- Volume 46, Issue 5, 1997

The aerobic and anaerobic microbiology of sinus aspirates obtained during surgery was compared with culture of samples obtained by endoscopy. Six patients with chronic maxillary sinusitis were evaluated. Polymicrobial flora was found in all specimens (two-to-five isolates/sample). A total of 24 isolates (18 anaerobic, five aerobic and one microaerophilic) was obtained from sinus aspirates, and 25 isolates (16 anaerobic and nine aerobic) were found in endoscopic specimens. The predominant organisms were Prevotella spp., Fusobacterium nucleatum, Peptostreptococcus spp. and Staphylococcus spp. Concordance in the type and concentration of organisms was found in all cases. Sixteen of the 18 anaerobes isolated from sinus aspirates were also found in the concomitant endoscopic sample. Five aerobic isolates were found in both sinus aspirates and endoscopic samples and their concentration was similar. However, four aerobic gram-positive bacteria (<104 cfu/sample) were found only in endoscopy samples. This pilot study demonstrates the usefulness of endoscopic aspiration in the isolation of bacteria from chronically infected maxillary sinuses.

Since its discovery at the end of the nineteenth century, Moraxella (Branhamella) catarrhalis has undergone several changes of nomenclature and periodic changes in its perceived status as either a commensal or a pathogen. Molecular analysis based on DNA hybridisation or 16S rDNA sequence comparisons has established its phylogenetic position as a member of the Moraxellaceae and shown that it is related more closely to Acinetobacter spp. than to the genus Neisseria in which it was placed formerly. However, confusion with phenotypically similar Neisseria spp. can occur in the routine diagnostic laboratory if appropriate identification tests are not performed. M. catarrhalis is now accepted as the third commonest pathogen of the respiratory tract after Streptococcus pneumoniae and Haemophilus influenzae. It is a significant cause of otitis media and sinusitis in children and of lower respiratory tract infections in adults, especially those with underlying chest disease. Nosocomial spread of infection, especially within respiratory wards, has been reported. Invasive infection is uncommon, but analysis of reports for England and Wales between 1992 and 1995 revealed 89 cases of M. catarrhalis bacteraemia, with the peak incidence in children aged 1-2 years. Carriage rates of M. catarrhalis are high in children and in the elderly, but its role as a commensal organism has probably been overstated in the past. Approximately 90% of strains are now β-lactamase positive and, given that the first such strain was reported in 1976, this represents a dramatic increase in frequency over the last 20 years which has not been paralleled in any other species. The BRO-1 and BRO-2 β-lactamase enzymes of M. catarrhalis are found in other Moraxellaceae, but are not related to β-lactamases of any other species and their origin is therefore unknown. Molecular and typing studies have shown that the M. catarrhalis species is genetically heterogeneous and these methods have aided epidemiological investigation. Studies of factors that may be related to pathogenicity have shown the existence of three serotypes of lipooligosaccharide and the presence of fimbriae and a possible capsule. Some strains are serum-resistant, probably by virtue of interference with complement action, whilst transferrin- and lactoferrin-binding proteins enable the organism to obtain iron from its environment. An antibody response in humans to various M. catarrhalis antigens, including highly conserved outer-membrane proteins, has been demonstrated. Increased understanding of the organism’s pathogenic properties and the host response to it may help to identify suitable vaccine targets or lead to other strategies to prevent infection. Whilst it remains, at present, the third most important respiratory pathogen, the impact of immunisation strategies for other organisms may change this position. The speed with which M. catarrhalis acquired β-lactamase demonstrates the capacity of this organism to surprise us.

Mycoplasma contamination was detected in a widely used commercially available Chlamydia pneumoniae antigen preparation. Contamination was studied with a mycoplasma group-specific 16S rRNA polymerase chain reaction (PCR) and sequence analysis. Several lots of the purified C. pneumoniae antigen from the Washington Research Foundation appeared to be contaminated with the same Mycoplasma species, which appeared to be closely related to M. arginini. Antigen slides prepared for the detection of chlamydia antibodies by MRL Diagnostics were contaminated with the same Mycoplasma sp. Chlamydia antigen slides from Labsystems OY and two chlamydia complement fixation reagents (Virion International Distribution Ltd and Behring Werke) were not contaminated. It is concluded that commercially available C. pneumoniae antigens may contain mycoplasma antigens as well. Although the impact of such mycoplasma contamination on the results of chlamydia serology may not be significant, routine screening of all antigen preparations obtained by tissue culture before their distribution and use is recommended.

The recent isolation of Helicobacter pylori from cats obtained from a commercial supplier has potentially important public health implications. The present study investigated whether H. pylori infection was common in stray cats. Twenty-five cats were examined for the presence of H. pylori by histological examination, culture and two polymerase chain reaction (PCR) assays. Histologically, the gastric biopsy specimens from all cats showed large spiral organisms typical of H. felis and not H. pylori. Samples from 23 cats yielded bacterial growth and two had no growth. Colonies grossly similar to H. pylori were tested for catalase, oxidase, urease and Gram’s stain reactions. None was H. pylori. All samples tested as positive by the Helicobacter 16S rRNA genus-specific PCR assay and only six cats and a mouse stomach infected with H. heilmannii gave positive results with the adhesin subunit A (hpaA)-specific PCR assay, which is consistent with either H. pylori or H. heilmannii. The helicobacters identified in these samples by PCR were not cultivable and hence were probably H. heilmannii. H. pylori infection is uncommon in stray cats and owning pet cats should not be a threat to public health in relation to H. pylori infection.

The suseptibilities of Actinobacillus actinomycetemcomitans cultures, grown as 1- or 3-day-old biofilms or as planktonic suspensions, to concentrations of chlorhexidine digluconate, cetylpyridinium chloride or triclosan used in commercial mouthwashes were compared. Three-day biofilms were the most resistant form of the organism and chlorhexidine was the most active antiseptic. Comparison of solutions of the pure antibacterial agent with commercial products containing the same concentration of antiseptic showed little difference in in-vitro activities. The results emphasise that the testing of antimicrobial mouthwashes should be performed on bacteria grown as biofilms.

Specific pathogen-free Mongolian gerbils were infected orally with Helicobacter pylori to establish a new small animal model of severe gastritis H. pylori was recovered by culture from both antrum and body over a 16-week period after a single inoculation. The number of H. pylori colonising the antrum was about 100-fold higher than in the body, and this was consistent throughout the experiment. Histological examination showed that all animals developed severe inflammation with infiltration of polymorphonuclear leucocytes and mononuclear cells into the lamina propria and submucosa of the antrum from 4 weeks after infection. From 8 weeks after infection, multifocal lymphoid follicles appeared in the lamina propria and submucosa, and micro-erosions were also observed in the epithelial layer. At 16 weeks after infection, ulceration with disruption of the lamina muscularis mucosae was observed in the antral mucosa. To determine whether H. pylori caused gastritis or not, infected gerbils were treated with amoxycillin. After the treatment, gastritis could not be seen in the gastric mucosa. Therefore, the Mongolian gerbil is a useful small animal model to study the pathogenesis of H. pylori in gastric ulceration and severe gastritis and to assess anti-H. pylori treatment.

Previously the heat-stable enterotoxin in Vibrio cholerae and V. mimicus has been detected by suckling mouse assay, a non-specific approach, and by DNA probes, a time-consuming method. This report describes a polymerase chain reaction (PCR) procedure for the detection of the stn (NAG-ST) and sto (O1-ST) gene sequences that is rapid and specific, allowing toxin gene molecular characterisation. A total of 34 V. cholerae and V. mimicus isolates was examined for ST and CT genes. The NAG-ST gene sequence was amplified in 13 of 22 non-O1/non-O139 V. cholerae and three of five V. mimicus strains. A new enterotoxin gene sequence pattern was found with MseI and TaqI restriction endonuclease PCR fragment digestion of two V. cholerae isolates, in addition to the pattern anticipated from the Genbank sequence, and found with the other ST+, These results show that ST-PCR detection is useful for the characterisation of V. cholerae and V. mimicus.