Search

A toxin produced by Clostridium difficile has been implicated in the pathogenesis of antibiotic-associated colitis. It is not known how often the microorganism is encountered in Germany particularly in high risk patients. Therefore, following a lethal case of colitis, stool samples of 90 patients and 30 staff members of an intensive care unit were screened routinely for C. difficile over 2 months. The organism was found in 6 of 41 patients treated with antibiotics (14.6%); four of them apparently acquired C. difficile while in hospital whereas in 2 a pre-existing carrier state could not be excluded. Colitis developed in 3 of the 6 patients as judged from endoscopy or a positive cytotoxin assay; in 2 patients (not subjected to endoscopy) colitis was suspected on clinical grounds, and 1 patient became an asymptomatic carrier. C. difficile was not found in 49 patients without antibiotic medication, in the health personal and in 12 patients of a general ward. Patients harbouring C. difficile were clustered in certain bed sites of the unit. Environmental studies recovered the microorganism from bed pan washing machines of bedridden and from toilets of ambulant patients but not from other sites like the hands of the personal. These results suggest that chronic carriers of C. difficile, as far as they are identified by current bacteriological methods, are rare in Germany (not more than 2 out of 132 persons investigated, i.e. 1.5%). The frequent finding of C. difficile in patients treated in certain bed sites supports the view that the infection may be acquired from exogenous sources. Antibiotic-associated colitis should be considered more often when intensive care patients are treated with antibiotics.

A case of Kingella kingae septicemia following acute gastroenteritis is described. Intravenous antibiotic treatment with mezlocillin and tobramycin led to rapid and sustained recovery. The infection with Kingella kingae may have been food-borne.

The protein composition of the outer membranes of eight serogroups of Legionella pneumophila has been determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Outer membranes were prepared by detergent extraction using sodium lauryl sarcosinate or by isopycnic sucrose gradient centrifugation. With both techniques one major outer membrane protein of about 29,000 daltons was found to be characteristic for the species L. pneumophila. It was the predominating feature in all 22 strains of L. pneumophila studied, regardless of serogroup. SDS-PAGE patterns of non inactivated L. pneumophila strains were compared with those following formaldehyde-, heat- or ether inactivation. Formaldehyde inactivation gave the fewest protein bands while the outer membrane protein profiles of non inactivated as well as of heat- or ether-inactivated strains revealed some additional minor components. With the exception of a 46,000 dalton band that showed, in some strains, an altered electrophoretic mobility of ca. 48,000 dalton, all strains and serogroups of L. pneumophila presented with the same outer membrane protein pattern. Analysis of outer membrane protein profiles by SDS-PAGE should therefore be a valuable tool for the identification of L. pneumophila. Comparing total membrane preparations the 29,000 dalton component was also the predominant feature, an appreciable number of additional bands, however, allow a clear discrimination between different strains. The protein profiles of outer and total membranes of L. pneumophila as determined by SDS-PAGE therefore may be used for taxonomical and epidemiological studies.

Fungicidal activities of pentachloronitrobenzene and derivatives were tested with Candida albicans, Aspergillus fumigatus, Trichophyton rubrum, Trichophyton mentagrophytes, and Microsporon canis. In relation to pentachloronitrobenzene, no increasing fungistatic activities were found with cysteine derivatives. Rising fungistatic activities were seen with pentachlorophenylmethylsulfone and, in some of the strains, with pentachloronitrosobenzene, pentachlorothiophenol, pentachlorophenol, pentachloroaniline, pentachlorophenylmethylsulfoxide, the isomeric tetrachloronitrobenzenes, tetrachlorothiophenols, tetrachlorophenols, and tetrachloroanilines.

The applicability of whole-cell protein patterns obtained by sodium dodecylsulfate-polyacrylamide gel electrophoresis as a typing method for Clostridium difficile was examined using a total of 227 strains isolated from 191 patients and their surroundings. Computer-aided densitometric analysis was used to establish a reliable standardization technique with which a large number of protein patterns could be efficiently classified. The normalized tracks could be electronically superimposed and compared to give reproducible results. The influence of sample preparation for electrophoresis was found to be negligible. By this technique 35 subgroups could be differentiated, and further discrimination was possible within each subgroup using minor, even very weak protein bands. Epidemiologically related strains of Clostridium difficile yielded absolutely identical patterns, allowing unequivocal identification. Thus protein electrophoresis combined with densitometric analysis was shown to be useful for typing Clostridium difficile isolates.

More and more beta-lactamase-producing, penicillin-resistant strains of Neisseria gonorrhoeae are nowadays isolated in most parts of the world including the European continent. Therefore, there is a need for reliable alternatives in the treatment of gonorrhoea. Cefotaxime--first representative of a new generation of beta-lactamase-resistant cephalosporins--was evaluated for this reason, first in vitro and then in vivo. All 191 strains tested proved susceptible, the highest MIC amounting to 0.03 microgram/ml, a drug concentration well exceeded in plasma for more than 4 h after i.m. application of 0.5 g cefotaxime. In contrast to other investigators we have therefore decided to test this relatively small dose clinically without the addition of probenecid. The clinical results were excellent: 146 of 151 patients (96.7%) were cured. In the female sub-group (34 patients) the cure rate amounted to 100%. Thus, the i.m. injection of 0.5 g cefotaxime as a single dose must be looked upon as a reliable regimen for the cure of uncomplicated gonorrhoea, both in males and females.

In a randomized clinical trial the prophylactic effects of locally administered antimicrobials on quantitative colonization and respiratory infections were studied in intubated patients with an expected period of mechanical ventilation of greater than 6 days. Nineteen patients received 50 mg of polymyxin B and 80 mg of gentamicin distributed among nose, oropharynx and stomach at 6-h intervals, as well as 300 mg of amphotericin B in the oropharynx. Twenty untreated patients served as controls. In the control group colonization by respiratory pathogens was more common (oropharynx 19 vs 6 patients (p less than 0.001); trachea 19 vs 11 (p less than 0.01)), and the number as well as the count of the colonizing species was usually higher. Fourteen patients of the control group developed respiratory infections, including nine cases of pneumonia, as compared to four patients with prophylaxis, including one case of pneumonia (p less than 0.01). Pneumonia-associated deaths were prevented with prophylaxis; however, the overall mortality remained unchanged. Respiratory infections in the prophylaxis group were associated with organisms resistant to the agents used, but the overall occurrence of resistance was not increased, as compared to the control group. We conclude that unrestrained upper airway colonization by respiratory pathogens and respiratory tract infection were causally related. Local antimicrobial prophylaxis proved to be a highly effective strategy for the prevention of potentially life-threatening pneumonias in critically ill patients, but in the present study the host setting appeared to be the major determinant of outcome.

Aztreonam was given orally to eight healthy volunteers in two different dosage regimens. To determine the concentration of aztreonam in faecal specimens a method was established using reversed-phase high pressure liquid chromatography (HPLC). Comparison of microbiological and HPLC assays showed a linear relationship between both techniques which, however, was not 1:1. The microbiological assay tended to yield higher aztreonam levels than the HPLC method. The HPLC assay for aztreonam proved to be five-fold less sensitive than the bioassay; however, since in most cases high aztreonam levels were found in the faeces of the test subjects, this was not a disadvantage. The HPLC assay was much easier to perform than the bioassay and yielded easily quantifiable results in a wider concentration range. In the stool specimens of one volunteer no aztreonam could be detected by either method, indicating inactivation and/or degradation of the compound.

The usefulness of plastic adhesive drapes for the prophylaxis of wound infections following to orthopedic operations was investigated in a prospectively randomized study including 123 patients. The drape was used in 68 cases, 55 patients were operated without drape. In order to carry out qualitative bacteriological examinations, smears were taken prior to, one and two hours after the beginning and after the end of the operations. Bacterial infestation in the operation area was found in 30 patients (54.5%) operated without drape and in 30 patients (44.1%) in whose operations the drape was employed. Most of the bacteria found were coagulase-negative staphylococci, in some cases corynebacteria and aerobic spore-forming organisms. There were no postoperative wound infections. No evidence of a significant difference was shown by a statistical evaluation of the results using the chi 2 test. The use of incision drapes for the prophylaxis of postoperative wound infections is therefore not necessary in orthopedic surgery.

The susceptibility of 408 strains of N. gonorrhoeae to spectinomycin was determined by an agar plate dilution test. The 401 beta-lactamase-negative and 7 beta-lactamase-positive strains were isolated from patients of the Department of Dermatology, University of Munich, in the years 1977 to 1980. The minimum inhibitory concentrations (MIC) ranged from 2 to 32 micrograms/ml. Only one strain was less susceptible with a MIC of 64 micrograms/ml. A comparison between the isolates of 1977/1978 and 1979/1980 showed no decrease in the susceptibility to spectinomycin.

In an open prospective study the efficacy and tolerance of imipenem/cilastatin was investigated in 24 critically ill patients on mechanical ventilation with nosocomial respiratory tract infection. Nine patients had previously received antibiotic therapy, eight of them with various other beta-lactam antibiotics which had failed. Imipenem was given in a dose of 1-3 g/24 h over 5-37 (mean 11) days. Seven patients were additionally treated with aminoglycosides, one patient with erythromycin. Pseudomonas aeruginosa (n = 14), Staphylococcus aureus (n = 4), Haemophilus influenzae (n = 4) and Escherichia coli (n = 3) were the potential pathogens most frequently isolated from tracheo-bronchial secretions. All of the isolates were susceptible to imipenem. 91% of the infections without and 77% with involvement of P. aeruginosa were successfully treated. Two patients who had not responded to previous treatment succumbed to the consequences of progressive respiratory distress syndrome. All of the gram-positive and 85% of the gram-negative pathogens (Pseudomonas not included) were eliminated in the course of therapy. By contrast, 64% of the isolates of P. aeruginosa persisted; half of these became imipenem-resistant. Nine patients showed adverse reactions including one case of pseudomembranous colitis or laboratory abnormalities which were all reversible. Imipenem/cilastatin proved highly effective and was relatively well tolerated; it is suitable as a single agent for the initial treatment of nosocomial respiratory tract infections in ventilated patients, although only with limitations in cases of infection due to P. aeruginosa.

In an open prospective study the efficacy and tolerance of imipenem/cilastatin was investigated in 24 critically ill patients on mechanical ventilation with nosocomial respiratory tract infection. Nine patients had previously received antibiotic therapy which had failed. Imipenem was given in a dose of 1-3g/24 h over 5-37 (mean 11) days. Seven patients were additionally treated with aminoglycosides, one patient with erythromycin. Pseudomonas aeruginosa, Staphylococcus aureus, Hemophilus influenzae and Escherichia coli were the most frequently isolated pathogens from tracheobronchial secretions. 91% of the infections without and 77% with involvement of Pseudomonas aeruginosa were successfully treated. All of the gram-positive and 85% of the gram-negative pathogens (Pseudomonas not included) were eliminated in the course of therapy. By contrast, 64% of the isolates of Pseudomonas aeruginosa persisted; half of these became imipenem-resistant. Nine patients showed adverse reactions including one case of pseudomembranous colitis which were reversible. Imipenem/cilastatin proved highly effective and was relatively well tolerated; limitations in the efficacy were seen in cases of infection due to Pseudomonas aeruginosa.

The in vitro activity of flomoxef (6315-S) was determined and compared to that of different cephalosporins against 787 clinical isolates of staphylococci, Enterobacteriaceae and anaerobes. Flomoxef is similar in activity to latamoxef and cefotaxime against Enterobacteriaceae, slightly more active than cephalothin and cefamandole against oxacillin-sensitive strains of Staphylococcus aureus and minimally less active than cefamandole against oxacillin-resistant strains. Flomoxef showed similar or better activity than latamoxef and cefoxitin against most of the anaerobic species of medical importance.

47 strains of L. pneumophila, 9 reference strains of eight serogroups, 15 clinical isolates and 23 water-derived strains from different cities were analysed with respect to three chemical constituents of the cell envelope: outer- membrane proteins (OMPs), ubiquinones and fatty acids. The OMPs were obtained by Sarkosyl-extraction of a total membrane preparation and analysed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). The ubiquinone content was quantitated by high-performance liquid chromatography (HPLC) and the fatty acid composition was established by gas-liquid chromatography coupled with mass spectrometry (GLC-MS). In all strains the OMP yielded the known characteristic pattern with the major component of 29 kilodalton. The ubiquinone content was very consistent within different strains revealing Q-12 with 65% as the predominant feature. Q-11 and Q-13 were present in amounts of 11% and 23%, respectively. Q-14 was found in trace amounts of about 0.65%. Only a very few ubiquinones with side chains shorter than 11 residues were present. GLC-MS allowed an unequivocal identification of each fatty acid. The branched chain fatty acid i-16:0 was the predominant feature with 33% followed by the unsaturated straight-chain acid 16:1. In this respect earlier reports by other authors were confirmed but minor compounds not detected so far could be revealed as 15:1, the doublet 18:1 and i-18:0, 19:1 and 20:1. OMP profiles are easy to establish and to interpret. They are well suited for identification of the species L. pneumophila. Ubiquinone analysis permits rapid but preliminary species identification, whereas fatty acid analysis by GLC-MS is an intricate technique providing a valuable chemical marker for L. pneumophila. The biochemical analyses presented here can supplement immunological studies, clarify immunological findings and help to identify new serogroups of L. pneumophila.

With 28 beta-lactam antibiotics the susceptibilities of 60 strains of Legionella spp. (49 Legionella pneumophila and 11 ATCC type strains of other Legionella species) were determined. Agar dilution testing was used on buffered charcoal-yeast extract agar to which 0.1% alpha-ketoglutarate was added. The most active of the penicillins tested were ampicillin (MIC = 0.06-8 mg/l) and temocilin (MIC = 0.125 - 16 mg/l); the most active cephalosporins were ceftazidime (MIC = 0.03 - 0.5 mg/l), HR 810 (MIC = 0.06 - 1 mg/l) and cefoxitin (MIC = 0.125 - 2 mg/l). Of all the drugs tested imipenem had the most pronounced activity (MIC = .0075 - 0.06 mg/l).

An absorptive, hormonal, bacteriological and morphological study was performed in 9 proctocolectomized patients with continent ileal reservoirs established for 2-57 months. Vitamin B 12 malassimilation (as assessed by the Schilling test and serum vitamin B 12 concentration), bile salt deconjugation (modified 14C-glycocholate breath test), increased stool fat excretion and high intestinal sodium loss with secondary hyperreninism/hyperaldosteronism were encountered in a large percentage of patients; proximal small intestinal absorption (serum parameters, xylose test) appeared intact. In reservoir stool samples total and differential bacterial cell counts yielded values close to a normal rectum flora. Morphologically (endoscopy, quantitative histology) the reservoir mucosa showed moderate to severe inflammation; structural changes were essentially absent and inflammation in the adjoining ileum was minimal. These results indicate that reservoir bacteria frequently produce disturbances in small intestinal function and that these may be found without secondary structural transformation of the mucosa.

In February 1979 a 51 year old man fell will in Munich, displaying symptoms of an influenza-like illness which developed into pneumonia. The patient died eight days later of circulatory collapse which failed to respond to treatment, accompanied by high temperature, leucopenia and agranulocytosis. Typical rods detected in the lung tissue and histological sections by immunofluorescence indicated the possibility of a Legionella pneumophila infection. The pathogen isolated from the lung tissue on CYE agar was identified as L. pneumophila, serogroup I. The diagnosis was confirmed by the CDC, Atlanta. This is the first time this organism has been isolated in Central Europe from a case with a fatal outcome.

The number of different Legionella species is increasing at an impressive rate. In two prospective studies, one involving 110 intensive-care unit (ICU) patients with mainly nosocomial pneumonias and the other 105 patients with community-acquired pneumonias, we investigated the incidence and significance of Legionella pneumophila and non-pneumophila pneumonias on the basis of 17 different main serogroups. In the first study, 14 ICU patients had 15 (13.6%) Legionella pneumonias, which, in 5 cases (33%), were of non-pneumophila etiology. In the second study, 9 patients with community-acquired pneumonias had 10 (9.5%) Legionella pneumonias. Leading this study were 6 L. gormanii infections, followed by 2 L. dumoffii and only 1 L. pneumophila and 1 L. longbeachae pneumonia. Of the total, 22 of 23 patients with Legionnaires' disease suffered from severe basic diseases and complications (acute renal failure, respiratory insufficiency, etc.) predominant among the nosocomial pneumonias. The mortality rate was significant in these patients at 33% (5 patients) in the ICU group and 10% (1 patient) in the group with community-acquired pneumonias. We conclude that non-pneumophila Legionella species should receive more diagnostic and therapeutic consideration in patients with nosocomial or community-acquired pneumonias.

In Munich 169 isolates of Neisseria gonorrhoeae were investigated with respect to nutritional profiles (auxotypes) and antibiotic susceptibility. Of the 165 penicillin-susceptible strains 97 proved to be prototrophic (auxotype 1), 42 proline-dependent (auxotype 2). Only 3 arginine-, hypoxanthine- and uracil-dependent strains (auxotype 14) were found. A total of 10 different auxotypes were identified among the non-penicillinase-producing strains and one among the penicillinase producers. The minimal inhibitory concentrations of penicillin G ranged from 0.01 to 1 microgram/ml, those of cefuroxime from 0.001 to 4 mg/ml; tetracycline and kanamycin had a narrow spectrum of effective concentrations, from 0.25 to 8 micrograms/ml and from 4 to 64 micrograms/ml respectively. The type 14 strains showed the well-known high susceptibility to penicillin G.

The antibacterial activity of pentachlorophenol and 35 of its known or possible metabolites against 30 different species of bacteria was tested. In comparison with pentachlorophenol, no increase of inhibitory activity was found for any of the chlorinated anisoles tested (except for pentachloroanisole against Streptomyces spp.), 2-chlorophenol, 2,6-dichlorophenol, 2,3,6- and 2,4,6-trichlorophenol, 2,3,5,6-tetrachlorophenol, tetrachloro-1,4- and -1,3-benzenediol (except for the 1,3-isomer against Streptomyces spp.), tetrachloro-1,3-dimethoxybenzene, and tetrachloro-1,3-benzenediol diacetate. Two chlorophenols, five dichlorophenols, four trichlorophenols, two tetrachlorophenols, and tetrachloro-1,2-benzenediol were more active than pentachlorophenol against some, but not all, of the strains tested.

The effects of conventional food and of formula diet on gut microflora were tested in six healthy persons. In comparison with conventional food, the total gut microflora concentrations slightly increased during formula diet with oligosaccharides. During the periods of formula diet rich in sucrose of maltose, total flora concentrations declined. These changes of total gut microflora were especially caused by the increase and decrease of the enterococci and enterobacteria, the bacteroides showing rather small changes. The concentrations of lactobacteria, sporeforming bacilli and yeasts decreased rapidly with formula diet and did not increase again until normal food was supplied.

Studies on the incidence of bacteraemia following endoscopic injection sclerotherapy produce equivocal results. Accordingly, we performed a prospective study in 24 patients who underwent a total of 40 sclerotherapy sessions. Blood was drawn before, during, and 5 minutes, 30 minutes, 3 hours and 24 hours after sclerotherapy. Transient bacteraemia (mostly during and 5 minutes after sclerotherapy) was detected in 21 (53%) procedures. The bacteraemic events bore no relation to febrile episodes. The most frequently isolated microorganisms were alpha-haemolytic Streptococcus spp. and coagulase-negative Staphylococcus spp.. We conclude that injection sclerotherapy is associated with a high incidence of bacteraemia which, however, in most cases is transient and does not lead to septic disease.

The synthesis of benzylamines with various N-alkyl chains and substituents in the aromatic system as well as their evaluation on Mycobacterium tuberculosis H 37 Ra are described. The most active compounds in this test, N-methyl-3-chlorobenzylamine (19, MIC 10.2 micrograms/mL), N-methyl-3,5-dichlorobenzylamine (93, MIC 10.2 micrograms/mL), and N-butyl-3,5-difluorobenzylamine (103, MIC 6.4 micrograms/mL), also exhibited a marked inhibitory effect on Mycobacterium marinum and Mycobacterium lufu used for the determination of antileprotic properties. The combinations of 93 with aminosalicylic acid, streptomycin, or dapsone exert marked supra-additive effects on M. tuberculosis H 37 Ra.

815 recent clinical isolates of different species representing pathogenic or saprophytic constituents of human microbial flora were submitted to agar dilution tests. In concentrations above 64 micrograms/ml tyrothricin is in general equally as gramicidin or slightly more effective whereas below 8 micrograms/ml gramicidin is mostly more effective than tyrothricin. Of 401 streptococci all were inhibited by tyrothricin and gramicidin in concentrations up to 96 micrograms/ml; staphylococci were more resistant. The pathogenic species of 130 strains of gram-negative cocci were more susceptible than the saprophytic species. Haemophilus strains were mostly resistant to gramicidin and to a lesser extent to tyrothricin. Enterobacteriaceae were totally resistant to both antibiotics.

A 42-yr-old woman with long-standing ulcerative colitis of the descending colon, sigmoid, and rectum presented with bloody diarrhea, tenesmus, and high fever. Endoscopic findings were compatible with an acute attack of ulcerative colitis, which proved to be resistant to systemic corticosteroid treatment. In the presence of an acute abdomen with ascites and double-contoured colonic wall, hemicolectomy was performed. Postoperatively, high temperature, hyponatremia, and elevated liver enzyme levels persisted. Pleural effusions developed. Antibodies to Legionella pneumophila serogroup 3 were detected in the serum. Erythromycin therapy induced rapid improvement. In a massive submucosal edema of the affected colon, L. pneumophila of the same serogroup was demonstrated by direct immunofluorescence staining.

The protein composition of the outer membrane and the whole cell wall of 21 strains representing 14 different serotypes of seven different Legionella species has been determined by sodium dodecylsulfate-polyacrylamide gel electrophoresis. The insoluble residue after extraction of cell envelopes with sodium laurylsarcosinate was considered to represent the outer membrane. Alternatively isopycnic sucrose density gradient centrifugation could be used; this approach gave similar results to the detergent method. Furthermore the effect of different methods of inactivation, e.g. treatment of the organisms with formaldehyde, heat or either on the outer membrane proteins was investigated. Each of 14 strains from seven serogroups of Legionella pneumophila yielded identical patterns of outer membrane proteins. The most prominent feature is a L. pneumophila specific major outer-membrane protein with a molecular weight of 29,000 dalton. This characteristic component was present after every method of inactivation and could also be found as a prominent protein band in total membrane preparations of non-inactivated L. pneumophila. More protein bands were observed after heat or ether inactivation than after formaldehyde inactivation. None of the other Legionella species under investigation contained the characteristic 29,000 dalton major outer membrane protein of Legionella pneumophila. Under all preparation conditions Legionella micdadei showed a characteristic intensively staining protein of 39,000 dalton. Neither the 29,000 dalton protein of L. pneumophila nor the 39,000 dalton component of L. micdadei were present in any of the other Legionella species. These other Legionella species exhibited on the contrary no single dominant membrane component but some weaker staining protein bands were observed and these were characteristic for each species. Both serogroups of Legionella longbeachae yielded identical patterns. (ABSTRACT TRUNCATED AT 250 WORDS)

The fungicidal activity of pentachlorophenol and its derivatives against 16 species of fungi representing 14 genera was tested. In relation to pentachlorophenol, no increase in fungistatic activity was found for pentachloroanisole, pentachloronitrobenzene, hexachlorobenzene, pentachlorophenyl acetate, o- and p-chloranil, the three isomeric chlorophenols, 2,6-dichlorophenol, the three isomeric tetrachlorobenzenediols, the three isomeric tetrachlorodimethoxybenzenes, the three isomeric tetrachlorobenzenediol diacetates, and all of the isomeric mono-, di-, tri-, and tetrachloroanisoles, except for 2,3,5-trichloroanisole with Geotrichum candidadum PC 67 and for 2,3,5,6-tetrachloroanisole with Mucor circinelloides PC 1. Increasing fungistatic activities were seen with 3,5-dichlorophenol, four trichlorophenols, and 2,3,4,5-tetrachlorophenol for all of the strains, with four dichlorophenols, 2,4,6-trichlorophenol, and two tetrachlorophenols for some strains, and with 2,3,6-trichlorophenol for only one strain (M. circinelloides PC 1).

The severe and complicated course of a Legionella pneumonia in an 18-year-old female patient is reported. The serogroup 8 of Legionella pneumophila was identified as the infecting agent for the first time in West Germany. The etiological diagnosis was confirmed by immunofluorescence, enzyme immunoassay, and immunoblot. We emphasize the importance of serological testing of all Legionella pneumophila serogroups available.

To investigate diabetic alterations of small intestinal transit and bacterial growth, we performed hydrogen breath tests (10 g lactulose via duodenal tube at the ligament of Treitz), bacterial cultures, and determinations of unconjugated serum bile acids in 19 patients with long-standing diabetes and 7 healthy controls. Asymptomatic diabetics had a late rise in breath hydrogen, indicating prolonged jejunal-cecal transit (86 +/- 10 min, p less than 0.05) as an early pathogenic event. Rise in breath hydrogen in symptomatic diabetics (constipation: 50 +/- 6 min; diarrhea: 41 +/- 11 min) was not significantly different from controls (57 +/- 8 min). Bacterial studies and increased unconjugated serum bile acids suggest bacterial overgrowth in some symptomatic diabetics. Bacterial overgrowth was associated more frequently (p less than 0.05) with a rise in breath hydrogen before 45 min or after 75 min. Changes in the hydrogen breath test, bacterial growth, or unconjugated serum bile acids did not correlate with gastrointestinal symptoms of diabetes.

Outbreaks of febrile illness consistent with legionellosis occurred in successive groups of vacationers at an Adriatic resort in 1980. Illness was associated with one of two hotels used by the groups. A cohort study of guests of the suspect hotel revealed 23 cases of febrile illness with pulmonary symptoms, significant antibody titers to Legionella pneumophila, or both, among 291 persons at risk. Two patients died. Attack rates ranged from 0-19% in the nine cohorts of vacationers and were highest among the most elderly. Febrile illness in the last two cohorts of the season was associated with an antibody titer greater than or equal to 128. L. pneumophila was isolated from shower heads in the suspect hotel, but no association was found between showering and illness or seropositivity. Bacteria identified as L. pneumophila by direct immunofluorescence were also found in water from an adjacent hotel and from the outflow from a common well. No cases were associated with the adjacent hotel.

Antibody titres against Legionella pneumophila (serogroups 1 and 2) were determined by the indirect immunofluorescence test on 206 patients with various forms of bronchopulmonary disease. In one third of cases there was a very weak titre (1:32 to 1:64), a moderately to markedly elevated one against one or both bacterial strains (greater than or equal to 1:128) in 4%. In one of four cases with a titre greater than or equal to 1:512 Legionnaires' disease, contracted via an air-conditioning unit, was suspected. In another case there was probably chronic Legionnaires' disease with subsequent pulmonary fibrosis. In the remaining two cases chronic Legionnaires' disease was the likely diagnosis, the clinical picture being one of nonspecific bronchopneumonia. These findings suggest that the causative organism of Legionnaires' disease is widespread also in Southern Germany and that the disease does not always lead to severe pneumonic complications.

Serum and corresponding lung tissue concentrations of ciprofloxacin (Ciprobay) were investigated in 25 patients undergoing open lung surgery for pulmonary malignancies. Drug levels were measured at various times (50-240 min) after completion of a single i.v. dose of 200 mg by bioassay and HPLC. Lung tissue concentrations peaked within one hour after dosing (bioassay: 3.2 micrograms/g, HPLC: 4.5 micrograms/g). Tissue levels exceeded corresponding serum level 3- to 4fold throughout the observation period. The results demonstrate excellent penetration properties of this new antimicrobial compound into lung tissue. Ciprofloxacin was concentrated in the lung and thus by far exceeded known minimum inhibitory concentrations for most nosocomial respiratory pathogens.