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Antibiotic-Resistant Salmonella in Ground Meats
This study of ground chicken, turkey, beef, and pork purchased from supermarkets in the Washington, D.C., area showed that 20 percent of the samples contained salmonella of 13 different serotypes. Eighty-four percent of the isolates were resistant to at least one antibiotic, and more than half were resistant to three or more antibiotics.
Salmonella is a major cause of foodborne illness, and the frequency of resistant strains is increasing. These data show that retail ground meats are often contaminated with salmonella and that most of the organisms are resistant, probably as a result of the wide use of antibiotics in food animals. The findings in this study provide support for strengthening food-safety regulations.
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Streptogramin-Resistant Enterococci in Chicken and Human Stools
Quinupristin-dalfopristin was approved two years ago for use in vancomycin-resistant Enterococcus faecium infections, but a related streptogramin has been used for decades as a growth promoter in farm animals. In this study, cultures of samples from chickens purchased at supermarkets in four states identified quinupristin-dalfopristin–resistant E. faecium in at least 17 percent of the samples in each state. Low-level resistance in E. faecium was also identified in 1 percent of 334 stool samples from outpatients.
This study was conducted in the United States before the approval of quinupristin-dalfopristin, so the resistant organisms identified are likely to be the result of the use of streptogramins in animals. The results do not prove that there was foodborne transmission of the resistant E. faecium. However, the findings suggest that the widespread use of streptogramins in animals may have clinical consequences.
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Intestinal Carriage after Ingestion of Antibiotic-Resistant Enterococcus faecium from Chicken and Pork
Antibiotic-resistant organisms are often found in retail meats, but it has been unclear whether the ingestion of these organisms has any clinical consequences. Resistant strains of E. faecium obtained from raw chicken and pork were ingested by 12 healthy volunteers. Various concentrations of these strains were isolated from stool samples for up to two weeks.
After volunteers ingested a single, small dose of resistant enterococci in milk along with a light meal, the organisms survived gastric passage, multiplied, and were then transiently present in stool. This unusual study proves that the consumption of the resistant enterococci present in retail meats can lead to intestinal carriage of these organisms.
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A Recessive Form of Ehlers–Danlos Syndrome Caused by Tenascin-X Deficiency
Up to half of people with classic Ehlers–Danlos syndrome, a condition marked by hyperextensible skin, hypermobile joints, and tissue fragility, have mutations of the genes for type V collagen, raising the possibility that other genes may also be involved. Because tenascins are extracellular-matrix proteins with high levels of expression in connective tissues affected in the Ehlers–Danlos syndrome, these investigators searched for genetic defects in tenascin-X as a potential cause. Tenascin-X deficiency was found in 5 unrelated patients with the Ehlers–Danlos syndrome (of 151 screened), all of whom had distinct mutations in the tenascin-X gene.
Tenascin-X probably has a central role in maintaining the integrity of the collagen matrix, and its interruption can result in the Ehlers–Danlos syndrome. The search for still other candidate genes should extend beyond the collagens.
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Current Concepts: Prevention of Pneumococcal Disease in Children
Streptococcus pneumoniae accounts for half of all cases of acute otitis media, and it remains a major cause of illness and death in children. The strategies for prevention now include the use of a conjugate vaccine to induce immunity in infants, who are the group at highest risk.
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Medical Progress: Tourette's Syndrome
The French neurologist Georges Gilles de la Tourette first described this syndrome, which consists of motor tics sometimes accompanied by uncontrollable noises or utterances, attention-deficit–hyperactivity disorder, obsessive–compulsive disorder, and poor impulse control. Although the pathogenesis of the disorder remains obscure, tics may be treated effectively with haloperidol or pimozide, and other clinical features may also respond to pharmacologic therapy.
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