Showing papers in "Scandinavian Journal of Infectious Diseases in 1986"

Fungal infections in patients with AIDS and AIDS-related complex.

Abstract: Persons with AIDS are predisposed to a variety of previously rare bacterial and fungal infections. Improvement in the quality and duration of survival of AIDS patients depends on the efficacy of treatment for these infections. Between 58-81% of AIDS patients contract fungal infections at some time and 10-20% of AIDS patients die as a direct consequence of such infections. Oral candidiasis commonly known as thrush is the most common fungal infection among AIDS and AIDS Related Complex patients occurring in 80-90% of cases. In a recent U.S. study 59% of persons with oral candidiasis who were at high risk of contracting AIDS went on to develop Kaposis sarcoma and other life- threatening infections. The most common life-threatening fungal infection experienced by AIDS patients is cryptococcosis a disease occurring among 6% of American AIDS patients and having a mortality rate of 17% during initial infections and 75-100% on relapse. Other opportunistic infections associated with AIDS and AIDS Related Complex are bronchial candidiasis invasive aspergillosis disseminated histoplasmosis and disseminated coccidioidomycosis. All are treatable but eradication i s difficult and relapse common.

Epidemiological, bacteriological and complicating features of erysipelas.

Abstract: 233 patients with erysipelas, admitted to the Department of Infectious Diseases, Danderyd Hospital, during a 2-year period were analysed for epidemiological, bacteriological and complicating features. Erysipelas was defined clinically as a febrile skin infection with a sudden onset of a red indurated expanding plaque with a distinct border. Common predisposing factors were alcohol abuse, diabetes mellitus and venous insufficiency, and complications were more common among such patients. No seasonal variation was found. 5 % of patients with blood culture had streptococcemia (7/149). Erysipelas emerging from an infected ulcer was seen in 52 % (122/233) and in 46 % of these streptococci were isolated (57/122), 67 % of which were of type A (38/57). Staphylococcus aureus was isolated from 59 % of ulcerative cases (72/122) and in 3 of them staphylococci were found in the blood.

Serological Immunity to Diphtheria in Sweden in 1978 and 1984

Abstract: Antibody levels in relation to diphtheria toxin were studied in 2409 serum specimens collected from different age-groups in Sweden in 1977-78 and 1983-84. Among children and young adults less than 20 years of age, 46% showed antibody levels considered to be protective (greater than or equal to 0.1 IU/ml). The corresponding percentage among adults was 21%. In the child population, 35% showed a relative degree of protection (less than 0.1-greater than or equal to 0.01 IU/ml), while 19% lacked immunity (less than 0.01 IU/ml). After 40 years of age, only 15% showed protective levels. No difference between males and females was seen in the younger population, while women had a lower prevalence of immunity than men among the adult population. Thus, more than 70% of the adult women lacked immunity, while the figure for the men was 50%.

Antitoxin Antibody Levels and the Outcome of Illness during an Outbreak of Diphtheria among Alcoholics

Abstract: During an outbreak of diphtheria among alcoholics in Goteborg, Sweden, a study was made of the diphtheria-antitoxin antibodies in serum samples from 8 clinical cases and 36 carriers of toxin-producing Corynebacterium diphtheriae. 33/36 carriers were antibody-positive and had antitoxin titres greater than 0.01 IU/ml, a level which is regarded as relative protective, while only 1/8 clinical cases had such a titre. This patient presented a mild illness with no complications. The results of the study of this outbreak stress the importance of maintaining adequate antibody levels against diphtheria in highly developed societies.

Evaluation of beta-lactamase activity and microbial interference in treatment failures of acute streptococcal tonsillitis

Abstract: Out of 169 patients with Streptococcal tonsillitis treated with phenoxymethylpenicillin, 13 (8%) developed a new clinical infection with the same streptococcal strain within 2 weeks of completing the therapy (clinical treatment failure) and 24 (14%) were clinically healthy but harboured the same streptococcal strain after treatment (bacterial treatment failure). Patients with clinical treatment failure showed beta-lactamase activity in their saliva pellet significantly more often than patients with bacterial treatment failure, healed streptococcal tonsillitis or non-streptococcal tonsillitis as well as healthy controls. In an interference study, clinical treatment failures were compared with healthy streptococcal carriers, i.e. persons living in the same household and harbouring the same beta-streptococcal strain. 11/12 healthy carriers had alpha-streptococci with interfering activity against their own beta-streptococcal strain, while the corresponding figure for the clinical treatment failures was 2/13. ...

Antimicrobial induced alterations of the human oropharyngeal and intestinal microflora.

Abstract: Although the role of the normal oropharyngeal and intestinal microflora is not fully understood, there are evidences that alterations in the flora may have serious consequences. The most common and significant cause of disturbances in the normal microflora is the administration of antimicrobial agents. The microflora can be influenced by antimicrobial agents because of incomplete absorption of any orally administered antimicrobial agent, secretion of an antimicrobial agent by the salivary glands or in the bile, or secretion from the intestinal mucosa. In most cases the influence is not beneficial to the patient because suppression of the indigenous microorganisms often permits potential pathogens to overgrow and cause septic conditions, stomatitis, diarrhoea, or colitis. Antimicrobial agents that influence the normal microflora also promote the emergence of antimicrobial-resistant strains. During the recent years, the impact of different antimicrobial agents on the human microflora has been investigated by our research group. Thus the effects on the oropharyngeal and intestinal microflora by peroral administration of penicillin, bacampicillin, erythromycin, clindamycin, doxycycline, nitroimidazole, norfloxacin and ciprofloxacin have been studied. The impact on the microflora by parenteral administration of ampicillin + sulbactam, azlocillin, aztreonam, piperacillin, cefoperazone, cefoxitin, ceftriaxone, moxalactam, imipenem, nitroimidazole and clindamycin has also been investigated. Pronounced changes were observed in the microflora in patients receiving clindamycin, erythromycin, cefoperazone, ceftriaxone and moxalactam, whereas moderate changes were seen in those patients receiving doxycycline, cefoxitin, aztreonam, ampicillin + sulbactam, azlocillin and piperacillin. Penicillin, bacampicillin, imipenem, nitroimidazole, ciprofloxacin and norfloxacin produced only minor changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Incidence and Prognosis of Central Nervous System Infections in a Birth Cohort of 12 000 Children

Abstract: All types of central nervous system (CNS) infections were investigated in a 1966 birth cohort of 12000 children from Northern Finland followed up from birth to the age of 14. 174 CNS infections occurred in 167 children, 110 boys and 64 girls. The annual incidence of bacterial CNS infections was 36.3/100000 and that of viral infections 688.0/100000. It is concluded that bacterial CNS infections were recorded very fully but only 2/3 of the viral infections could be traced, even though the more severe cases were quite well documented. 8/55 children (14.5%) with bacterial meningitis died; the corresponding figure for viral encephalitis and meningitis (excluding mumps) was 3/67 (4.5%). 17/55 (30.9%) developed mental retardation, epilepsy, cerebral palsy or hearing defect or some combination of these after bacterial CNS infection, and 9 (8.1%) after viral infection. The difference with respect to the children who had not experienced CNS infection was statistically significant only for the bacterial infection ca...

Outbreak of cryptosporidiosis among veterinary students.

Abstract: We describe an outbreak of human cryptosporidiosis in 5 veterinary students in contact with experimentally infected calves. All persons experienced symptoms of gastroenteritis, with the main complaint of diarrhoea lasting for 1–13 days. The persons recovered spontaneously; one was hospitalized for 10 days. The diagnosis was based on the demonstration of Cryptosporidium oocysts from stools by the smear method and the formalin-ether concentration method, both combined with the acid-fast staining technique. Both methods gave almost equal results. The role of Cryptosporidium as an occupational risk is discussed.

Group B streptococci at delivery: high count in urine increases risk for neonatal colonization.

Abstract: Of 858 pregnant women studied in matched rectal, urethral and urine cultured specimens, 186 (22%) were found to be colonized by group B streptococci (GBS). GBS were detected significantly more often in rectal specimens (159) than in urethral specimens (108) or in urine specimens (64). This is supporting evidence for the gastrointestinal tract as the main habitat of GBS. Of 1786 women whose urine was sampled at delivery, GBS were isolated from 128 (7%), in 22 of whom (1% of the total) GBS were present in quantities ≤104 colony forming units (cfu)/ml urine. Neonates born to women with ≤104 cfu GBS/ml urine were apparently at greater risk for neonatal infection, as they were more commonly and more heavily colonized than were the newborns of women with lower quantities of GBS in urine, or if positive urethral or rectal specimens were considered. The incidence of preterm delivery or obstetric infection was not higher among women in whom GBS were isolated in specimens from any of the 3 sites; foetal distress wa...

The use of antibiotic serum levels to predict concentrations in tissues.

Abstract: A review of the literature shows that antibiotic concentrations in tissues and tissue fluids are often quoted as being different in profile to concurrent serum levels. To study the relationship between serum and tissue concentrations we analysed published studies where different experimental models were tested simultaneously. In some models serum levels predicted tissue levels while in others they did not. The factors likely to be responsible for the differences were examined. The most important of these factors was tissue geometry (surface area to volume ratio; SA/V). Serum levels predicted tissue levels in models where the SA/V was high (>60) but not where the SA/V's were low (<10); here the antibiotic concentrations were lower and more prolonged than serum levels. These observations can be extrapolated to the clinical situation. In most situations involving prophylaxis or treatment of infections in non-specialised tissues (naturally high SA/V), serum levels will closely reflect levels in extracellular ...

Guillain-Barré syndrome as an early manifestation of HIV central nervous system infection.

Abstract: Two cases of HIV infection associated with Guillain-Barre syndrome are described. The neurologic symptoms started 1 week and 20 weeks, respectively, after the primary HIV infection. Seroconversion for anti-HIV occurred during the disease. A rapid spread of virus to the central nervous system was shown.

Predisposing factors, bacteriology and antibiotic therapy in 35 cases of septic bursitis.

Abstract: In a retrospective study the etiology was verified in 35/52 patients with suspected septic prepatellar or olecranon bursitis. Staphylococcus aureus was the most common pathogen and 86% of them were penicillinase-producing. Other strains were streptococci. Mean age was 47 (18-83) years and males predominated (91%). Predisposing factors were seen in most cases. Preceding trauma was found in 27 and/or associated diseases (e.g. diabetes mellitus) in 11 patients. Hyperglycemia was found in 38% of the patients. Treatment with antimicrobial agents, mostly penicillins, and bursal drainage were successful in 32 cases. Two patients had local spread of the infection and 1 patient chronic bursitis.

Norfloxacin versus co-trimoxazole in the treatment of recurring urinary tract infections in men.

Abstract: Norfloxacin is a lipid-soluble weak organic acid bound to plasma proteins to a low extent. Norfloxacin has a pKa1 from 6.2 to 6.4 and a pKa2 from 8.7 to 8.9. Mean concentrations of norfloxacin in prostatic tissue have been reported as 1.7 mg/kg. Recurrent urinary tract infection (UTI) in men is frequently associated with prostatic infection, and chronic prostatitis is both difficult to diagnose and to treat. One hundred and twenty-nine patients were entered into a randomized, open controlled, comparative multiclinic study of the efficacy and safety of norfloxacin vs. co-trimoxazole in male patients with recurrent UTI. Norfloxacin 400 mg and co-trimoxazole 160/800 mg were given twice daily for 4 to 6 weeks. One hundred and nine patients were considered evaluable for efficacy. Norfloxacin effected bacteriologic eradication in 56 of 60 (93%) patients; co-trimoxazole effected eradication in 39 of 49 (67%) patients. This difference in bacteriologic outcome had statistical significance (p less than 0.05). A subset of these patients had prostatic fluid cultures pre- and post-therapy. The eradication rate was 23 of 25 (92%) for norfloxacin and 10 of 15 (67%) for co-trimoxazole. Bacteria isolated were (norfloxacin/co-trimoxazole): E. coli 27/25; K-E-S 14/13; Proteus spp. 7/5; Ps. aeruginosa 2/0; other gram-negative bacilli 4/3; gram-positive cocci 7/3. Four patients, one on norfloxacin and three on co-trimoxazole had drug-related clinical and/or laboratory adverse experiences. None was serious. Norfloxacin appears to be an effective drug for the treatment of recurrent UTI in men.

Pneumonia: a deadly disease despite intensive care treatment.

Abstract: In a retrospective study of 30 patients with pneumonia treated in the intensive care unit, it was found that cultures from sputum and bronchial secretions did poorly correspond with blood cultures or serological tests. In only 15 of the patients a reliable etiological diagnosis was ever established. Mechanical ventilation was used in 22 patients, usually with a high oxygen need. At the start of this ventilation a significant blood pressure fall and a further pulmonary deterioration was observed. In fatal cases this pulmonary dysfunction was progressive. The overall mortality was 47%. When an FI02 above 0.6 was needed in the ventilator the mortality was 13/14 (93%).

Post-neurosurgical and Spontaneous Gram-negative Bacillary Meningitis in Adults

Abstract: In order to evaluate the clinical aspects of gram-negative bacillary meningitis (GNBM) we reviewed the charts of 20 adult patients with the discharge diagnosis of meningitis caused by gram-negative bacilli (bacteriologically proved) seen between 1973 and 1984. Nine patients had post-neurosurgical (post-NS) GNBM and 11 patients spontaneous (S) GNBM; the mean age of the former was 42 ± 16 years and of the latter 56±14 years (p>0.05). The overall mortality rate was 50% (33% in the post-NS group and 64% in the S group). The glucose levels in CSF were significantly lower in the patients who died. Patients treated with combined aminoglycoside therapy presented a lower mortality rate than those treated with intravenous aminoglycoside only (25% versus 70%). We suggest that if aminoglycoside therapy is employed, these antibiotics must be administered both intravenously and directly into CNS.

In vivo significance of bacteriocins and bacteriocin receptors.

Abstract: Bacteriocins are protein or protein-complex antibiotics produced by a wide variety of bacterial species. By conventional definition, bacteriocins differ from most other antibiotics in that the producer strain is immune to the action of its own bacteriocin and the inhibitory activity of individual bacteriocins is directed only to bacteria which are closely related to the strains which produce them. Bacteriocin production is regulated by plasmid or chromosomal elements and bacteriocin activity is initiated by adsorption of bacteriocin to specific outer membrane receptors on susceptible cells. In Darwinian terms, production of bacteriocin by a bacterial strain, within a particular ecological niche, could be considered advantageous by ensuring elimination of other closely related, and thus competitive, bacteria. In contrast, conservation of bacteriocin receptors appears suicidal if their only function is to initiate cell death. The paper will illustrate the ubiquity of bacteriocins and discuss evidence for their in vivo function in terms of bacterial survival. Evidence will also be presented to indicate that bacteriocin receptors in Escherichia coli and Pseudomonas aeruginosa have important alternative physiological functions in outer-membrane mediated nutrient uptake, particularly with respect to bacterial iron metabolism.

Bengt E. Gustafsson memorial lecture. Function of the normal human microflora.

Abstract: The normal human microflora maintains a delicate balance between its constituent parts, numbering 10(11) bacteria per gram with over 400 different species. Certain metabolic functions and enzyme activities can be attributed to the microflora, and these play a role in metabolizing nutrients, vitamins, drugs, endogenous hormones and carcinogens. Our laboratory has studied estrogen and cholesterol metabolism and activation of colon carcinogens. Three techniques to change the flora and its enzymatic activities have been used. Switching the diet from an omnivore diet to a vegetarian diet decreases bacterial deconjugating enzymes in the intestine. Administering antibiotics also suppresses the metabolic activity of the microflora. Similar suppressive effects can be achieved by feeding a human strain of Lactobacillus that implants in the gastrointestinal tract. Manipulation of these various modalities can maximize the beneficial activities of the intestinal microflora.

Primary throat anthrax. A report of six cases.

Abstract: 73 cases of anthrax were recorded by the Health Office in the Sivas region in the last 4 years. This paper presents a rare and severe clinical form of anthrax displaying diagnostic difficulties. Six women aged between 16-46 were diagnosed as having throat anthrax and treated in the Infectious Diseases Department of Cumhuriyet University. The lesions were localized on the tonsils in 5 cases and on the base of the tongue in 1 case. The main clinical features were sore throat, dysphagia, fever, regional lymphadenopathy on the neck and toxemia. Three patients died with toxemia and sepsis. The diagnosis was confirmed by the isolation of Bacillus anthracis.

Yersinia enterocolitica Septicemia: Clinical and Microbiological Aspects

Abstract: Septicemia is a rare but serious complication of infection with Yersinia enterocolitica (Y.e.). Seven cases of Y.e. septicemia are presented. Five of the patients had no underlying disease predispo...

The importance of pre bone marrow transplantation serology in determining subsequent cytomegalovirus infection. An analysis of risk factors.

Abstract: The yearly incidence of cytomegalovirus (CMV) infection among 73 consecutive bone marrow transplant (BMT) recipients was 68%. Recipients with negative CMV serology prior to transplantation had a yearly incidence of CMV infection of 35% compared to 87% in CMV seropositive patients (p=0.0001). When the ages of donors and recipients were analysed as continuous variables, both recipients with a younger donor and young recipients had a lower incidence of CMV infection (p=0.04; p=0.05). White cell transfusions were significantly associated with an increased incidence of CMV infection (p=0.03). If white cell transfusions were controlled for, lower marrow cell doses were significantly associated with an increased risk of CMV infection, compared to higher cell doses (p=0.035). In multivariate analyses, the impact of negative recipient serology was so strong that the other analysed factors did not affect the prognosis for CMV infection, when taken together or separately. 14 patients had symptomatic CMV infection an...

Clinical Significance of Nontuberculous Mycobacteria: A Bacteriological Survey of Swedish Strains isolated between 1973 and 1981

Abstract: An account is rendered of mycobacteria other than Mycobacterium tuberculosis isolated from specimens sent for culture during 9 years. The possible etiological significance of these bacteria was estimated from clinical data and the degree of bacterial growth. Pulmonary infection was the most common nontuberculous manifestation in the adults. In about 50% of the patients with slowly growing mycobacteria in their respiratory tract, these bacteria were considered to be an etiological factor. This applied to the species of the M. avium-intracellulare (MAI) complex and M. xenopi. M. kansasii, a common cause of lung disease in many other countries, was rarely isolated. The corresponding figure for the rapidly growing mycobacteria belonging to the M. fortuitum-chelonei complex was 15%. These patients were all severely debilitated by other diseases. Lymphadenitis was the most common nontuberculous infection in children, but occurred only in children not vaccinated with BCG. Bacteria of the MAI complex was the pred...

Acute Yersinia Infections in Man Increase Intestinal Permeability for Low-molecular Weight Polyethylene Glycols (PEG 400)

Abstract: The passive intestinal permeability of patients with acute diarrhoea was investigated with a liquid meal of oral rehydration fluid containing differently sized, low-molecular weight polyethylene glycols (PEG 400). The recovery of test molecules was measured in 6 h specimens of urine. The subjects suffered from acute infections caused by yersinia bacteria accompanied by joint pains. They were investigated during the infection and at least 3–4 weeks later when they had recovered clinically. It was found that yersinia infections were associated with increased urinary recovery of PEG molecules, and with reduced restriction towards the larger PEG molecules. After the infection, the resorption of PEGs returned towards normal. Thus, the altered restriction of the gut wall towards the passage of probe molecules might help to explain the extraintestinal manifestations often seen in connection with these agents.

Gamma-aminobutyric acid (GABA) production by eight common bacterial pathogens.

Abstract: Gamma-aminobutyric acid (GABA) is a potent amino acid neurotransmitter that suppresses normal neuronal activity in the central nervous system. Recently it has been suggested that GABA may play an important role in the pathogenesis of hepatic encephalopathy. In the present study GABA production by 8 common bacterial pathogens was measured during midlog, stationary and mid-death phases of growth. All bacteria produced some GABA (range: 160–50 250 pmole/ml) with the majority of GABA production occurring during the mid-death phase of growth. These results suggest that the depressed levels of consciousness seen in patients with overwhelming sepsis or advanced liver disease and extraintestinal infection may in part be secondary to increased bacterial GABA production.

Oral-administration of antibiotics and intestinal flora associated endotoxin in mice

Abstract: The contribution of aerobic and anaerobic gram-negative intestinal bacteria to the release of endotoxin in the intestinal tract was investigated during oral administration of various nonabsorbable antimicrobial drugs to C3H/Law mice. The intestinal endotoxin release was studied by determination of the endotoxin concentration in faecal supernatants with the Limulus amebocyte lysate assay. Selective elimination of aerobic gram-negative bacteria by oral treatment with polymyxin, aztreonam or temocillin resulted in a reduction of the endotoxin concentration of faecal supernatants to 10% of the untreated control. Further decrease of the endotoxin concentration to 1% was achieved by total decontamination of the intestinal tract by oral cephalothin/neomycin treatment. Endotoxin determination with the Limulus amebocyte lysate assay appeared to be unaffected by the antibiotics present in the faecal supernatants after oral treatment. On basis of these experiments, it is concluded that in mice 90% of the faeces derived endotoxin can be ascribed to release of endotoxin by intestinal aerobic gram-negative bacteria.

Chromosomal beta-lactam resistance in enterobacteria.

Abstract: Most enterobacterial species carry a chromosomal ampC beta-lactamase gene. In Escherichia coli and Shigella, expression from ampC is non-inducible and the beta-lactamase is synthesized at low levels. Mutations leading to increased beta-lactamase synthesis occur rather infrequently, making resistance to modern cephalosporins a rare event in these species. In other enterobacteria and Pseudomonas, ampC beta-lactamase synthesis is induced by beta-lactams. In Enterobacter cloacae, Citrobacter freundii and probably also in other species with inducible beta-lactamase expression, ampC is regulated by at least two genes, ampR and ampD. Mutations affecting ampR abolish beta-lactamase inducibility, and mutants devoid of ampR, produce ampC beta-lactamase at low constitutive levels. Mutations in ampD lead to constitutive overproduction of inducible beta-lactamase if an intact ampR protein is present in the cell. The latter type of mutations occur at a high frequency and result in clinical resistance to several third-generation cephalosporins.

In vivo significance of bacteriocins and bacteriocin receptors.

Abstract: Bacteriocins are protein or protein-complex antibiotics produced by a wide variety of bacterial species. By conventional definition, bacteriocins differ from most other antibiotics in that the producer strain is immune to the action of its own bacteriocin and the inhibitory activity of individual bacteriocins is directed only to bacteria which are closely related to the strains which produce them. Bacteriocin production is regulated by plasmid or chromosomal elements and bacteriocin activity is initiated by adsorption of bacteriocin to specific outer membrane receptors on susceptible cells. In Darwinian terms, production of bacteriocin by a bacterial strain, within a particular ecological niche, could be considered advantageous by ensuring elimination of other closely related, and thus competitive, bacteria. In contrast, conservation of bacteriocin receptors appears suicidal if their only function is to initiate cell death. The paper will illustrate the ubiquity of bacteriocins and discuss evidence for their in vivo function in terms of bacterial survival. Evidence will also be presented to indicate that bacteriocin receptors in Escherichia coli and Pseudomonas aeruginosa have important alternative physiological functions in outer-membrane mediated nutrient uptake, particularly with respect to bacterial iron metabolism.

Erythema chronicum migrans in Sweden: clinical manifestations and antibodies to Ixodes ricinus spirochete measured by indirect immunofluorescence and enzyme-linked immunosorbent assay.

Abstract: 26 Swedish patients with erythema chronicum migrans (ECM) were studied regarding associated clinical symptom and antibodies to Swedish Ixodes ricinus spirochete. 11/26 (42%) of the patients had associated symptoms, compared to more than 90% of 314 American patients with ECM, as described by Steere et al. Only 2/26 (8%) had multiple skin lesions, compared to 48% of the American patients. Elevated erythrocyte sedimentation rate and circulating immune complexes were demonstrated in 6/25 (24%) and 8/25 patients (32%), respectively, as against in 53% and 84%, respectively, of the American patients. The antibody response to Ixodes ricinus spirochete was measured by indirect immunofluorescence (IFA) and enzyme-linked immunosorbent assay (ELISA). Compared to the 95% percentile of controls, significantly high antibody titers were demonstrated in 3/25 (12%) by IFA, and 7/25 (28%) by ELISA. The ELISA antibody titers differed significantly (p<0.05) between ECM-patients and controls. The spirochetal antibody response ...

Serum Amyloid Protein A (SAA): An Indicator of Inflammation in AIDS and AIDS-related Complex (ARC)

Abstract: The acute phase protein serum amyloid A (SAA) and C-reactive protein (CRP) were measured in a group of 30 homo- and bisexual males with AIDS, 31 males with AIDS-related complex (ARC) and 23 healthy male homosexual controls (HC) in Copenhagen. The mean values of SAA and CRP were significantly higher in the AIDS group compared to the two other groups. SAA was elevated also in the ARC group, whereas the mean CRP value was normal. No increase in SAA and CRP was found in the HC group. The AIDS patients with Pneumocystis carinii infections had the highest SAA values, those with Kaposi's sarcoma the lowest. The elevations in SAA and CRP preceded episodes of acute opportunistic infections often by several days before the infectious agents were identified. We conclude that patients with AIDS are able to establish an acute phase response as reflected by elevated SAA and CRP, and that measurement of these proteins may be of diagnostic and prognostic value.

Dyslipoproteinemia in Patients with Severe Bacterial Infections

Abstract: Infection induces changes in the serum lipoprotein pattern in man. In this report the concentration of cholesterol and triglycerides in the major serum lipoprotein classes were followed in 9 patients with severe bacterial infections. Blood samples for lipoprotein analysis were obtained in the fasting state the first 4 days after admission to the hospital and after 2-3 weeks and 2 months. The serum lipoprotein concentrations of the patients were compared with those from a group of healthy subjects. The total serum cholesterol concentration was lowered during the acute stage of the disease and remained low the first days in hospital. The very low (VLDL) density lipoprotein cholesterol level in serum was mainly within the normal range. The low (LDL) density lipoprotein cholesterol values in serum were low during the first 4 days in hospital. The high (HDL) density lipoprotein cholesterol concentration values were extremely decreased on the first day in hospital and had a tendency to further reduction from da...

Serum Lipids in Viral and Bacterial Meningitis

Abstract: The changes in serum triglycerides (Tg), cholesterol and high density lipoprotein (HDL) cholesterol were examined in 17 patients with viral (VM) and in 7 patients with bacterial (BM) meningitis. In VM, there were low values of cholesterol (p<0.001) and HDL cholesterol (p<0.01) on admission to hospital and a rise in Tg after 1 week (p<0.01). In BM, caused in 4 cases by meningococci and in 3 cases by various streptococci, both cholesterol and HDL cholesterol were decreased during the acute phase (p<0.001 and <0.02, respectively). Corresponding changes were observed when the meningococcal cases were treated as a separate group (p<0.02 and <0.05, respectively). On admission cholesterol and HDL cholesterol levels in BM were lower than those in VM (p<0.05 in each case). In VM, the changes in serum lipids did not correlate with the changes of protein and glucose levels or leucocyte counts in cerebrospinal fluid (CSF). In BM, protein concentration in CSF correlated negatively with serum Tg (p<0.01) and positively...