Significado de la Leucopenia en pacientes con bacteriemia

Objetivo: Evaluar parámetros clínicos, bacteriológicos y morbimortalidad de las bacteriemias en pacientes con leucopenia (<4.000 leucocitos/mm 3) y compararlas con bacteriemias con leucocitosis (>12.000/mm3). Material y métodos: Estudio protocolizado, descriptivo y observacional en pacientes con 2 o más hemocultivos positivos para el mismo germen hospitalizados en un servicio de clínica médica desde Marzo de 1989 a Agosto de 2007. Resultados: Se identificaron 728 bacteriemias, 94 (12,91%) con leucopenia (Grupo A) y 407 (55,90%) con leucocitosis (Grupo B). La edad media fue de 55,57 años (DS±16,93) en A y de 58,40 años (DS±17,34) en B. No hubo diferencias en la permanencia media: 19,59 días (DS±18,67) en A vs 21,21 (DS±19,53) en B ni en el sexo masculino (65,96 vs 57,25%)(pNS). La adquisición nosocomial (57,44 vs 40,29%) y el foco desconocido (25,53 vs 9,33%) y abdominal (17,14 vs 9,21%) fueron más frecuentes en A (p<0.01). La comorbilidad mayor (82,98 vs 41,24%), neoplasias (45,74 vs 12,84%) y la inmunosupresión (31,91 vs 6,17%) fueron significativas en A (p<0.01). La anemia (86,17 vs 62,40%) y la trombocitopenia (84,04 vs 25,06%) predominaron en A (p<0.01). Los Bacilos Gram Negativos predominaron en A (61,71 vs 37,83%)(p<0.01) [Klebsiella (17,02 vs 9,82%) y Pseudomonas (10,64 vs 1,47%) las más frecuentes (p<0.05)] y en B fue más frecuente S. aureus (31,69 vs 11,70%)(p<0.01). La mortalidad fue de 39,36% en A y 25,30% en B (p=0.006) y se asoció en el grupo A a mayor mortalidad en las primeras 24 horas (32,43 vs 16,50%), inmunosupresión (27,02 vs 7,76%), neumococcemias (52,94 vs 23,07%), sepsis (100 vs 88,35%) y trombocitopenia (75,67 vs 30,09%)(p<0,01).- Conclusiones: Las bacteriemias en pacientes leucopénicos comparadas con aquellas con leucocitosis se asociaron significativamente a adquisición nosocomial, foco desconocido y abdominal, presencia de comorbilidad mayor, neoplasias e inmunosupresión, a bacteriemias por Klebsiella y Pseudomonas y a significativa mayor mortalidad. Palabras claves: leucopenia, bacteriemias

Bacteriemias en Mayores de 65 años : resultados de un análisis comparativo

Objetivos: Evaluar parámetros clínicos, bacteriológicos y morbimortalidad en pacientes mayores de 65 años con bacteriemia (Grupo A) y compararlos con aquellas ocurridas en menores de 65 años (grupo B) hospitalizados en un servicio de clínica médica. Material y métodos: Estudio protocolizado, descriptivo y observacional, desde 1989-2006. Criterios de inclusión: dos o más hemocultivos positivos. Análisis estadístico con Epi Info 6.4 . Resultados: Se identificaron 668 bacteriemias: 258 (38,6%) en A y 410 (61,4%) en B. La edad media fue de 74,2 años (DS±7.01) y de 47,2 años (DS±13.7) respectivamente. No hubo diferencias en la permanencia media: 19,1 días (DS±17.07) en A y 19,9 (DS±18,1) en B, ni en el origen nosocomial (40,7 vs 44%). Los focos pulmonar (31 vs 21,2%)(p<0,008) y urinario (27 vs 18,8%)(p=0.017) fue más frecuentes en A. La fiebre >de 38 ºC fue menos frecuente en A (83,8 vs 90,9%)(p=0.0068), mientras que la hipotensión arterial (40,8 vs 32,2%)(p=0.03), oliguria (41,7 vs 30,9%)(p=0.005) y encefalopatía (54,5 vs 39,4%)(p=0.00014) fueron mas comunes en A. Los bacilos gram negativos predominaron en A (46 vs 37%)(p<0.01) con diferencias entre A.baumani (9,16 vs 4,6%) y E.coli (54,1 vs 42,7%)(p<0.05) y en B fueron más frecuentes por S.aureus MS (34.39 vs 24,63)(p=0.01). El shock séptico (33,9 vs 22,4%) y nuevas insuficiencias de órganos (31,1 vs 20,1%) prevalecieron en A (p<0,001). La mortalidad fue de 34,49% para A y de 23,41% para B (p=0,018) Conclusiones: Las bacteriemias en pacientes internados mayores de 65 años comparadas con las ocurridas en pacientes. de menor edad, se caracterizaron significativamente por tener predominio del foco pulmonar y urinario, de hipotensión arterial, oliguria y encefalopatía, de bacteriemia por BGN, principalmente A. baumanii y E. coli; mayor desarrollo de shock séptico, menor frecuencia de fiebre >38°C y de bacteriemia por MSS A, y significativa mayor mortalidad.

Bacteriemias por Pseudomonas Aeruginosa : análisis comparativo

Objetivos: Analizar características clínicas y morbimortalidad de las bacteriemias por Pseudomonas aeruginosa comparadas con Klebsiella spp en pacientes hospitalizados en un Servicio de Clínica Médica de adultos. Material y métodos: Estudio protocolizado, descriptivo, observacional de 15 años de duración. Criterio de inclusión: 2 o más hemocultivos positivos para el germen. Los datos fueron procesados en EPI Info 6.04. El criterio de significación se estableció para un error alfa menor del 5%. Resultados: Se detectaron en el período de estudio 282 bacteriemias por bacilos gram negativos de las cuales 19 fueron por Pseudomonas aeruginosa (6.7%) y 76 por Klebsiella (26.9%). No se encontraron diferencias significativas entre ambas en cuanto a edad media [53.9 años (DS±17.9 ) vs 58.7 años (DS±15.2)], sexo (femenino: 26.3 vs 38.2%) ni complicaciones (77.8 vs 77.3%). La presencia de neutropenia (52.6 vs 9.2%)(p<0.0001), comorbilidad mayor (94.7 vs 68.4%)(p<0.05), neoplasias (47.4 vs 22.4%)(p<0.05), uso de corticoides (21.1 vs 3.9%)(p<0.05), e inmunosupresores (31.6 vs 7.9%)(p<0.01), trombocitopenia (77.7 vs 49.3%) (p<0.05) y leucopenia (52.6 vs 21.3%)(p<0.01) fueron más frecuentes en las bacteriemias por P. aeruginosa. Resultó más frecuente la hipoalbuminemia (88.5 vs 37.5%)(p<0.001) en las bacteriemias por Klebsiella spp. No se encontraron diferencias significativas en cuanto a puerta de entrada conocida (78.9 vs 77.6%), anemia (84.2 vs 71.2%), complicaciones infecciosas (84.2 vs 73.7%), descompensación de comórbidas (55.6 vs 51.3%) y encefalopatía (36.8 vs 57.9%)(pNS). La mortalidad precoz (dentro de los 7 días) fue significativamente mayor en el grupo de las bacteriemias por P.aeruginosa (57.1 vs 12%) (p<0.01), sin diferencias en la mortalidad global (36.8 vs 32.9%) (pNS). Conclusiones: Las bacteriemias por P.aeruginosa comparadas con las producidas por Klebsiella spp. se asociaron significativamente a mayor frecuencia de neoplasias, leucopenia, trombocitopenia y neutropenia, comorbilidad mayor, uso de corticoides e inmunosupresores, y a mortalidad precoz.

Abundance and community structures of heterotrophic and oligotrophic bacteria from the Sierra Leone Abbyssal Plain

Colony counts on high and low-nutrient agar media incubated at 2 and 20 °C, Acridine Orange Direct Counts and biomasses are reported for sediments of the Sierra Leone Abyssal Plain. All isolates from low-nutrient agars also grew in nutrient-rich seawater broth (100 % SWB). However, a greater proportion of the 2 °C than of the 20 °C isolates grew in 2.5% SWB, containing 125 mg/l peptone and 25 mg/l yeast extract. Only 14 strains or 12.7% of the 2 °C isolates, but none of the 20 °C isolates, grew in 0.25 % SWB. Psychrophilic bacteria with maximum growth temperatures below 12 °C, isolated at 2 °C, were predominant among the cultivable bacteria from the surface layer. They required seawater for growth and belonged mainly to the Gram-negative genera Alteromonas and Vibrio. In contrast to the earlier view that psychrophily is connected with the Gram-negative cell type, it was found that cold-adapted bacteria of the Gram-positive genus Bacillus predominated in the 4 to 6 cm layer. The 20 °C isolates, however, were mostly Gram-positive, mesophilic, not dependent on seawater for growth, not able to utilize organic substrates at 4 °C, and belonged mainly to the genus Bacillus and to the Gram-positive cocci. The majority of the mesophilic bacilli most likely evolved from dormant spores, but not from actively metabolizing cells. It can be concluded that only the strains isolated at 2 °C can be regarded as indigenous to the deep-sea.

Geochemistry, microbiology and phospholipid fatty acid content of ODP Site 169-1036 sediments

Phospholipid fatty acids were measured in samples of 60°-130°C sediment taken from three holes at Site 1036 (Ocean Drilling Program Leg 169) to determine microbial community structure and possible community replacement at high temperatures. Five of six samples had similar concentrations of phospholipid fatty acids (2-6 pmol/g dry weight of sediment), and biomass estimates from these measurements compare favorably with direct microscopic counts, lending support to previous microscopic measures of deep sedimentary biomass. Very long-chain phospholipid fatty acids (21 to 30 carbons) were detected in the sediment and were up to half the total phospholipid fatty acid measured; they appear to increase in abundance with temperature, but their significance is not known. Community composition from lipid analysis showed that samples contained standard eubacterial membrane lipids but no detectable archaeal lipids, though archaea would be expected to dominate the samples at high temperatures. Cluster analysis of Middle Valley phospholipid fatty acid compositions shows that lipids in Middle Valley sediment samples are similar to each other at all temperatures, with the exception of very long-chain fatty acids. The data neither support nor deny a shift to a high-temperature microbial community in hot cores, so at the present time we cannot draw conclusions about whether the microbes observed in these hot sediments are active.

Oligotrophic bacteria from the Antarctic Ocean

From enrichment cultures in dialysis chambers held in natural seawater tanks, 104 strains were isolated and kept in culture. All strains proved to be Gram-negative and psychrotrophic, having optimum growth temperatures of between 20 and 24 °C. Maximal growth temperatures were 30 to 37 °C, or even higher. With 55 isolates, substrate utilizations in Biolog MicroPlates were determined, and the obtained metabolic fingerprints used for clustering. Five groups could be distinguished at the 80% similarity level. Fifteen strains belonged to cluster 1, seven strains to cluster 2, and each of the clusters 3 and 4 contained nine strains. Cluster 5 can be divided into subcluster 5a and 5b, with 6 strains showing a few substrates metabolized, and 9 strains without any reactions, or weak reactions for one or two substrates, respectively. Each cluster could be characterized by specific metabolic fingerprints. Strains from cluster 1 metabolized N-acetyl-D-glucosamine, alpha-hydroxybutyric acid and gamma-hydroxybutyric acid, strains from cluster 2 citric acid, formic acid, thymidine and putrescine, strains from cluster 3 glycyl-L-aspartic acid, glycyl-L-glutamic acid, L-threonine and inosine, whereas strains from cluster 4 metabolized alpha-cyclodextrin and N-acetyl-D-galactosamine, typically. Methylamine was not utilized by the isolates, but strains from cluster 1, 2 and 3 could grow on basal seawater agar. Morphological characteristics and photomicrographs of the oligotrophic strains are presented. Due to their typical morphologies and ampicillin resistence, the nine strains from cluster 3 can be regarded as new species of the genus Planctomyces. These bacteria have not been cultivated before.

The role of secretion systems and small molecules in soft-rot enterobacteriaceae pathogenicity

Soft-rot Enterobacteriaceae (SRE), which belong to the genera Pectobacterium and Dickeya, consist mainly of broad host-range pathogens that cause wilt, rot, and blackleg diseases on a wide range of plants. They are found in plants, insects, soil, and water in agricultural regions worldwide. SRE encode all six known protein secretion systems present in gram-negative bacteria, and these systems are involved in attacking host plants and competing bacteria. They also produce and detect multiple types of small molecules to coordinate pathogenesis, modify the plant environment, attack competing microbes, and perhaps to attract insect vectors. This review integrates new information about the role protein secretion and detection and production of ions and small molecules play in soft-rot pathogenicity.

The type II secretion system (Xcp) of Pseudomonas putida is active and involved in the secretion of phosphatases.

The genome of the Gram-negative bacterium Pseudomonas putida harbours a complete set of xcp genes for a type II protein secretion system (T2SS). This study shows that expression of these genes is induced under inorganic phosphate (Pi ) limitation and that the system enables the utilization of various organic phosphate sources. A phosphatase of the PhoX family, previously designated UxpB, was identified, which was produced under low Pi conditions and transported across the cell envelope in an Xcp-dependent manner demonstrating that the xcp genes encode an active T2SS. The signal sequence of UxpB contains a twin-arginine translocation (Tat) motif as well as a lipobox, and both processing by leader peptidase II and Tat dependency were experimentally confirmed. Two different tat gene clusters were detected in the P.?putida genome, of which one, named tat-1, is located adjacent to the uxpB and xcp genes. Both Tat systems appeared to be capable of transporting the UxpB protein. However, expression of the tat-1 genes was strongly induced by low Pi levels, indicating a function of this system in survival during Pi starvation.

The type II secretion system (Xcp) of Pseudomonas putida is active and involved in the secretion of phosphatases.

The genome of the Gram-negative bacterium Pseudomonas putida harbours a complete set of xcp genes for a type II protein secretion system (T2SS). This study shows that expression of these genes is induced under inorganic phosphate (Pi ) limitation and that the system enables the utilization of various organic phosphate sources. A phosphatase of the PhoX family, previously designated UxpB, was identified, which was produced under low Pi conditions and transported across the cell envelope in an Xcp-dependent manner demonstrating that the xcp genes encode an active T2SS. The signal sequence of UxpB contains a twin-arginine translocation (Tat) motif as well as a lipobox, and both processing by leader peptidase II and Tat dependency were experimentally confirmed. Two different tat gene clusters were detected in the P.?putida genome, of which one, named tat-1, is located adjacent to the uxpB and xcp genes. Both Tat systems appeared to be capable of transporting the UxpB protein. However, expression of the tat-1 genes was strongly induced by low Pi levels, indicating a function of this system in survival during Pi starvation.

Exploring new roles for the rpoS gene in the survival and virulence of the fire blight pathogen Erwinia amylovora

Erwinia amylovora causes fire blight in economically important plants of the family Rosaceae. This bacterial pathogen spends part of its life cycle coping with starvation and other fluctuating environmental conditions. In many Gram-negative bacteria, starvation and other stress responses are regulated by the sigma factor RpoS. We obtained an E. amylovora rpoS mutant to explore the role of this gene in starvation responses and its potential implication in other processes not yet studied in this pathogen. Results showed that E. amylovora needs rpoS to develop normal starvation survival and viable but nonculturable (VBNC) responses. Furthermore, this gene contributed to stationary phase cross-protection against oxidative, osmotic, and acid stresses and was essential for cross-protection against heat shock, but nonessential against acid shock. RpoS also mediated regulation of motility, exopolysaccharide synthesis, and virulence in immature loquats, but not in pear plantlets, and contributed to E. amylovora survival in nonhost tissues during incompatible interactions. Our results reveal some unique roles for the rpoS gene in E. amylovora and provide new knowledge on the regulation of different processes related to its ecology, including survival in different environments and virulence in immature fruits.

NF-κB-dependent inhibition of apoptosis is essential for host cell survival during Rickettsia rickettsii infection

The possibility that bacteria may have evolved strategies to overcome host cell apoptosis was explored by using Rickettsia rickettsii, an obligate intracellular Gram-negative bacteria that is the etiologic agent of Rocky Mountain spotted fever. The vascular endothelial cell, the primary target cell during in vivo infection, exhibits no evidence of apoptosis during natural infection and is maintained for a sufficient time to allow replication and cell-to-cell spread prior to eventual death due to necrotic damage. Prior work in our laboratory demonstrated that R. rickettsii infection activates the transcription factor NF-κB and alters expression of several genes under its control. However, when R. rickettsii-induced activation of NF-κB was inhibited, apoptosis of infected but not uninfected endothelial cells rapidly ensued. In addition, human embryonic fibroblasts stably transfected with a superrepressor mutant inhibitory subunit IκB that rendered NF-κB inactivatable also underwent apoptosis when infected, whereas infected wild-type human embryonic fibroblasts survived. R. rickettsii, therefore, appeared to inhibit host cell apoptosis via a mechanism dependent on NF-κB activation. Apoptotic nuclear changes correlated with presence of intracellular organisms and thus this previously unrecognized proapoptotic signal, masked by concomitant NF-κB activation, likely required intracellular infection. Our studies demonstrate that a bacterial organism can exert an antiapoptotic effect, thus modulating the host cell’s apoptotic response to its own advantage by potentially allowing the host cell to remain as a site of infection.

Midgut-specific immune molecules are produced by the blood-sucking insect Stomoxys calcitrans

We have cloned and sequenced two defensins, Smd1 and Smd2, from anterior midgut tissue of the blood-sucking fly Stomoxys calcitrans. The DNA and N-terminal protein sequences suggest both are produced as prepropeptides. Smd1 differs from the classic defensin pattern in having an unusual six-amino acid-long N-terminal sequence. Both Smd1 and Smd2 have lower pI points and charge than insect defensins derived from fat body/hemocytes. Northern analysis shows both of these defensin molecules are tissue specific; both are produced by the anterior midgut tissue and, unlike the other insect defensins reported to date, neither appears to be expressed in fat body or hemocytes. Northern analysis also shows that mRNAs for both defensins are constitutively produced in the anterior midgut tissues and that these transcripts are up-regulated in response to sterile as well as a lipopolysaccharide-containing blood meal. However, anti-Gram-negative biological activity in the midgut is substantially enhanced by lipopolysaccharide. These findings suggest that the insect midgut has its own tissue-specific immune mechanisms and that this invertebrate epithelium is, like several vertebrate epithelia, protected by specific antibacterial peptides.

Molecular immune responses of the mosquito Anopheles gambiae to bacteria and malaria parasites

Immune responses of the malaria vector mosquito Anopheles gambiae were monitored systematically by the induced expression of five RNA markers after infection challenge. One newly isolated marker encodes a homologue of the moth Gram-negative bacteria-binding protein (GNBP), and another corresponds to a serine protease-like molecule. Additional previously described markers that respond to immune challenge encode the antimicrobial peptide defensin, a putative galactose lectin, and a putative serine protease. Specificity of the immune responses was indicated by differing temporal patterns of induction of specific markers in bacteria-challenged larvae and adults, and by variations in the effectiveness of different microorganisms and their components for marker induction in an immune-responsive cell line. The markers exhibit spatially distinct patterns of expression in the adult female mosquito. Two of them are highly expressed in different regions of the midgut, one in the anterior and the other in the posterior midgut. Marker induction indicates a significant role of the midgut in insect innate immunity. Immune responses to the penetration of the midgut epithelium by a malaria parasite occur both within the midgut itself and elsewhere in the body, suggesting an immune-related signaling process.

An opsonic function of the neutrophil bactericidal/permeability-increasing protein depends on both its N- and C-terminal domains

The host response to Gram-negative bacterial infection is influenced by two homologous lipopolysaccharide (LPS)-interactive proteins, LPS-binding protein (LBP) and the bacteridical/permeability-increasing protein (BPI). Both proteins bind LPS via their N-terminal domains but produce profoundly different effects: BPI and a bioactive N-terminal fragment BPI-21 exert a selective and potent antibacterial effect upon Gram-negative bacteria and suppress LPS bioactivity whereas LBP is not toxic toward Gram-negative bacteria and potentiates LPS bioactivity. The latter effect of LBP requires the C-terminal domain for delivery of LPS to CD14, so we postulated that the C-terminal region of BPI may serve a similar delivery function but to distinct targets. LBP, holoBPI, BPI-21, and LBP/BPI chimeras were compared for their ability to promote uptake by human phagocytes of an encapsulated, phagocytosis-resistant strain of Escherichia coli. We show that only bacteria preincubated with holoBPI are ingested by neutrophils and monocytes. These findings suggest that, when extracellular holoBPI is bound via its N-terminal domain to Gram-negative bacteria, the C-terminal domain promotes bacterial attachment to neutrophils and monocytes, leading to phagocytosis. Therefore, analogous to the role of the C-terminal domain of LBP in delivery of LPS to CD14, the C-terminal domain of BPI may fulfill a similar function in BPI-specific disposal pathways for Gram-negative bacteria.