Inclusion criteria were similar to control ...

Enteropathogenic Klebsiella pneumonia in HIV-infected adults in Africa - Letters to >> << Phuong L. Nguyen Thi, Simon Yassibanda, Ava Aidara, Chantal Le Bouguenec John Teutons

To the Editor: Although Klebsiella pneumonia life as a commensal in the intestine, the bacteria can sometimes cause diarrhea in HIV-negative individuals (1-4). Some of these diarrheagenic strains encode thermostable toxins thermally or (2). One group of researchers showed that the strain of K. pneumonia isolated from bloody diarrhea can bind to HeLa cells and proteins of cytoskeleton such as actin, which accumulates at the point of bacterium-host contact (3). However, this exclusion does not contain genes that encode virulence factors that are attributed to pathogenic strains of Escherichia coli and are responsible for bloody diarrhea or dyzenteriyna syndromes (3). In Bangui, the rate of selection of pure cultures of K. pneumonia from the chair of immunity to HIV-infected adults with chronic diarrhea increases. This finding was noted during the regular biological tests at the Pasteur Institute of Medical Laboratory and meets that made Gassama et al. in Dakar (5). The role of K. pneumonia in HIV-infected adults is not well documented. Like no other known enteric pathogens isolated from these samples, we conducted a case-control study in Bangui in 1999-2001 to determine the clinical significance of K. pneumonia. The study included 31 adults hospitalized with chronic diarrhea and 31 controls. (Due to civil unrest in Bangui in connection with military revolts and difficulties associated with a set of controls, the study was conducted on a small sample.) For inclusion in the study patients were HIV positive, will be [greater than or equal to] 18 years, gave stool sample containing K. pneumonia per day of hiring, and gave informed consent. Inclusion criteria were similar to control except that they did not have diarrhea on the day of employment or in the previous month. Management were family members or neighbors of patients comparable in age (within 5 years) and sex. Samples taken in business and management were collected during the same 1-month period. Known enteric pathogens were identified using standard methods as described (6). Endoscopic studies were used for the diagnosis of pseudomembranous colitis in patients with chronic diarrhea or bloody watery chronic diarrhea. Average CD4 cell was 122 cells / ml in patients and 436 cells / ml in the control group. AIDS-related symptoms were observed in all cases (Centers for Disease Control and Prevention [CDC] stage C2 and C3), and all controls (CDC stage Al). Of the 31 patients, 7 (22. 6%) had bloody chronic diarrhea, 9 (29%) had chronic diarrhea watery, and 15 (48. 4%) had mild chronic diarrhea. Pseudomembranous colitis was diagnosed in nine patients (six with bloody diarrhea, three of watery chronic diarrhea) that several antibiotics, including ampicillin, for a long time (> 1 month). Five colonies of C. pneumonia randomly picked from each sample and the case is considered. Office of the colonies were selected if their appearance suggested K. pneumonia. The average number of strains was 4. 99 patients and 4. 64 for control (does not matter, p = 0. 969). All intestinal bacteria isolated from patients and grown on selective medium were bromkrezolovoho purple K. pneumonia, while an average of 10% to 20% of intestinal bacteria isolated from control were K. pneumonia. We used tests commonly used to identify virulence factors of diarrheagenic E. coli (7) to characterize the properties of virulent strains of K. pneumonia, their genotypes, and their phenotype (their ability to communicate with cultural st-2 cells and contribute to cytoskeleton changes [fluorescent actin staining test], invade epithelial cells for the production of various enterotoxins and cytotoxin and cause fluid accumulation in the gut of newborn mice ). Rabbit lihuvaty ileal loop test was performed when the genetic or phenotypic (on Vero cells or Y1) tests were positive for toxins. All isolates from 27 patients (7, 9 and 11 with bloody, watery, and mild chronic diarrhea, respectively) and two strains of one element of aggregate phenotype displayed adherence to HEp-2 cells. This phenotype appears to be significantly associated with chronic diarrhea (27/31 cases to 1/31 control, [or] = 40. 7, p

K. pneumonia is usually resistant [ beta]-lactams. multidrug-resistant K. pneumonia were reported (1). All K. pneumonia isolates in this study were resistant to antibiotics, including several kotrimoksazola and ampicillin, which are widely used in Bangui as recommended by the World Health Organization 'I (8). In addition, nonspecific measures applicable to prevention and correction fluid, electrolyte imbalance and nutrients, all persons with bloody and watery chronic diarrhea (including pseudomembranous colitis) and 5 of 15 patients with mild chronic diarrhea (10 were lost to follow-up) received ofloxacin (800 mg / day) or Ceftriaxone (2 g / day) based on the results of antimicrobial susceptibility. status of all patients with pseudomembranous colitis and mild chronic diarrhea, and n ' Five patients with chronic watery diarrhea (one patient died), improved within 10 days of treatment. In Dakar, the study describe normal and opportunistic enteropathogenic associated diarrhea in adults (5), stool samples were collected from five HIV- infected adults with chronic watery diarrhea. In all cases of severe pneumonia C. growth was observed in the primary growth media, and no other known pathogens were found. These K. pneumonia strains were subjected to the same phenotypic and genotypic tests strains isolated in Bangui. HEp- 2 - a supporter of K. pneumonia was detected in four of these five samples. status of all patients improved rapidly after treatment with ofloxacin. in Bangui and Dakar, repeated stool cultures were negative for C. pneumonia at the end of treatment, providing further evidence that these K. pneumonia are important etiological, especially the GPU-2-adherent K. pneumonia strains. Only seven patients (four with mild, two with watery, and one with bloody chronic diarrhea) received no antibiotics for 2 weeks before stool collection. feces of these seven patients gave a pure culture of primary GPU-2-adherent K. pneumonia and no other bacterial enteric pathogens. None of these seven participants were diagnosed with pseudomembranous colitis. GPU-2-adherent K. pneumonia strains isolated from two members of the watery chronic diarrhea induced fluid accumulation in rabbit ileal loops bandaged, and GPU-2-adherent strains isolated from three participants with mild chronic diarrhea carried gene ASTA, which is associated with pathogenic EurAsEC. Among the five patients with pseudomembranous colitis, all of which received antibiotics prior to illness, we found that the four strains from patients with chronic diarrhea was bloody tsytopatohennoho: one isolate from patients with chronic diarrhea were watery pathogenic markers for enteroaggregative E.coli. These results show that not only K . pneumonia associated with chronic diarrhea in HIV-infected persons, and that infection with a particular HEp-2-adherent K. pneumonia subtypes may be associated with specific clinical manifestations. Financial support was provided by the National Agency for AIDS Research ( contract 1227) and Groupe d'Etude-where infection Diarrheiques (ACIP, Réseau International de Pasteur Institute and other Institutes strattera side effects Associes). (1). Ananthan S, S Raju, Alavandi S. Enterotoxigenicity with. Klebsiella pneumonia associated with childhood gastroenteritis in Madras, India Jpn J infect Dis 1999; .. 52:16-7 (2.) Arora DR, Chugh TD, Vadhera DY Enterotoxigenicity with Klebsiella pneumonia Ind J Pathol Microbiol 1983. 26:65 ..? -70 (3 .) Guerin F, Le Bouguenec C, Gilquin J, F Haddad, Goldstein FW bloody diarrhea caused by Klebsiella pneumonia: a new mechanism of bacterial virulence Clin infect Dis 1998; 27:648-9 (4 ...) Guerrant RL, RA Moore, Kerschfeld PM, MA Sunday Role toxigenicity and invasive bacteria in acute diarrhea of ​​childhood N Engl J Med 1975;. 293:567-71 (5) Gassama, Sow PS, Fall F.., Camara P, Philippe H, Heye-N 'Diay A. Ordinary and opportunistic enteropathogenic associated with diarrhea in Senegalese adults in relation to human immunodeficiency virus serostatuse Int J infect Dis 2001;. 5:192-8 (6). Germans Y., Minssart P, Vohito M , S Yassibanda, Glaziou P, D Hocquet et al. etiology of acute, persistent, and dyzenteriynoyi diarrhea in adults in Bangui, Central African Republic, in connection with human immunodeficiency virus serological status. Am J Med Trop Hyg 1998; 59:1008 - 14 (7). Nataro JP, privateer JP Diarrheagenic Escherichia coli Clin Microbiol Rev 1998; ..... 11:142-66 (8.) World Health Organization guidelines for clinical management of HIV infection in ... adults, not pub WHO / FFS / IDS / utilities / 91 6 Geneva. Organization, Global Programme on AIDS, since 1991