Pylephlebitis, a septic thrombophlebitis of the portal vein or one of its tributaries, is a life-threatening complication of intra-abdominal infection. The causes of pylephlebitis include acute diverticulitis, appendicitis, acute cholecystitis, necrotizing pancreatitis, inflammatory bowel disease, and bowel perforation. Although pylephlebitis is an unusual complication of diverticulitis, its morbidity and mortality remain high. Therefore, early diagnosis and initiation of adequate antibiotic therapy is important for improving the long-term prognosis of patients suffering from this rare disease. We report a case of pylephlebitis with Streptococcus viridans and Bacteroides fragilis bacteremia secondary to diverticulitis with a review of the literature.
Appendicitis ; Bacteremia ; Bacteroides ; Bacteroides fragilis ; Cholecystitis, Acute ; Diverticulitis ; Early Diagnosis ; Humans ; Inflammatory Bowel Diseases ; Intraabdominal Infections ; Pancreatitis ; Portal Vein ; Prognosis ; Rare Diseases ; Streptococcus ; Stress, Psychological ; Thrombophlebitis ; Viridans Streptococci

A 20 kDa heat-labile toxin (BFT) produced by enterotoxigenic Bacteroides fragilis (B. fragilis) is associated with diarrhea and mucosal inflammation. Although intestinal epithelial cells are known to activate mitogen-activated protein kinase (MAPK) in response to bacterial infection, there has been little understanding on the association between MAPK activation and BFT-induced enteritis. This study was performed to investigate the role of MAPK in enteritis induced by BFT. In human colon epithelial cells, BFT increased IL-8 secretion in a dose-dependent manner. BFT activated the three main MAPK cascades, including extracellular signal-regulated kinase (ERK), p38, and c-Jun NH2-terminal kinase (JNK). BFT stimulation also activated AP-1 activation signals. Overexpression of dominant-negative plasmid of the c-Jun decreased the activated AP-1 signals and the up-regulated IL-8 expression induced by BFT stimulation. In addition, SB203580 and ERK inhibitor U0126 significantly reduced IL-8 secretion in colon epithelial cells stimulated with BFT. Furthermore, SB203580 significantly prevented BFT-induced severity of enteritis and fluid secretion in mouse ileum. These results suggest that MAPK activation may be required for IL-8 transcription in intestinal epithelial cells exposed to BFT and that the activated MAPK can mediate intestinal inflammation and mucosal damage induced by BFT.
Animals ; Bacterial Infections ; Bacteroides fragilis* ; Bacteroides* ; Colon ; Diarrhea ; Enteritis* ; Enterotoxins* ; Epithelial Cells ; Humans ; Ileum ; Inflammation ; Interleukin-8 ; Mice ; Phosphotransferases ; Plasmids ; Protein Kinases* ; Transcription Factor AP-1

OBJECTIVE: Bacteroides fragilis is the most frequently isolated anaerobes in tissue of intraabdominal infection, particularly in intraabdominal sepsis or abscess. In acute experimental model with an intraabdominal infection, the response to B. fragilis is characterized by infiltration of neutrophils and monocytes. To understand the pathogenesis of B. fragilis infection, it is important to explore the mechanism for inflammatory signals such as chemokines induced by this bacteria. The goal of this study was to determine whether peritoneal monocytes or fibroblasts surrounding with intraabdominal abscess induced by B. fragilis could express chemokines such as monocyte chemotactic protein-1 (MCP-1) or macrophage inflammatory protein-1a (MIP-1a). METHODS: 1) After C57BL/6 mice were intraperitoneally inoculated with abscess-inducing agents containing B. fragilis, RNA was extracted from the intraperitoneal tissues of the mice using Ottawa sand and the guanidinium thiocyanate-phenol-chloroform method in 3 days later. 2) After C57BL/6 mouse peritoneal monocytes were infected with B. fragilis for 1, 4 and 9 hours, cellular RNA was extracted from the cells. 3) Fibroblasts isolated from intraabdominal abscess nodules induced by B. fragilis infection were growth in tissue culture for 3 to 4 weeks. After the fibroblasts were stimulated with IL-1alpha (0.1-10 ng/ml) or TNFalpha (0.1-10 ng/ml) for 24 hours, total cellular RNA was extracted. MCP-1 or MIP-1alpha mRNA expression was assessed using RTPCR. MCP-1 or MIP-1alpha proteins in cluture supernatants or tissue extracts were also measured by ELISA. RESULTS: 1) MCP-1 or MIP-1alpha mRNA was highly expressed in peritoneal tissue of C57BL/6 mice bearing with intraabdominal abscess induced by B. fragilis. 2) Expression of MCP-1 mRNA increased at 9 hours in mouse peritoneal monocytes infected with B. fragilis. MIP-1alpha mRNA was initially expressed and perisisted in the monocytes infected with B. fragilis for 9 hours. MCP-1 or MIP-1alpha proteins was also parallel to the expression of those chemokines. 3) The fibroblasts isolated from intraabdominal abscess nodules by B. fragilis infection constitutively expressed MCP-1, MIP-1alpha, production in the fibroblasts was significantly upregulated in response to proinflammatory cytokines produced in the monocytes, including IL-1alpha and TNFalpha, but MCP-1 production were not. The normal fibroblasts from uninfected mice didnot show significant production of MCP-1 or MIP-1a in response to IL-1a or TNFalpha. CONCLUSION: These results suggest that peritoneal monocytes and fibroblasts surrounding with abscesses induced by B. fragilis produce MCP-1 or MIP-1a. Furthermore, it could be extrapolated that those effects may play a role in the formation of intraabdominal abscess nodules.
Abscess* ; Animals ; Bacteria ; Bacteroides fragilis* ; Bacteroides* ; Chemokine CCL2* ; Chemokine CCL3 ; Chemokines ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Fibroblasts ; Guanidine ; Intraabdominal Infections ; Macrophages* ; Mice ; Models, Theoretical ; Monocytes* ; Neutrophils ; RNA ; RNA, Messenger ; Sepsis ; Silicon Dioxide ; Tissue Extracts ; Tumor Necrosis Factor-alpha

BACKGROUND: beta-lactam antibiotics are one of the most common antimicrobial agents. However, the increasing of beta-lactamase-producing bacteria makes these agents less useful. Therefore, agents stable for beta-lactamase have been developed. This study was conducted to determine the activities of the combination agent ceftriaxone-sulbactam and to compare its activities with other agents. METHODS: A total of 437 clinical isolates of aerobic and anaerobic bacteria were collected in Severance Hospital from 2007 to 2011. Using 23 antimicrobial agents, antimicrobial susceptibility tests were performed using the Clinical and Laboratory Standards Institute (CLSI) agar dilution method. RESULTS: The minimal inhibitory concentrations (MICs) of ceftriaxone and ceftriaxone-sulbactam were similar to or lower than those of other beta-lactam antibiotics for methicillin-susceptible Staphylococcus aureus (MSSA), Streptococcus pneumoniae, S. pyogenes, and viridans group streptococci. For Moraxella catarrhalis, Neisseria gonorrhoeae, Haemophilus influenzae, and H. parainfluenzae, ceftriaxone and the ceftriaxone-sulbactam combination also show low MIC50 and MIC90. For extended-spectrum beta-lactamase (ESBL)-producing E. coli, the MICs of ceftriaxone-sulbactam were lower than those of other cephalosporins. Among the anaerobes, ceftriaxone-sulbactam showed good activity compared to ceftriaxone alone for the Bacteroides fragilis group, B. thetaiotaomicron, other Bacteroides sp., Prevotella sp., and Porphyromonas sp. CONCLUSIONS: Ceftriaxone-sulbactam showed good antimicrobial activity and thus is useful for the treatment of infections by MSSA, S. pneumoniae, S. pyogenes, viridans group streptococci, M. catarrhalis, N. gonorrhoeae, H. influenzae, H. parainfluenzae, E. coli, and K. pneumoniae, B. fragilis group, B. thetaiotaomicron, other Bacteroides sp., Prevotella sp., and Porphyromonas sp.
Agar ; Anti-Bacterial Agents ; Anti-Infective Agents ; Bacteria ; Bacteria, Anaerobic ; Bacteroides ; Bacteroides fragilis ; beta-Lactamases ; Ceftriaxone ; Cephalosporins ; Haemophilus influenzae ; Influenza, Human ; Moraxella (Branhamella) catarrhalis ; Neisseria gonorrhoeae ; Paramyxoviridae Infections ; Pneumonia ; Porphyromonas ; Prevotella ; Staphylococcus aureus ; Streptococcus pneumoniae ; Sulbactam

The author reviews 28 cases of brain anscess treated in Kyung Hee University over 13 years from January 1979 to December 1991. The patients consisted of 21 males and 7 females with predominance of 2nd and sixth decade. The commonest causes were ear and nose origin and respiratory tract infection. Common symptoms of the patients were headache and focal neurologic deficit which were followed nausea and mental disturbance and elevated WBC in peripheral blood and ESR also. The frequent location were parietal, temporal, frontal and cerebellum in order. As oon as the provizional diagnosis of brain abscess was made, antibiotics were started. Sterile cultures were obtained in 57% of abscess, common pathogen were proteus in aerobic culture and bacteroides in anaerobic culture in this study. In according to operative methods, drainange and aspiration had some recurrent cases, but excision had no recurrent cases. Excision was the best method in brain abscess which were large size, well capsulated and superficial location.
Abscess ; Anti-Bacterial Agents ; Bacteroides ; Brain Abscess* ; Brain* ; Cerebellum ; Diagnosis ; Drainage ; Ear ; Female ; Headache ; Humans ; Male ; Nausea ; Neurologic Manifestations ; Nose ; Proteus ; Rabeprazole ; Respiratory Tract Infections

Pylephlebitis is defined as septic thrombophlebitis of the portal vein or one of its tributaries. Pylephlebitis is an uncommon and often fatal complication of intra-abdominal infections, such as diverticulitis and appendicitis. The most common bacteria isolated from patients with pylephlebitis are Escherichia coli and Bacteroides fragilis. The overall mortality rate is 32%. We describe a case of septic thrombophlebitis of the main portal vein and inferior mesenteric vein successfully treated with broad-spectrum antibiotics and anticoagulants. The early diagnosis and treatment with the timely administration of antibiotics is most important for pylephlebitis.
Anti-Bacterial Agents ; Anticoagulants ; Appendicitis ; Bacteria ; Bacteroides fragilis ; Cavernous Sinus Thrombosis ; Diverticulitis ; Early Diagnosis ; Escherichia coli ; Humans ; Intraabdominal Infections ; Mesenteric Veins ; Portal Vein ; Thrombophlebitis

Pylephlebitis is defined as septic thrombophlebitis of the portal vein or one of its tributaries. Pylephlebitis is an uncommon and often fatal complication of intra-abdominal infections, such as diverticulitis and appendicitis. The most common bacteria isolated from patients with pylephlebitis are Escherichia coli and Bacteroides fragilis. The overall mortality rate is 32%. We describe a case of septic thrombophlebitis of the main portal vein and inferior mesenteric vein successfully treated with broad-spectrum antibiotics and anticoagulants. The early diagnosis and treatment with the timely administration of antibiotics is most important for pylephlebitis.
Anti-Bacterial Agents ; Anticoagulants ; Appendicitis ; Bacteria ; Bacteroides fragilis ; Cavernous Sinus Thrombosis ; Diverticulitis ; Early Diagnosis ; Escherichia coli ; Humans ; Intraabdominal Infections ; Mesenteric Veins ; Portal Vein ; Thrombophlebitis

Oral lichen planus (OLP) is a chronic inflammatory disease that is frequently detected in oral tissues. The aim of our study was to identify the prevalence of the detection of periodontopathogenic microorganisms (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Treponema denticola in OLP patients and to compare with this prevalence of periodontopathogenic microorganisms in healthy non-OLP patients. Our study included 27 (18 chronic periodontitis (OLPP) and 9 gingivitis (OLPG)) patients diagnosed with OLP along with 26 (13 chronic periodontitis (HP) and 13 gingivitis (HG)) healthy non-OLP patients. The multiplex polymerase chain reaction (PCR) with subsequent reverse hybridization method (micro-IDent) was used for identifying periodontopathogenic microorganisms present in subgingival plaque samples. The percentages of detection for A. actinomycetemcomitans, P. gingivalis, P. intermedia, T. forsythia and T. denticola in subgingival plaque samples taken from OLP patients (OLPG and OLPP) were 18.5%, 85.1%, 81.4%, 88.8% and 74%, respectively. Meanwhile, in the non-OLP patients (HG and HP), these values were 7.6%, 50%, 46.1%, 73% and 57.7%, respectively. Thus, comparing the non-OLP groups with the OLP groups, the periodontopathogens' percentages of detection in the OLP groups were higher than those in the non-OLP groups. According to our study results, OLP patients have higher levels of infection with A. actinomycetemcomitans, P. gingivalis, P. intermedia, T. forsythia and T. denticola than non-OLP patients. We argue that the high percentages in patients with OLP may help identify the importance of periodontopathogenic microorganisms in the progress of periodontal diseases of OLP.
Actinobacillus Infections ; diagnosis ; Adult ; Aggregatibacter actinomycetemcomitans ; isolation & purification ; Bacteroidaceae Infections ; diagnosis ; Bacteroides ; isolation & purification ; Bacteroides Infections ; diagnosis ; Chronic Periodontitis ; microbiology ; Dental Plaque ; microbiology ; Dental Plaque Index ; Female ; Gingivitis ; microbiology ; Gram-Negative Bacteria ; isolation & purification ; Humans ; Lichen Planus, Oral ; microbiology ; Male ; Middle Aged ; Periodontal Attachment Loss ; microbiology ; Periodontal Index ; Periodontal Pocket ; microbiology ; Porphyromonas gingivalis ; isolation & purification ; Prevotella intermedia ; isolation & purification ; Treponema denticola ; isolation & purification ; Treponemal Infections ; diagnosis

BACKGROUND: Periodic monitoring of antimicrobial resistance trends of clinically important anaerobic bacteria such as Bacteroides fragilis group organisms is required. We determined the antimicrobial susceptibilities of clinical isolates of B. fragilis group organisms recovered from 2009 to 2012 in a tertiary-care hospital in Korea. METHODS: A total of 180 nonduplicate clinical isolates of B. fragilis group organisms were collected in a tertiary care hospital. The species were identified by conventional methods: the ATB 32A rapid identification system (bioMerieux, France) and the Vitek MS matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (bioMerieux). Antimicrobial susceptibility was determined by the CLSI agar dilution method. RESULTS: Imipenem and meropenem resistance rates were 0-6% for B. fragilis group isolates. The rate of resistance to piperacillin-tazobactam was 2% for B. fragilis and 0% for other Bacteroides species, but 17% for B. thetaiotaomicron isolates. High resistance rates to piperacillin (72% and 69%), cefotetan (89% and 58%), and clindamycin (83% and 69%) were observed for B. thetaiotaomicron and other Bacteroides spp. The moxifloxacin resistance rate was 27% for other Bacteroides spp. The MIC50 and MIC90 of tigecycline were 2-4 microg/mL and 8-16 microg/mL, respectively. No isolates were resistant to chloramphenicol or metronidazole. CONCLUSIONS: Imipenem, meropenem, chloramphenicol, and metronidazole remain active against B. fragilis group isolates. Moxifloxacin and tigecycline resistance rates are 2-27% and 8-15% for B. fragilis group isolates, respectively.
Anti-Infective Agents/*pharmacology ; Bacteroides Infections/*microbiology/pathology ; Bacteroides fragilis/*drug effects/isolation & purification ; Drug Resistance, Multiple, Bacterial ; Humans ; Imipenem/pharmacology ; Inhibitory Concentration 50 ; Microbial Sensitivity Tests ; Penicillanic Acid/analogs & derivatives/pharmacology ; Piperacillin/pharmacology ; Republic of Korea ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; Tertiary Care Centers ; Thienamycins/pharmacology

BACKGROUND: beta-lactam antibiotics are one of the most frequently used antimicrobial agents. However, with the increase of beta-lactamase-producing bacteria, penicillins arid 1 st generation cephalosporins have become less useful. Cefatrizine and clavulanic acid combination (CTCA) was developed to restore the activity. The aim of this study was to determine the activities of CTCA against major recent clinical isolates. METHODS: Aerobic and anaerobic bacteria tested were isolated from clinical specimens in Severance Hospital during 1996 to 1999. Antimicrobial susceptibility was determined by the NCCLS agar dilution methods. RESULTS: MICs of cefatrizine (CT) and CTCA were similar for methicillin-susceptible Staphylococcus aureus, Streptococcus pyogenes and S. pneumoniae. For Moraxella (Branhamella) catarrhalis, MIC90 CTCA was 1 microgram/mL, which was 1/8-fold lower than that of cefatrizine. MIC90S of CTCA for Escherichia coli and Klebsiella pneumoniae were 4 microgram/mL and 8 microgram/mL, respectively, which were 1/4- to 1/16-fold lower than those of CT. However, it was less active against Citrobacter freundii, Enterobacter cloacae and Serratia marcescens. Against Bacteroides fragilis group organisms, it showed good activities similar to those of other beta-lactam and beta-lactamase inhibitor combinations. CONCLUSIONS: CTCA showed good antimicrobial activities against M. (B.) catarrhalis, Haemophilus influenzae, Neisseria gonorrhoeae, extended spectrum beta-lactamase-producing E. coli and K. pneumoniae, Proteus vulgaris and B. fragilis. In conclusion, it would be useful for the treatment of infections due to those organisms, and for the empirical treatment of respiratory and urinary tract infections.
Agar ; Anti-Bacterial Agents ; Anti-Infective Agents ; Bacteria* ; Bacteria, Anaerobic ; Bacteroides fragilis ; beta-Lactamases ; Cefatrizine ; Cephalosporins ; Citrobacter freundii ; Clavulanic Acid ; Enterobacter cloacae ; Escherichia coli ; Haemophilus influenzae ; Klebsiella pneumoniae ; Moraxella (Branhamella) catarrhalis ; Neisseria gonorrhoeae ; Penicillins ; Pneumonia ; Proteus vulgaris ; Serratia marcescens ; Staphylococcus aureus ; Streptococcus pyogenes ; Urinary Tract Infections