2011). Two kind of commercial microbial agents (EXTN-1 and Cillus suspension concentrate) and 2 kind of microbial agents (Bacillus subtilis strain 'B4' and 'B17') developing by National academy of agricultural science were used in this study. In the 1st experimental year, the microbial agents were sprayed on leaves for 2-4 times at 1-2 weeks interval from 3 weeks after transplanting, and then disease occurrence were observed. As a result, the control efficacies of commercial EXTN-1 and Cillus suspension concentrate (SC) against gray mold were 59.6% and 50.5% in the treatment of 4 times foliar application at 1 week interval from 3 weeks after transplanting, and the control efficacy of commercial EXTN-1 SC against gray mold was 55.4% in the treatment of 3 times foliar application at 1 week interval from 4 weeks after transplanting. However, the control efficacies of EXTN-1 and Cillus SC were not enough for tomato crop protection against powdery mildew. In the 2nd experimental year, the microbial agents were treated following by the planned combination schedule of transplanting stage drip-watering, early stage root irrigation and early blooming stage foliar application. The control efficacies of EXTN-1 SC and B17 treatment following by transplanting stage drip-watering, 2 times root irrigation at 2 weeks interval root irrigation and 4 times foliar application at 1 weeks interval for gray mold management were 57.0 and 55.1%, respectively. In the case of same treatment for gray mold management mentioned at above, the control efficacies of EXTN-1 SC, B4 and B17 treatment for powdery mildew management were 50.5, 51.3 and 52.5%, respectively.

UNLABELLED Early-life exposure to microbial agents may play a protective role in asthma and allergies development. Geographical differences in the prevalence of these diseases exist, but the differences in early-life indoor microbial agent levels and their determinants have been hardly studied. We aimed to describe the early-life levels of endotoxin, extracellular polysaccharides (EPS), and β(1-3)-glucans in living room dust of four geographically spread European birth cohorts (LISA in Germany, PIAMA in the Netherlands, INMA in Spain, and LUKAS2 in Finland) and to assess their determinants. A total of 1572 dust samples from living rooms of participants were analyzed for endotoxin, Penicillium/Aspergillus EPS, and β(1-3)-glucans. Information on potential determinants was obtained through questionnaires. Concentrations of endotoxin, EPS, and β(1-3)-glucans were different across cohorts. Concentrations of endotoxin and EPS were respectively lower and higher in INMA than in other cohorts, while glucans were higher in LUKAS2. Season of sampling, dog ownership, dampness, and the number of people living at home were significantly associated with concentrations of at least one microbial agent, with heterogeneity of effect estimates of the determinants across cohorts. In conclusion, both early-life microbial exposure levels and exposure determinants differ across cohorts derived from diverse European countries. PRACTICAL IMPLICATIONS This study adds evidence of variability in the levels of indoor endotoxin, extracellular polysaccharide, and β(1-3)-glucans across four geographically spread European regions. Furthermore, we observed heterogeneity across regions in the effect of exposure determinants. We hypothesize that the variations observed in our study may play a role in the differences in asthma and allergies prevalences across countries.

Brain abscesses are uncommon in neonates. Klebsiella pneumoniae is a very uncommon microbial agent to cause brain abscess. We report 2 infants with Klebsiella pneumoniae sepsis who developed brain abscesses. One infant was a premature neonate who required mechanical ventilation for respiratory distress syndrome and subsequently developed nosocomial sepsis and brain abscess without evidence of preceding meningitis. Another infant was a full-term neonate without risk factors for sepsis who developed seizures on the sixth postnatal day and was found to have meningitis and brain abscess. Both infants had Klebsiella pneumoniae septicemia with multiple relatively large brain abscesses that responded poorly to antimicrobial agents. These infants were managed with transfontanel drainage and prolonged courses of antimicrobial agents. Key message of this report is that Klebsiella pneumoniae brain abscess may occur in the absence of meningitis and even in the absence of any identifiable risk factors.

In order to elucidate the significance and related mechanisms of microbial agents in modulating the growth of broilers, one-day-old Avian broilers were employed to investigate the effect of microbial agents on body weight, daily gain and feed efficiency at various stages. The birds in the experimental groups were given salmonella pullorum then fed with antibiotics to counteract it. The results showed that the average broiler weight of the oral microbial agent group at the age of 40 days was significantly increased by 16.58% from 1520 g to 1772 g (P < 0.05). The feed conversion efficiency was decreased from 2.21 to 1.82 (P < 0.01). In the experimental group fed with microbial agents, microscopic observation revealed that the intestinal villi increased in number, length and orderliness. The intestinal wall became thickened. The glands in the intestine were developed, which would be beneficial to nutrient absorption. The effect of oral microbial agents was identical to that due to antibiotics. It was also observed that Lactobacillus dominated the cecal microorganisms in broilers.

BACKGROUND: Dampness and mould exposure have been repeatedly associated with respiratory health. However, less is known about the specific agents provoking or arresting health effects in adult populations. We aimed to assess predictors of microbial agents in mattress dust throughout Europe and to investigate associations between microbial exposures, home characteristics and respiratory health. METHODS: Seven different fungal and bacterial parameters were assessed in mattress dust from 956 adult ECRHS II participants in addition to interview based home characteristics. Associations between microbial parameters and the asthma score and lung function were examined using mixed negative binomial regression and linear mixed models, respectively. RESULTS: Indoor dampness and pet keeping were significant predictors for higher microbial agent concentrations in mattress dust. Current mould and condensation in the bedroom were significantly associated with lung function decline and current mould at home was positively associated with the asthma score. Higher concentrations of muramic acid were associated with higher mean ratios of the asthma score (aMR 1.37, 95%CI 1.17-1.61). There was no evidence for any association between fungal and bacterial components and lung function. CONCLUSION: Indoor dampness was associated with microbial levels in mattress dust which in turn was positively associated with asthma symptoms. This work was supported by the European Commission as part of HITEA (Health Effects of Indoor Pollutants: Integrating microbial, toxicological and epidemiological approaches), Grant agreement no. 211488 under the Seventh Framework Programme. The (1,3)-ß-D-glucan analysis was funded by the Spanish Health Institute Carlos III, project FIS PS09/02668.

Dust collection by study participants instead of fieldworkers would be a practical and cost-effective alternative in large-scale population studies estimating exposure to indoor allergens and microbial agents. We aimed to compare dust weights and biological agent levels in house dust samples taken by study participants with nylon socks, with those in samples taken by fieldworkers using the sampling nozzle of the Allergology Laboratory Copenhagen (ALK). In homes of 216 children, parents and fieldworkers collected house dust within the same year. Dust samples were analyzed for levels of allergens, endotoxin, (1-->3)-beta-D-glucans and fungal extracellular polysaccharides (EPS). Socks appeared to yield less dust from mattresses at relatively low dust amounts and more dust at high dust amounts than ALK samples. Correlations between the methods ranged from 0.47-0.64 for microbial agents and 0.64-0.87 for mite and pet allergens. Cat allergen levels were two-fold lower and endotoxin levels three-fold higher in socks than in ALK samples. Levels of allergens and microbial agents in sock samples taken by study participants are moderately to highly correlated to levels in ALK samples taken by fieldworkers. Absolute levels may differ, probably because of differences in the method rather than in the person who performed the sampling. Practical Implications Dust collection by participants is a reliable and practical option for allergen and microbial agent exposure assessment. Absolute levels of biological agents are not (always) comparable between studies using different dust collection methods, even when expressed per gram dust, because of potential differences in particle-size constitution of the collected dust.

BACKGROUND Growing up on a farm and an anthroposophic lifestyle are associated with a lower prevalence of allergic diseases in childhood. This might be related to increased inhalatory exposure to microbial agents. OBJECTIVE To assess the association between microbial agents in house dust and atopic wheeze in farm children, Steiner school children and reference children. METHODS Levels of bacterial endotoxin, fungal beta(1,3)-glucans and fungal extracellular polysaccharides (EPS) in mattress and living room floor dust were measured in a population of 270 atopic (=Phadiatop-positive) children with self-reported wheezing, including 168 current atopic wheezers, and 441 non-atopic, non-symptomatic controls. These children were selected from a cross-sectional study in five European countries. RESULTS In the study population as a whole, average levels of mattress dust endotoxin, EPS and glucans were slightly (1.1-1.2-fold; P

BACKGROUND: House dust samples collected for exposure studies are often stored for variable time periods until analysis. However, there is currently no information on the effects of dust storage on the content of biocontaminants. Therefore, associations were analysed between the levels of mite allergens (Der p 1, Der f 1), cat allergen (Fel d 1) and microbial components (endotoxin, beta(1-->3)-glucan) on the one hand and the storage duration of dust samples at -20 degrees C on the other hand. METHODS: Within the framework of a study on the influences of INdoor factors and Genetics on Asthma (INGA), dust samples were collected from living room floors between June 1995 and August 1998 and extracted according to a standardized protocol. The concentrations of Der p 1, Der f 1, Fel d 1 and beta(1-->3)-glucan were determined with specific enzyme immunoassays. Endotoxin content was quantified using a chromogenic kinetic Limulus amoebocyte lysate (LAL) test. All concentrations were expressed per gram of dust RESULTS: Dust samples (n = 1236) were obtained from 655 homes in Hamburg, Hettstedt, Zerbst and Bitterfeld. Storage duration (range 8-298 days) was grouped into four categories ( 120 d). After adjustment for city of residence and season of dust sampling, means ratios comparing categories 2-4 to the first category were not statistically significant for Der p 1, Der f 1, endotoxin and beta(1-->3 glucan). However, Fel d 1 concentrations significantly declined with increased storage times of dust samples. CONCLUSIONS: Storage of house dust at -20 degrees C for up to 10 months has no effect on mite allergen, endotoxin and beta(1-->3)-glucan levels. A potential loss of Fel d 1 during storage of frozen dust samples needs further investigations by repeated measurements of allergen in identical dust samples. &nbsp

Molecular mimicry has been proposed as a pathogenetic mechanism for autoimmune disease, as well as a probe useful in uncovering its etiologic agents. The hypothesis is based in part on the abundant epidemiological, clinical, and experimental evidence of an association of infectious agents with autoimmune disease and observed cross‐reactivity of immune reagents with host ‘self’ antigens and microbial determinants. For our purpose, molecular mimicry is defined as similar structures shared by molecules from dissimilar genes or by their protein products. Either the molecules' linear amino acid sequences or their conformational fits may be shared, even though their origins are as separate as, for example, a virus and a normal host–self determinant. An immune response against the determinant shared by the host and virus can evoke a tissue‐specific immune response that is presumably capable of eliciting cell and tissue destruction. The probable mechanism is generation of cytotoxic cross‐reactive effector lymphocytes or antibodies that recognize specific determinants on target cells. The induction of cross‐reactivity does not require a replicating agent, and immune‐mediated injury can occur after the immunogen has been removed—a hit‐and‐run event. Hence, the viral or microbial infection that initiates the autoimmune phenomenon may not be present by the time overt disease develops. By a complementary mechanism, the microbe can induce cellular injury and release self antigens, which generate immune responses that cross‐react with additional but genetically distinct self antigens. In both scenarios, analysis of the T cells or antibodies specifically engaged in the autoimmune response and disease provides a fingerprint for uncovering the initiating infectious agent.—Oldstone, M. B. A. Molecular mimicry and immune‐mediated diseases. FASEB J. 12, 1255–1265 (1998)

Introduction: The recording of microbial agent upon patients admission in the Intensive Care Unit (ICU) can be useful for the prevention and reduction of dispersion, forecasting new colonization or infection respectively bacteria and guide empirical antimicrobial therapy. Aim: The aim of the present study was to investigate the factors associated with microbial colonization of patients admitting to ICU. Material and Method: The studied sample consisted of 72 patients admitted to the ICU in a period of seven months. During patient admission in the ICU, rectal swab and secretions were received, samples were cultivated and an epidemiological registration form was completed. Results: Bronchial colonization was more frequent in patients with pressure ulcers of previous hospitalization (33.3%). These patients were in mechanical ventilation for longer, and they had central venous catheter and catheter bladder for longer compared to patients who were not colonized. Rectal colonization was more frequent in patients with chronic breakdown (p=0.001). These patients had catheter bladder for longer (6.8 days) compared to patients who were not colonized (p=0.049). Conclusion: In both types of colonization samples tested, the rate of positive performance was significant. Only few well-known factors that prognosticate positive admittance carriers were found to be statistically significant in this analysis. We presume that continuing and improving the recording and analysis process will lead to the identification of more and stronger correlations.

"The forgotten organ", the human microbiome, comprises a community of microorganisms that colonizes various sites of the human body. Through coevolution of bacteria, archaea and fungi with the human host over thousands of years, a complex host-microbiome relationship emerged in which many functions, including metabolism and immune responses, became codependent. This coupling becomes evident when disruption in the microbiome composition, termed dysbiosis, is mirrored by the development of pathologies in the host. Among the most serious consequences of dysbiosis, is the development of cancer. As many as 20% of total cancers worldwide are caused by a microbial agent. To date, a vast majority of microbiome-cancer studies focus solely on the microbiome of the large intestine and the development of gastrointestinal cancers. Here, we will review the available evidence implicating microbiome involvement in the development and progression of non-gastrointestinal cancers, while distinguishing between viral and bacterial drivers of cancer, as well as "local" and "systemic", "cancer-stimulating" and "cancer-suppressing" effects of the microbiome. Developing a system-wide approach to cancer-microbiome studies will be crucial in understanding how microbiome influences carcinogenesis, and may enable to employ microbiome-targeting approaches as part of cancer treatment.

The present review aims to provide insight into the complex interactions between the host and Pseudomonas aeruginosa-an opportunistic microbial agent causing skin infections. Heat, humidity and skin pH are among the factors beneficial for the development of this Gram-negative agent. To cause infection, Pseudomonas aeruginosa should first overcome the primary mechanisms of defense including the cell elements and humoral factors of the skin, as well as non-specific responses-phagocytosis, inflammation, acute phase response. All they are analysed with emphasis on the fact that their detailed understanding would help revealing their potential and allow for their efficient control. The microorganism, being more alterable and more flexible than the host, uses stealth strategies and modes of life. The review goes over the arsenal of virulence factors, used by Pseudomonas aeruginosa to attack the host defense mechanisms. The bacterial pathogenic strategies for invasion, resulting in collapse of skin defense are analysed. Several novel therapeutic approached to Pseudomonas aeruginosa skin infections are briefly reviewed.

Almost 200 species fungus are associated with human infections have been described. The musculoskeletal involvement can develop by direct extension of a lesion or by inoculation and hematogenous spread. The joint infection has an indolent course and diagnosis tends to be delayed because of the paucity of clinical signs and the rarity of the pathology. Despite the small number of fungal species involved, the incidence of diseases they can provoke has increased over the last 40 years particularly in hospital environments which has resulted in individuals having their immunologic system compromised. There is no special prevalence for gender or age. A review of the joint involvement in such conditions is described on this chapter.

Acute otitis media (AOM) is closely associated with viral upper respiratory tract infections, but the most common microbial agent found in the middle ear fluid during AOM is Streptococcus pneumoniae (Pnc). Pnc is also a common colonizer of the nasopharynx, and its prevalence is further increased during the viral infection. The aim of this study was to investigate the interplay between viral infection, pneumococcal acquisition and carriage in the development of Pnc AOM.Pnc carriage was assessed in a longitudinal study of 329 infants at scheduled visits at 3, 6, 9, 12, 15 and 18 months of age (N = 1715). The clinical outcome of the first episode of respiratory infection ("sick visit," N = 774) in the following 3-month period was recorded. The occurrence and timing of Pnc AOM in relation to serotype specific carriage at the start of the observation period were assessed.The occurrence, timing and duration of symptoms of the sick visits or the frequency of overall AOM were not associated with preceding pneumococcal carriage. Pnc AOM was in each case associated with concurrent carriage and 3.8 times (95% confidence interval, 1.4-10.0) more often with carriage acquired after the start of the observation period than with carriage already present at the scheduled visit. In all, 79% (55 of 70) of Pnc AOM events were caused by a serotype acquired after the start of the period.The majority of Pnc AOM events develop in association with newly acquired carriage of pneumococcus.

Purpose: To determine the number of multiple alternating layers of liver abscess, and changes in this number,as revealed by spiral CT, and to ascertain which factors are related to changes occurring during the three phas-es of this modality.Materials and Methods: Using three-phase spiral CT imaging we studied 26 cases of liver abscess (pyogenic:amebicm=23:3). The number of layers comprising the abscess, as seen on postcontrast CT scans, was deter-mined during the arterial (30sec), portal (70sec), and delayed (220sec) phase, and all cases were assigned to one of two groups according to changes in the number of layers observed during the three phases. With regard to underlying disease, the two groups were compared in terms of the presence of abscess and of diabetes melli-tus,CT interval (time from onset of symptoms to CT scanning), microbial agent (pyogenic vs. amebic), and the largest diameter of abscess as revealed by CT.Results: Except in one case, three or four alternating layers [in 13(50%) and 7(27%) cases, respectively] were seen only during the arterial and portal phase. During each of the three phases-and especially the delayed phase, where it was present in 25 of cases (96%)-two alternating layers (2:2:2) was the most common pattern,with a 3:3:3 pattern occurring in one case. All 12 cases (46%) in the unchanging-layer group showed one of these two patterns. All changing-layer group cases (14;54%) demonstrated three or four layers during the arter-ial and portal phase but only two during the delayed phase. The CT interval was the only significantly differ-ent factor between the two groups. During the first week, the number of cases in the unchanging-layer group was much higher than in the changing-layer group (86%,14%), but during the second week this situation re-versed (25%, 75%).Conclusion: Our study reveals that on three-phase dynamic CT images, a characteristic enhancement feature of liver abscesses is three or four layers during the arterial and portal phases, with reduction to two layers dur-ing the delayed phase. This change, as revealed by spiral CT, is rare during the week following the onset of symptoms, but common during the second week.

“Much of the data cited is derived from Proficiency Surveys of the College of American Pathologists. The opinions and conclusions expressed are those of the authors and not of The College of American Pathologists. Such determinants include the immunologic and nutritional status of the host; the site of infection; the etiologic microbial agent; the susceptibility of the offending microbe to antimicrobial agents; the pharmacokinetics of the drug(s) being considered together with recognized adverse and beneficial interactions between host and infectious agent, host and antimicrobial, infectious agent and antimicrobial. The in vitro antimicrobial susceptibility test aids in the determination of only one of these factors, and when considered in isolation from the other determi

The clinical course of 59 patients with acute nongonococcai septic arthritis has been reviewed with special emphasis on the changing bacterial spectrum in recent years. The results of treatment were dependent on various factors, including the specific microbial agent and host defenses. Treatment should include parenteral antibiotics and drainage with needle aspfratton, except in hips which should be surgically drained. Successful therapy requires rapid initiation of treatment and ongoing assessment of adequacy of response.

Although the etiology of rheumatoid arthritis remains unknown, recent evidence seems to suggest that pathogenetic mechanisms are multifactorial. Genetic predisposition, perhaps mediated by the HLA system, may render an individual susceptible to the action of an undefined microbial agent, most likely a virus, resulting in the triggering of an inflammatory reaction that, if unchecked, will lead to the development of synovitis and eventually to tissue destruction. It is quite possible that similar pathogenetic events play a role in some of the extra-articular manifestations of the disease, including Felty’s and Sjogren’s syndromes, and vasculitis. Further understanding of the mechanisms involved in the disease process may result in new therapeutic approaches.

The periodontal syndrome in rice rats was produced as a result of oral inoculations with a pooled culture containing four micro-organisms isolated from the oral cavities in rice rats with rapidly developing, advanced periodontal lesions. Inoculations with the single micro-organisms from this mixture did not result in conclusive identification of the aetiologic agent although a gram-positive, thick, spore-forming rod may have been responsible. Penicillin pre-treatment among rice rats from the syndrome-inactive strain did not result in oral circumstances whereby the periodontal syndrome-producing agent or agents could establish themselves more readily than without a preliminary period of penicillin administration. Oral inoculations of white rats with faecal paste or microbial cultures from rice rats did not result in a demonstrable periodontal syndrome.

Objective: To investigate the effectiveness of ciprofloxacin in the treatment of chronic bacterial prostatitis due to various microorganisms. Methods: Patients with chronic prostatitis symptoms were evaluated by culture of their expressed prostatic secretion and fractionated urine samples according to the four-glass localization test of Meares and Stamey. Patients with an isolated microbial agent were treated with ciprofloxacin 500 mg twice a day for 4 weeks and re-evaluated 1 week and 6 months after the treatment. Results: Sixteen of the 68 (23.5%) evaluated patients were diagnosed as having chronic prostatitis with an isolated microbial agent. Ureaplasma urealyticum was the most common microorganism related to chronic prostatitis. Eradication of the previously isolated microbial agent was found in 11 of the 16 patients at the first-week evaluation. At the 6-month control evaluation no growth was observed on the cultures of seven of the 16 (43.8%) patients, which was accepted as successful treatment. Conclusions: U. urealyticum can be the responsible agent in some chronic prostatitis patients. Ciprofloxacin may be a treatment option in chronic prostatitis.

Three spontaneous prostate adenocarcinomas from aged, randombred, germfree Lobund Wistar rats were transplanted, without change, through several series of conventional Lobund Wistar rats. One tumor type differed histologically from the other two tumor types. Rats with subcutaneously transplanted tumors developed metastatic tumors in the lymph nodes and lungs. No microbial agent was detected in the tumor cells.

Nosocomial infections comprise a variety of diseases that have all of the characteristics and problems traditionally associated with the epidemiology of chronic diseases. Each infection is multifactorial in origin, and most of these factors remain either unknown or unquantified. The microbial agent is not the sole determinant of outcome. Time is also an important variable, especially with regard to variation in incubation (latent) period for different infections, and variation in duration of hospitalization (exposure and follow-up). Methods used for the study of chronic diseases may be employed in evaluating some aspects of nosocomial infection. When time is considered as a variable, it is possible to use a common, interconvertible set of definitions of rates that includes measures of both prevalence and incidence of infection. Accuracy in estimation also may be improved by further consideration of the choice of subjects (validity of selection), experimenter effects, misclassification (validity of information), and confounding (validity of comparison).

The diagnosis of the chronic tonsillitis is mostly based on the clinical picture available. The true pathophysiological process can not be assessed by clinical work-out only. The throat swab taken from tonsil also fails to give true alma matter in the tonsil. In this work, we have established the role of hitherto unsuspected anaerobic organisms in the etiology of chronic recurrent tonsillitis, and thus suggested a trial of anti-anaerobic microbial agent before resorting to the surgery.

Publisher Summary Antibodies could be labeled with enzymes for use in histochemical staining procedures by enzyme-immunoassay (EIA). The use of EIA is an extension of previously used serological tests, using enzyme-labeled antibody or antigen to determine antibody content. Direct detection of antigen by EIA represents a more dramatic departure from previous methods based on culture. Also, the method has enabled detection of infectious agents that are difficult to cultivate, such as hepatitis A virus and rotavirus, or agents that cannot be cultivated, such as hepatitis B. The use of EIA tests for detection of microbial antigens provides an alternative to culture as a means for direct identification of a specific microbial agent. It also provides a means to detect microbial agents which have not been successfully propagated. The detection of circulating antigen or detection of antigen in other body fluids by EIA is more difficult than detection of antibody because of the sensitivity required, and because of interfering substances in specimens such as feces and respiratory secretions. For this reason, very few antigen detection assays have the sensitivity and specificity required to be used as a primary diagnostic test. The number of tests that have been developed, however, is impressive and because of the possibilities for rapid, specific diagnosis, the interest in antigen detection by EIA remains high.

An infectious etiology of rheumatoid arthritis has been suspected for many years; however, there is little agreement as to the involved microorganisms. It is generally believed by many investigators that the initiating agent is probably a viral-like agent or mycoplasma. The parasitic nature of some mycoplasmas makes them logical suspects to cause a systemic chronic disease and yet remain undetected. While there is an accumulation of evidence to indicate mycoplasma involvement in the disease process, the failure to isolate a common microbial agent appears to be the greatest deterrent to establishing an antecedent.

House dust-associated bacterial endotoxins have been shown to be associated with asthma severity, and a similar role has been suggested for fungal (1-->3)-beta-D-glucans. In this study the relation between these agents and peak expiratory flow (PEF) variability was investigated in 148 children 7 to 11 yr of age of whom 50% had self- or parent-reported chronic respiratory symptoms. All children self-monitored twice daily their PEF for a period of 16 wk. Dust samples were collected from mattresses and from living room and bedroom floors, and endotoxin and (1-->3)-beta-D-glucan were measured in dust extracts. The relations with mean daily PEF variability (Ampl%mean) were investigated by linear regression analysis, adjusting for dust mite allergen levels, presence of pets, and type of floor cover. In unadjusted analyses the levels of both endotoxin and (1--> 3)-beta-D-glucan per square meter of living room floor were significantly associated with PEF-variability (but not when expressed per gram of sampled dust), particularly in atopic children with asthma symptoms. Adjusted analyses showed the same association for (1--> 3)-beta-D-glucan but not for endotoxin. Although no associations were found with microbial agent levels in bedroom floor or mattress dust, high levels of (1-->3)-beta-D-glucan in living room floor dust apparently increase PEF variability in asthmatic children.