News Story #18078

U.S. doctors can no longer assume that group A streptococcus is sensitive to erythromycin, according to Dr. Judith M. Martin, the lead researcher in a study reported in the April 18, 2002 issue of The New England Journal of Medicine. Group A streptococcus is the bacterial pathogen responsible for strep throat, as well as rheumatic fever, tonsillitis and skin infections. It can also lead to life-threatening septic infections.

Dr. Martin and her colleagues conducted a prospective study on the prevalence of sore throats in K through 8th graders. In the first two years of the study (1998-2000), 15 percent of school children tested positive for strep throat, but none of the group A streptococci showed macrolide resistance. In the period from October 2000 to May 2001, however, 48 percent of isolates were macrolide-resistant, and resistant isolates were found in 38 percent of people in the wider community who tested positive for group A.

In routine cases of pharyngitis, Martin et al. suggest that throat swab culture and susceptibility testing should precede the use of macrolide antibiotics; using the rapid group A streptococcal antigen-detection test could lead to treatment failure if macrolides are prescribed and the strain is resistant.

Macrolides include erythromycin, azithromycin (sold under the brand name Zithromax) and clarithromycin (Biaxin). Standard treatment for strep throat is penicillin

or amoxycillin, but patients who report suspected penicillin allergy would be prescribed macrolide antibiotics. In addition, many doctors prescribe azitrhomycin to patients without penicillin allergy because it is a convenient pill, taken once a day for five days. Patients with true penicillin allergy (about five to 10 percent of the population) could be prescribed clindamycin, a third class of drug, instead of a macrolide. Or, if a doctor still wants to prescribe a macrolide, a throat culture should be taken and analyzed for resistance.

In a subsequent article, Dr. Pentti Huovinen suggests that the findings of resistant strep are particularly troubling in light of two concurrent trends in the U.S.: the resurgence of acute rheumatic fever and an emergence of serious and invasive disease caused by group A streptococci; and the growing popularity of macrolide antibiotics as empirical therapy for upper respiratory tract infections. The Pittsburgh clone or other resistant strains may have spread elsewhere in the U.S., Huovinen states, and physicians should know the prevalence of resistance in their area. Experience in Huovinen’s native Finland showed that decreased use of macrolides in turn decreased the prevalence of macrolide-resistant group A streptococci.

The finding of any type of macrolide resistance among streptococci has to be taken seriously, notes Huovinen, citing a recent case in which a single mutation in Streptococcus pneumoniae during treatment with azirthomycin led to a fatal pneumonia relapse. He also refers to another study’s early findings associating erythromycin resistance in group A streptococci with the ability to enter human respiratory cells. Such invasive bacteria may be resistant to beta-lactam antibiotics as well as macrolides.

‘Red gold: the epic story of blood’ to air on PBS in June
A new four-part PBS documentary, to air on Sunday nights, June 23rd and 30th, will explore the history of our understanding and use of blood from earliest times through the present.

The first episode begins in the period before written history, when virtually nothing was known about blood except that it was intimately connected with life and death.

Galen, the doctor who treated wounded Roman gladiators, is the first blood expert to be featured in the documentary. Also seen is a sequence on George Washington that explores the practice of blood-letting, believed to have precipitated the first President’s death. Then, in the 19th century, an obstetrician named James Blundell began saving lives by transfusing mothers during childbirth; using their husband’s blood also often led to fatal consequences from incompatible types. The reemergence of the blood typing work of Viennese pathologist Ernest Landsteiner ushered in the era of safe transfusion.

Episode two shows how the wars of the 20th century brought one advance after another to the collection, storage and handling of blood. Lessons learned on the battlefield through innovation and experimentation led to new methods that saved civilian lives.

In World War II, blood became a military resource and, like oil, it was collected by the barrel, broken down into parts and shipped to far off battlefields. It ultimately played an important part in helping the Allies, who had the techniques for shipping blood, to win the war. This episode also shows the first “blood bank” using blood collection from fresh cadavers. And, the episode depicts World War II era efforts to recruit civilian blood donors.

The third episode details the massive requirements for blood that came about post-war, to be used for new medical techniques from open heart surgery to the development of blood-based vaccines. This was the time when we became aware of the diseases and virus that can be transmitted through blood and body fluids.

Episode four looks at present blood supplies in both the industrial and developing world, and poses questions for the future. Highlights include interviews on issues of safety, elimination of threats of contagion, and availability and cost of blood. The story is shown of a husband in India who must search out relatives to donate an equivalent amount of blood to replenish the supply needed for his wife’s surgery, in order for the hospital to provide treatment. Also shown is a billionaire who is using his fortune to search for an artificial substitute for blood. And, a new variant CJD (Mad Cow disease) is discussed as the possible new threat to global blood supplies.

CRP levels predict risk of sudden death
The Journal of the American Heart Association in April reported research findings that deadly plaques in the arteries can be identified by CRP testing.

Researchers examined the hearts of people who had died suddenly to determine if they had stable or ruptured plaques in their blood vessels. They also determined C-reactive protein (CRP) levels from post-mortem blood samples and used a special staining technique to look at CRP levels in the plaque itself. Researchers found that people who had sudden cardiac death had higher levels of CRP in their blood and in their plaque than those who died from non-cardiac causes.

“Our research provides the first indication that CRP is a risk factor for atherosclerotic vascular disease and sudden death,” says lead investigator Renu Virmani, M.D., a researcher with the U.S. Armed Forces Institute of Pathology in Washington, D.C.

“Scientists have known for some time that elevated CRP in the blood indicates damage to arterial walls. However, until now it has not been known that blood levels also correlate to levels within plaque and its vulnerability to rupture, “ says Virmani.

“This is the first time it has been linked to sudden death from cardiovascular disease,” she says. “If circulating CRP levels are elevated, there are more vulnerable plaques. It is that simple. It is very important to identify vulnerable plaques in order to begin treatment.”

Previous studies have shown that baseline plasma levels of circulating CRP can predict risk of future stroke and heart attacks. In unstable angina, elevated CRP levels are associated with poorer disease prognosis. This study shows CRP is also significantly elevated in patients with coronary artery disease, both with and without acute coronary thrombosis.

Olympus Diagnostic Systems Group selected sole source for Quest Diagnostics chemistry laboratory network
The Diagnostic Systems Group of Olympus America, of Melville, N.Y., has been awarded a sole source agreement from Quest Diagnostics Incorporated covering automated chemistry systems used in Quest’s commercial reference labs throughout the United States.

Terms of the firms’ agreement were not disclosed. Under the agreement, Quest Diagnostics will purchase Olympus AU5400TM chemistry analyzers and Olympus reagents, consumables, parts, service and technical support for use throughout its laboratory network.

The new agreement extends the long-term relationship between Quest Diagnostics and Olympus in managing laboratory efficiency and costs. Olympus provides monthly management reports and, when needed, sends technical personnel into the laboratory to consult with laboratory directors, system operators and other staff in a joint effort to improve operating efficiency and manage costs.

“We are pleased to continue our long standing relationship with Quest Diagnostics,” said Stephen Wasserman, Group Vice President, Diagnostic Systems Group of Olympus. “The new line of Olympus analyzers and reagents is designed to optimize laboratory operations. Our goal has always been focused on providing high-quality, cost-effective diagnostic testing solutions for hospital and commercial laboratories.”

June 30, 2002 deadline for Nikon photomicrography contest
Nikon, Inc., of Melville, N.Y., has announced that June 30th, 2002 will be the deadline for submitting entries for the 28th annual Nikon International Small World Competition.

Created in 1975, this contest attracts photomicrography entries from around the world. Contestants are permitted to enter a maximum of three images, which are judged by an independent panel of experts for their originality, informational content, technical proficiency, and visual impact. Subject matter is unrestricted and any type of light microscopy technique is acceptable. Participants may submit their images in traditional 35mm format, or upload digital images directly on the Nikon Website.

Winners will be announced this summer, and honored at the International Small World ceremony to be held in New York City. Each year, exhibits containing the winning entries are displayed at museums and science centers throughout the U.S. and Canada. In the past, many of these images have been seen on the covers of scientific and industrial publications and journals.

A full-color calendar featuring all 20 winning images and honorable mentions will be available on the Nikon Website. This contest has been called the world’s leading forum for photographic excellence in the art and science of photomicrography. Images submitted to the contest capture the mysterious and often unseen universe viewed through a light microscope. Last year’s top winners were a photo of a freshwater rotifer, and a mouse cerebellum infected with CMV.

The first place winner receives a selection of Nikon products and equipment, or a trip worth $5,000. For additional information, please contact Nikon Small World, Nikon Instruments Inc., 1300 Walt Whitman Road, Melville, NY 11747, or phone (631) 547-8569. Entry forms may also be downloaded from MicroscopyU at www.nikonusa.com.