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Staphylococci and micrococci

After growth of yeasts, growth of a progression of bacteria occurs during smear development staphylococci and micrococci grow early in ripening generally followed by coryneform bacteria. Both staphylococci and micrococci can grow in the presence of 10 salt and they are also acid tolerant and may grow at pH 6.0. Staphylococci are more important than micrococci and have been reported to account for 5-25 of total counts in certain smear-ripened cheeses. They have been reported at levels of 105cfuml_1 in cheese brines.


The superbug technology, developed by Wang et al., made use of engineered bacteria through fermentation to provide all the necessary enzymes along the bio-synthetic pathway. A single microbial strain was transformed with a single artificial gene cluster of all the biosynthetic genes. The metabolism of the engineered bacteria can then be exploited to provide the necessary bioenergetics (ATP or PEP) to drive a glycosylation cycle. In this approach, it is unnecessary to purify and immobilize individual enzymes furthermore, the proteins may be expressed without tags (122). Around 7.2 g liter of isoglobotriose (Gala1,3Lac, also known as a-Gal epitope) were synthesized after 36 h using the superbug system (75) (Scheme 13). Five enzymes required for the synthesis of isoglobotriose including the sugar nucleotide regeneration pathway were cloned in tandem into single plasmid and transformed into E. coli. Similarly, globotriose and its derivatives (Gala1,4LacOBn) were also produced in high...

Bacterial Conjunctivitis

In the UK, the commonest organisms to cause conjunctivitis are the pneumococcus, Haemophilus spp. and Staphylococcus aureus. The last mentioned is normally associated with chronic lid infections, and the acute purulent conjunctivitis, known more familiarly as pink eye , is usually caused by the pneumococcus. Chronic conjunctivitis can also be caused by Moraxella lacunata but this organism is rarely isolated from cases nowadays. An important but rare form of purulent conjunctivitis is that caused by Neisseria gonorrhoeae this is still an occasional cause of a severe type of conjunctivitis seen in the newborn babies of infected mothers. Untreated, the cornea also becomes infected, leading to perforation of the globe and perma- nent loss of vision. Purulent discharge, redness and severe oedema of the eyelids are features of the condition, which is generally known as ophthalmia neonatorum (Figure 6.2). Ophthalmia neonatorum can also be caused by staphylococci and the chlamydia (see...

Vaccine development and licensing

Useful in manufacturing, but instrumental approaches provide validation and calibration of these assays. Whilst methods for protein analysis are reasonably standard, glycan methodology must be matched to the polysaccharide structure. Whilst meningococcal CPSs are acid labile and can be quantified after hydrolysis, Salmonella enterica serotype Typhi Vi and Staphylococcus aureus Types 5 and 8 CPSs resist hydrolysis. Characterisation methodology used for QC purposes, such as HPSEC-MALLS, NMR or mass spectrometry (32-33), should be validated in line with ICH Guidelines.

Antimicrobial Resistance Patterns

The utility of penicillins and traditional cephalosporins at some centers.7 Although imipenem, meropenem, and cefepime have extremely broad spectrums of activity, organisms resistant to these agents have also been described.4,5 Methicillin resistance in coagulase-nega-tive staphylococci and Staphylococcus aureus (MRSA) has become increasingly common, as has vancomycin-resistant Enterococcus (VRE).

Timing of Grampositive therapy

There has been considerable debate regarding the inclusion of Gram-positive coverage (particularly vancomycin) in the initial regimen, with studies suggesting that vancomycin can be safely added later.15 However, some institutions use vancomycin because of the fulminant syndrome that can occur with viridans streptococci, including those with reduced susceptibility to penicillins, and the rise of methicillin-resistant staphylococci in patients with indwelling catheters. Vancomycin may, however, predispose to VRE infection, renal dysfunction, and rash. The Hospital Infection Control Practices Advisory Committee (HICPAC) has issued guidelines, which discourage empiric use of vancomycin except in situations where the risk of omitting it is high.16 However, the benefits may still outweigh the risks at some centers with a high rate of methicillin resistance.

The Discovery of Thienamycin an Unstable Antibiotic with a Remarkably Broad Profile as an Inhibitor of Bacterial Cell

In the late 1970s, a soil sample that had been collected in New Jersey, was evaluated by Dr Sebastian Hernandez and his associates in the Merck Laboratories in Spain. The culture that contained the antibiotic thienamycin attracted the attention of Dr Hernandez's staff because it had an unusual lavender blue pigmentation. Further screening in Spain revealed the presence of inhibitors of bacterial cell wall synthesis. The organism was sent to Dr Edward Stapley, Executive Director of Basic Microbiology in Rahway, NJ. Dr Sheldon Zimmerman, Associate Director of Analytical Microbiology, concluded that the culture contained not only two known antibiotics, but also one new chemical entity. In another Rahway laboratory, Frederick and Jean Kahan were searching for cell wall synthesis inhibitors in Grampositive bacteria, such as Streptococcus and Staphylococcus. The Kahans encountered what became the first major challenge of the thienamycin problem its chemical instability. At the same time...

Granulocyte Colony Stimulating Factor and Granulocyte Macrophage Colony Stimulating Factor

Similar results have been reported for G-CSF, although CLL B-cells have to be stimulated with Staphylococcus aureus Cowan I (SAC) or the anti-CD40 antibody in combination with IL-2 or IL-4 to produce G-CSF in vitro (114). Moreover, leukemic CLL cells bear receptors for G-CSF that are upregulated in vitro by IL-2 and that have been reported to mediate an anti-apoptotic effect in some CLL cell samples (115,116).

Oligosaccharide Synthesis by Metabolically Engineered Bacteria

Produce oligosaccharides, there is no need to isolate enzymes and biotransformations can be carried out with inexpensive precursors (25). Kyowa Hakko Kogyo Co. Ltd. developed a system for large-scale synthesis of oligosaccharides by coupling multiple metabolically engineered bacteria (63,116-118). In addition, Wang et al. have developed the superbug technology utilizing single recombinant bacteria carrying one engineered recombinant plasmid. Samain et al. have also investigated in vivo synthesis of oligosaccharides in recombinant microorganisms (119,120).

Potential Etiologic Agents

BW Potential biological warfare agent and CW potential chemical warfare agent. Acute gastroenteritis Norwalk-like virus (vom-itoxin), Staphylococcus aureus toxinbw, Bacillus cereus toxin, all heavy metals (Hg, As). Noninflammatory diarrhea Enterotoxigenic E. coli (ETEC), Vibrio cholerae, astroviruses, cali-civiruses (genus Norovirus), rotaviruses, adeno-viruses, Cryptosporidium parvum, Cyclospora cayetanensis.

Genesis of the Upjohn Oxazolidinone Program

In October 1987, there was an appealing disclosure by DuPont scientists of two novel oxazolidinone antibacterial agents as clinical candidates, at the Interscience Conference on Antimicrobial Agents and Chemotherapy meeting, held in New York City. There, Andrew Slee and his co-workers14 disclosed preclinical data on DuP-105 (3) and DuP-721 (4), two totally synthetic compounds having potent antibacterial activity against Gram-positive bacteria, including MRSA, and good pharmacokinetic (PK) properties in rodents that included high oral bioavailability. Ranger20 has reviewed in significant detail the origin of these DuPont leads.

Management in Custody

The health care professional managing the detainee should clean and dress open wounds as soon as possible to prevent the spread of infection. It may also be appropriate to start a course of antibiotics if there is abscess formation or signs of cellulites and or the detainee is systemically unwell. However, infections can often be low grade because the skin, venous, and lymphatic systems have been damaged by repeated penetration of the skin. In these cases, signs include lymphedema, swollen lymph glands, and darkly pigmented skin over the area. Fever may or may not be present, but septicemia is uncommon unless the individual is immunocompromised (e.g., HIV positive). Co-Amoxiclav is the preferred treatment of choice because it covers the majority of staphylococci, streptococci, and anerobes (the dose depends on the degree of infection).

Scientific Foundations

By Staphylococcus aureus (Staph) and Streptococcus (Strep). Strep throat is a common sickness caused by Streptococcus. Some physicians also suggest that children with certain skin conditions such as acne or impetigo (a common skin infection that causes crusty sores) use antibacterial soap to control these conditions.

Other Bacteria Causing Perinatal Disease

Staphylococcal Infections Staphylococcus aureus has been described in nursery outbreaks for more than 100 years. It has only been recently that Staphylococcus epidermidis has received attention as an increasing cause of neonatal sepsis. S. epidermidis infections are especially common among infants who are premature or who otherwise require catheter placement, and this organism is the most frequent etiologic agent of sepsis in some neonatal intensive care units. Although positive blood cultures might be caused by contamination with skin flora during the specimen collection, the isolation of coagulase-negative sta-phylococci should not be readily dismissed. Prevention of the spread of S. aureus colonization within the nursery is a challenging prospect. Neonatal staphylococcal skin infections include bullous impetigo, sta-phylococcal scalded skin syndrome, and toxic shock syndrome. Staphylococcal pneumonia is associated with significant mortality and is characterized by the formation of...

Infectious Complications

Hypogammaglobulinemia may account for the increased susceptibility to polysaccharide encapsulated organisms, particularly at the time of diagnosis and following initial treatment (see next).3435 However, infections with gram negative bacilli and Staphylococcus aureus appear to be more common causes of serious and lethal infections in those patients undergoing chemotherapy within the first 2 months after diagnosis.36-38 In addition, such infections frequently necessitate delaying chemotherapy. Efforts to reduce the occurrence of infection in those patients undergoing initial treatment are warranted.

Biomedical Applications of Fullerenes

Fullerenes have been suggested to hold promise for the inhibition of HIV protease 309 , as a target to bone tissues 310 , and as an antibacterial agent 311 . In a study by Friedman et al. 309 , a diamino diacid derivative of fullerene was demonstrated to be a potent inhibitor for the protease enzyme specific to the human immunodeficiency virus. The study concluded that the strong hydrophobic interactions between the fullerene derivative and enzyme led to the inhibition of the virus. Another study by Gonzalez et al. 310 demonstrated that fullerene functionalized with a bisphosphate could be successfully used for the targeting of the specific bone tissue. This ability could be an important step toward the development of future fullerene derivatives as bone therapeutic agents. The trimalonic acid derivative of fullerene, carboxyfullerene, is water soluble and has been studied for its antibacterial activity on Gram-positive bacteria, Staphylococci 311 . The lethal action of...

Evaluation And Management Of The Febrile Patient

Staphylococci Viridans streptococci Gram-negative bacilli Gram-negative bacilli Staphylococci Community respiratory viruses Aspergillus species Staphylococci Gram-negative bacilli Candida species The selection of an empiric antimicrobial regimen should be guided by the suspected anatomic origin of the fever, by the pathogens suspected, and by local susceptibility profiles of institutional isolates. It is imperative to prospectively monitor and report to clinicians the antimicrobial susceptibility profiles of bacterial pathogens encountered within the institution and on the stem cell transplant unit, as this may impact on the selection of empiric antibacterial regimens and identify potential outbreaks.2 The recent change by the National Committee on Clinical Laboratory Standards in the breakpoint defining susceptibility of coagulase negative staphylococci to methicillin has led to the reclassification of 95 of coagulase negative staphylococci as methicillin-resistant. As these...

Thrombolytic Agents used in Trials and Clinical Practice

These groups of agents have been developed through modifications of the basic t-PA structure. They are either conjugates of plasminogen activators with monoclonal antibodies against fibrin, platelets, or thrombomodulin mutants, variants, and hybrids of t-PA and prourokinase (amediplase) or new molecules of animal (vampire bat) or bacterial (Staphylococcus aureus) origin.35 These molecular variations have yielded agents with better pharmacological properties than t-PA, a longer half-life, resistance to plasma protease inhibitors, and more selective fibrin binding.4,35 Several of these agents are being developed including reteplase (r-PA, retevase), lanoteplase (nPA), tenecteplase (TNKase), pamiteplase (YM866 Solinase), staphylokinase, and novel modified tissue plasminogen activator (E6010). Staphylokinase Staphylokinase was known to possess profibrinolytic properties more than four decades ago.35 It is produced by certain strains of S. aureus. It acts on the surface of the...

Do pathogens grow during cheese ripening

Whether pathogens grow or decline during ripening depends largely on the chemical and compositional properties of the cheese variety in question. In general, cheeses with high moisture contents, or those with a neutral pH due to bloomy rind or smear development, will support the survival or growth of pathogens during ripening. Conversely, in hard, low-moisture cheeses with a low pH, pathogens die during ripening. Pathogens can be present in cheeses either as a result of surviving pasteurisation or through recontamination from the ageing environment after manufacture. In studies of Swiss hard and semi-hard cheeses 117 where high levels of pathogens, including Aeromonas hydrophila, Campylobacter jejuni, Escherichia coli, Listeria monocytogenes, Pseudomonas aeruginosa, Salmonella spp., Staphylococcus aureus and Yersinia enterocolitica were inoculated to raw milk, no detection of pathogens beyond 1 day was recorded. The high curd cooking temperatures used for Swiss hard (Emmentaltype) and...

CASE 4 Progressive Diabetic Nephropathy Case Description

Her proteinuria was initially diagnosed in 1980 (age 20) on a routine urinalysis when hospitalized for a staphylococcal infection following a spider bite. A 24 urine for protein was 2.16 g. Her serum creatinine and iothlamate clearance were 0.8 mg dL and 111 mL min 1.73 m2, respectively.

Honey in Wound Healing

Five years later, Molan in a review article revisited the evidence for the use of honey as a wound dressing (46). This was an interesting review written by a person with an established interest in undertaking research and clinical usage of honey. The review details positive findings of the therapeutic applications of honey in 12 randomized controlled trials involving 1965 participants and 5 clinical trials (not randomized) involving 97 participants. Further evidence of the effectiveness of honey on wound healing was detailed in 16 trials involving 533 wounds in animals. It was noted that there were also numerous case reports detailing the efficacy of honey. Of note, there are reports of the success of honey in the treatment of some particularly difficult organisms including Methicillin-resistant Staphylococcus aureas and Vancomycin-resistant enterococci (47). What is particularly interesting however are the comments concerning the abundant clinical evidence to support the use of honey...

Indwelling iv catheters

Tunneled catheters are subject to several types of infection exit site cellulitis, bacteremia with or without external signs, tunnel infection, and septic thrombophlebitis. The most common causative organisms are coagulase-negative staphylococci, but Staphylococcus aureus, Enterococcus, Gram-negative bacilli, other skin flora, yeast, and occasionally nontuberculous mycobac-teria also may be causative organisms. Decisions regarding catheter removal often must be made in the face of fever, neutropenia, and need for multilumen access. In general, tunnel infections require catheter removal regardless of the organism, and pain over the tunnel may be the only sign in a neutropenic patient. In Candida, VRE, or Bacillus infection, it is particularly important to remove the catheter, and it is often desirable to do so for Staphylococcus aureus and Gram-negative bacilli. On the other hand, in the absence of tunnel infection, coagulase-negative staphylococcal infection can often be cleared...

Allergic Conjunctivitis

Keratoconjunctivitis have a higher risk than normal for the development of herpes simplex keratitis the condition is also associated with the corneal dystrophy known as keratoconus or conical cornea. They are likely to develop skin infections and chronic eyelid infection by staphylococcus. The recurrent itch and irritation (in the absence of infection) is relieved by applying local steroid drops, but in view of the long-term nature of the condition, these should be avoided if possible because of their side effects. (Local steroids can cause glaucoma in predisposed individuals and aggravate herpes simplex keratitis.)

CASE 2 Latent Autoimmune Diabetes In Adults Case Description

This fit, 75-yr-old male flight engineer was initially diagnosed with type 2 diabetes mellitus at the age of 73. At the time of diagnosis in November 1997, he was hospitalized with a deep-seated staphylococcus aureus infection following arthroscopic left rotator cuff repair. He was initially treated with insulin at the time of diagnosis, but later was switched to the combination of metformin and troglitazone by his primary physician. With

The Medical Need for New Antibiotics Multi Drug Resistance

Over the past 15 years, MDR strains have become highly prevalent among important Gram-positive pathogens, particularly in those isolates taken from patients with hospital-acquired infections in intensive care units (ICUs). The continually escalating incidence of methicillin-resistant strains of Staphylococcus aureus (MRSA) in many European countries now exceeds 25 10 in the USA11 and Japan,12 this figure currently approaches 60 and 70 , respectively. Of concern, new clones of MRSA have been isolated from outbreaks in healthy people within community settings.13 At the time that our work on the oxazolidinones initiated at Upjohn in late 1987, a new MDR strain of a Grampositive enterococcal pathogen was just on the cusp of emergence - but not yet recognized as the problem pathogen it has now become. Our interest at that time in the oxazolidinones was based on attributes of two lead compounds described by DuPont.14 Researchers there had demonstrated in animal models of infection the...

Carbohydrate Antigens and Vaccines

The capsular polysaccharide haptens of several serotypes of a given pathogen in the same conjugate, have been developed against S. pneumoniae (152), and others in clinical use are targeted against Neisseria meningitides, group B Streptococcus, Salmonella typhi, and Staphylococcus aureus (151). The field remains under active development with efforts to optimize the specific carbohydrate hapten component, the nature of the protein employed, and the mode of covalent linking of the two components (153).

Clinical Evaluation Of The Infant

Many different conditions may mimic HSV disease. In the infant with disseminated infection and its associated multiorgan involvement, other conditions that must be considered include hyaline membrane disease, intraventricular hemorrhage, necrotizing enterocolitis, and overwhelming bacterial sepsis caused by, among others, group B streptococcus, Staphylococcus aureus, Listeria monocytogenes, and Gram-negative bacteria.

Deficiencies in Humoral Immunity

In one study, some patients had deficiencies in only the early classical pathway (C1-C4), the late classical pathway (C5-C9), or the alternative pathway, whereas some had deficiencies in all three (28). In some studies, the most frequently detected deficiency was component C1 (29). Low concentrations of C1 and C4 have been associated with increased risk of infection, although this has not been confirmed by all studies. Sera from patients with deficiencies in these components have severely impaired bactericidal activity in vitro. Poor opsinization of Staphylococcus aureus, Haemophilus influenzae, and especially S. pneumoniae has been associated with defective activation of complement (30).

Surfaceripened cheeses

Microflora of commercial brines include halotolerant lactobacilli and yeasts such as Debaromyces hansenii. Immersion of cheeses in brine leads to halo-tolerant microflora developing on the surface of the cheese. In white mould-ripened cheeses 128 , growth of Penicillium camemberti is promoted by low levels of NaCl and is unaffected by levels up to 10 NaCl. Growth of P. camemberti is poor at levels less than 0.8 NaCl. If brining is delayed, Geotrichum candidum grows well but it is inhibited by relatively low salt levels and is totally inhibited by -6 NaCl. Smear-ripened cheeses 141 are brined and usually also have smear liquid (dilute brine) applied to their surface during ripening. This promotes the growth of a halotolerant surface microflora including coryneforms, brevibacteria, micrococci and staphylococci 142 which are capable of growth at 10 NaCl.

Ophthalmia Neonatorum

It is important to realise that in the early part of this century, a large proportion of the inmates of blind institutions had suffered from ophthalmia neonatorum. The disease affects primarily the conjunctiva and cornea and is the result of infection by organisms resident in the maternal birth passage. The gonococcus was the most serious cause of blindness but a number of other bacteria have been incriminated, including staphylococci, streptococci and pneumococci. It has also been shown that chlamydial infection of the genital tract can lead to the same problem, as can infection by the herpes simplex virus. The blindness that resulted from this condition was so serious that any excessive discharge from the eyes has been a notifiable disease in this country since 1914. Ophthalmia neonatorum is caused by unhygienic conditions at birth and its relative rarity nowadays is because of the fact that midwives are trained to screen for the condition. Bacterial conjunctivitis usually occurs...

Reduction of Infection

Heparin surface modification and heparin treatments of lenses may reduce the incidence of postoperative endophthalmitis and intraocular inflammation. Significantly fewer Staphylococcus epidermidis attached to heparin surface-modified intraocular lenses and to regular poly(methyl methacrylate) intraocular lenses treated with heparin than to untreated poly(methyl methacrylate) intraocular lenses (104). When heparin was added to the medium, the numbers of Pseudomonas aeruginosa adhering to the contact lenses were significantly lower than those adhering to the control lenses (105).

What cheeses are most liable to pathogens

The pathogens Salmonella spp., L. monocytogenes, Staphylococcus aureus and enteropathogenic Escherichia coli pose the greatest risk to the safety of cheese. If active lactic acid starter cultures 18 are used, S. aureus is considered to be a low-risk pathogen. However, in traditional cheeses where active starter cultures are not utilised, S. aureus may pose a significant risk for toxin production in cheese if numbers are sufficiently high. The factors that contribute to the safety of cheese with respect to pathogenic bacteria include milk quality, starter

Materials and Methods

Microbiological study controls in phase 1 were internal controls for amplification (DNA from Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 25923, P. aeruginosa ATCC 35218, Candida albicans ATCC 90028) whole blood of 20 healthy blood donors, and dialysis ultrapure water collected from different points of the treatment plant.

Distribution Of Cas

CAs were recently shown to be present in a multitude of prokaryotes, in which these enzymes play important functions, such as respiration, transport of carbon dioxide and photosynthesis (Smith and Ferry 2000). The possibility of developing CA-inhibitor-based antibiotics by inhibiting bacterial CAs present in pathogenic species raised much interest some years ago, with promising results in the use of ethoxzola-mide for treating meningitis (Eickhoff and Nelson 1966 Nafi et al. 1990). This type of inhibition has also been exploited for developing selective culture media for other pathogenic bacteria, such as Branhamella catarrhalis (Nafi et al. 1990), in the presence of different Neisseria species. Some strains of Pseudomonas, Staphylococcus,


The feasibility of antibiotic delivery systems based on lactide glycolide polymers was demonstrated a decade ago (102). Poly(DL-lactide-co-glycolide) comprising molar ratios of lactide glycolide in the range of 50 50 to 90 10 were investigated with ampicillin, gente-micin, polymyxin B, and chloramphenicol. Phase separation techniques and solvent evaporation procedures were used to formulate microspheres of each drug. In vivo studies in rats were conducted with induced infections with Streptococcus pyogenes and Staphylococcus aureus. Wounds were treated topically with ampicillin-loaded microspheres (68 32 DL-lactide glycolide). At 7 days postinfection, the test groups were free of infection and microbial assays showed no cultivatable organisms. Further studies confirmed these initial observations (103). Although parenteral antibiotic formulations ha re not received much attention, specialty applications have been studied. For example, compositions designed to release antibiotics in the...

Other Applications

As discussed above, ion implantation can also generate antibacterial properties on the metallic implant surfaces. It has been shown that F+ implanted titanium significantly inhibited the growth in vitro of both bacteria Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans than nonion implanted control polished titanium samples 70 . Other ions such as silver and copper also have favorable effects on antibacterial property of the surfaces. Dan et al. 71 demonstrated that implantation of copper ions into AISI 420 stainless steel with a dose of 5 x 1017 ions cm2 greatly improved its antibacterial property against both Escherichia coli and Staphylococcus aureus.


Staphylococcus aureus is commonly carried on the skin or in the nose of healthy people. Approximately 25-30 of the population is colonized with the bacteria but remain well (43). From time to time, the bacteria cause minor skin infections that usually do not require antibiotic treatment. However, more serious problems can occur (e.g., infection of surgical wounds, drug injection sites, osteomyelitis, pneumonia, or septicemia). During the last 50 years, the bacteria have become increasingly resistant to penicillin-based antibiotics (44), and in the last 20 years, they have become resistant to an increasing number of alternative antibiotics. These multiresistant bacteria are known as methicillin-resistant S. aureus (MRSA). MRSA is prevalent worldwide. Like nonresistant staphylococci, it may remain undetected as a reservoir in colonized individuals but can also produce clinical disease. It is more common in individuals who are elderly, debilitated, or immunocompromised or those with open...

Pyp 7790

Spectroscopy 19, 27, 47-51, 56-62, 66, 68, 69, 71, 79, 81, 85, 143, 145, 151, 155, 183, 196, 300, 327, 328 spheroidene 15, 27-47 spin angular momentum 46 spin polarization 39, 43, 46, 48 spinal chord 266 spiropyran 315 square-planar 4, 324, 331, 334 SRAS 272 SRP 209 stacking 172 Staphylococcus 305, 307 steady-state 90 stereoelectronic effect 12

T Beresford

Many cheeses contain a secondary flora that play a vital role in the ripening process. These include propionic acid bacteria (PAB) present in Swiss-type cheese 117 , micrococci, staphylococci, coryneform bacteria and yeasts present in smear-ripened cheese 142 and blue and white moulds present in mould-ripened cheese. These secondary flora grow during the ripening process and their metabolism directly influences the key quality attributes of the mature cheese. Secondary flora are often added during the manufacturing or ripening process but can also occur as natural contaminants. Potential spoilage and pathogenic organisms, which can include coliforms, clostridia, Staphylococcus aureus, Listeria monocytogenes and Salmonella enterica, all gain entry as contaminants from milk or during the manufacturing process. In general, such organisms find cheese a difficult environment for growth and survival however, they may attain levels in particular cheese types sufficient to cause spoilage of...

Acute toxicity

The major acute toxicity of 2-CdA is myelosuppression. In their long-term follow-up study, investigators at Scripps Clinic noted a 16 incidence of Grade 3 and a 71 incidence of Grade 4 neutropenia in the first 135 consecutive treated patients.5 Ten percent had Grade 3 and 10 had Grade 4 thrombocytopenia. Grade 3 anemia occurred in 20 and Grade 4 in 2 . Forty-two percent developed neutropenic fever, though in only 13 , was an infection documented. Of these, the most common infecting organism was Staphylococcus, usually associated with the indwelling intravenous catheter. Although there were several oral herpetic infections and acute dermatomal herpes reactivations, no fungal infections were found. This high rate of neutropenia with culture negative neutropenic fever was also noted at similar rates in other single-institution series with 2-CdA. Despite the frequency of myelosuppression, additional acute toxicities were uncommon. There were no significant rates of nausea, vomiting,...


Table 99.2 summarizes the common pathogens encountered during the preengraftment period. The most common portals of entry for bacterial infection during this period include central venous catheters and mucositis of the mouth and gut arising from the preparative regimen. Thus, not surprisingly, bacterial pathogens such as viridans streptococci and Gramnegative bacilli from the mouth and gastrointestinal tract, respectively, and skin organisms such as coagulase negative staphylococci are the most common bacterial pathogens encountered in the preengraftment period. Up to 12 of infections occur prior to transplant.4 Although Gram-negative infections were common during the 1980s, the use of prophylactic oral antibiotics such as fluoroquinolones and trimethoprim-sulfamethoxazole at the onset of neutropenia has led to a shift in the spectrum of bacterial pathogens seen in the preengraftment period. Gram-positive organisms now account for a majority of bacterial infections and for 50 of...

C W Donnelly

Indigenous microflora in the raw milk including pathogenic bacteria however, thermoduric organisms survive pasteurisation. Post-pasteurisation contamination of milk is problematic if the processing packaging environment is not maintained. Moreover, many contaminants, including Listeria, are able to form biofilms which protect them from cleaning and sanitising agents. Some regulations, such as those of the EU, have established microbiological limits at the sell-by date for products such as cheeses. With respect to regulations which govern the use of raw milk for cheesemaking, limits have been established for Staphylococcus aureus in raw milk. Finished cheeses must meet specific hygienic standards, in which case the presence of S. aureus and Escherichia coli indicate poor hygiene.


This refers to a chronic inflammation of the lid margins caused by staphylococcal infection. The eyes become red rimmed and there is usually an accumulation of scales giving the appearance of fine dandruff on the lid margins. The condition is often associated with seborrhoea of the scalp. Sometimes it becomes complicated by recurrent styes or chronic infection of the meibomian glands. The eye itself is not usually involved, although there could be a mild superficial punctate keratitis, as evidenced by fine staining of the lower part of the cornea with fluorescein. In more sensitive patients, the unsightly appearance can cause difficulties, but in more severe cases, the discomfort and irritation can interfere with work. Severe recurrent infection can lead to irregular growth of the lashes and trichiasis.


During the last 20 years, because it was thought that the issue of infectious diseases has been dealt with. Also vancomycin, which is used today as the last resort, is failing increasingly often. Resistant Staphylococcus strains have already developed even against the most recently introduced line-zolid.