Showing papers in "Scandinavian Journal of Infectious Diseases in 2001"
TL;DR: Direct molecular identification of the aetiological agents responsible for IE from blood culture material may enable specific treatment to commence at an earlier stage of the disease and hence reduce the need for valve replacement.
Abstract: The molecular approach of PCR amplification of specific gene targets and universal loci for bacteria (16S rRNA) and fungi (18S, 28S and 5.8S rRNA) and subsequent sequencing was used to identify the possible causal microbial agent(s) in blood culture (47 patients) and heart valve material (30 patients) from patients with suspected infective endocarditis (IE). Culture and molecular results were analysed with respect to the patients' clinical background and the Duke Criteria. The findings demonstrated that: (i) all patients who were definite or possible cases were positive by PCR, even patients whose blood culture and valve material were culture-negative; and (ii) all patients who were rejected as having IE were also negative by PCR, with the exception of 1 patient who had bacteraemia from another source and 5 patients whose blood culture material was believed to contain an environmental contaminant. Direct molecular identification of the aetiological agents responsible for IE from blood culture material may enable specific treatment to commence at an earlier stage of the disease and hence reduce the need for valve replacement. Such a molecular approach may aid in the diagnosis of IE and should therefore be included as an additional major criterion in the Duke's classification scheme.
197 citations
TL;DR: Diagnostic criteria are suggested in order to simplify the diagnosis and classification of Vertebral osteomyelitis, which has not previously been available.
Abstract: Vertebral osteomyelitis (VO) is a rare condition and the diagnosis is often overlooked initially. Delay in diagnosis may result in vertebral destruction or perforation of the spinal canal. We suggest diagnostic criteria in order to simplify the diagnosis and classification of VO. Medical records of 58 patients with VO from Goteborg during the years 1990-95 were studied retrospectively. The incidence, clinical presentation, microbiology and treatment of VO were evaluated. The median age at the time of admission was 59 y (range 13-83 y) and the male:female ratio was 1.6:1. The incidence was 2.2/100,000 inhabitants/y. Sixty-four percent of the patients were natives of Sweden. The patients were classified as definite (67%), probable (26%) and possible (7%) VO. Staphylococcus aureus was the most common infective agent (34%), followed by Mycobacterium tuberculosis (27%). The most common risk factors included recent or current infections, immunosuppressive diseases and previous surgery. CRP and ESR were elevated in 82% and 88% respectively and plain X-ray changes indicating VO were found in 56% of the patients. Radiological changes were found in 34/44 (77%) computerized tomography scans and 10/13 (77%) magnetic resonance imaging examinations. The median duration of intravenous and oral antibiotic treatment were 10 and 179 d respectively. A delay of > I month from the onset of symptoms until diagnosis was found in 38% of the patients. This indicates the need for a standardized protocol for diagnosing VO. In this paper we suggest diagnostic criteria, which have not previously been available.
190 citations
TL;DR: Recent data from South India indicate a complex interaction of age and time effects: BCG imparted consistent protection in children, but no protection for subjects > 15 y old, and may even have imparted negative protection among these older individuals, which has important implications for efforts to develop a vaccine against adult pulmonary tuberculosis.
Abstract: It is widely recognized that BCG provides inconsistent and often inadequate protection against tuberculosis; however, simple estimates of efficacy fail to reflect the complexity of protection within, let alone between, populations. A decline in protection with an increase in age at vaccination has been seen in many studies. This may reflect 2 things: (i) that as people age they are exposed to a variety of mycobacterial challenges which may interfere with, or mask, the protection of BCG; and/or (ii) that the vaccine is better at protecting against primary disease than against either reactivation- or reinfection-type disease. These factors need to be taken into consideration when interpreting the results obtained with screening vaccines in animal models, as most of these models mimic acute primary-type disease. In addition, we have no evidence that the protection induced by BCG lasts for > 15 y, in any population. Recent data from South India indicate a complex interaction of age and time effects: BCG imparted consistent protection in children, but no protection for subjects > 15 y old, and may even have imparted negative protection among these older individuals. If true, these findings have important implications for efforts to develop a vaccine against adult pulmonary tuberculosis.
130 citations
TL;DR: It is suggested that without eradication of helminth infections and/or modulation of the immune changes that they cause, HIV and TB vaccines may fail to confer protection against their respective infections in Helminth-endemic areas.
Abstract: Helminth infections affect over a quarter of the world's population, especially in the developing countries. These long-lasting parasitic infections cause widespread immune activation and dysregulation, a dominant Th2 cytokine immune profile and an immune hyporesponsiveness state. Considering these profound immune changes and the similar geographic distributions of helminthic infections, HIV and tuberculosis (TB), we suggest that helminthic infections play a major role in the pathogenesis of AIDS and TB. They apparently make the host more susceptible to infection by HIV and Mycobacterium tuberculosis, and impair his/her ability to generate protective immunity against both infections. The implication of these ideas is that without eradication of helminth infections and/or modulation of the immune changes that they cause, HIV and TB vaccines may fail to confer protection against their respective infections in helminth-endemic areas.
110 citations
TL;DR: The administration oflinezolid mainly had an impact on the gram-positive bacteria and linezolid thus had an ecological profile different from that of amoxicillin/clavulanic acid.
Abstract: Twelve healthy subjects (6 females, 6 males; age range 18-40 y) participated in this trial. Linezolid was given as 600 mg tablets b.i.d. for 7 d and amoxicillin/clavulanic acid as 1000 mg tablets o.d. for 7 d. The washout period between the administration of the 2 antibacterial agents was 4 weeks. Faecal samples were collected prior to administration (Days -2 and -1), during administration (Days 4 and 8) and after administration (Days 14, 21 and 35) for microbiological analyses. The samples were diluted in pre-reduced media and inoculated aerobically and anaerobically on non-selective and selective media. Different colony types were identified to genus level by morphological, biochemical and molecular analyses. During the administration of linezolid, enterococci in the intestinal aerobic microflora were markedly suppressed while Klebsiella organisms increased in number. In the anaerobic microflora, the numbers of bifidobacteria, lactobacilli, clostridia and Bacteroides decreased markedly while no impact on the other anaerobic bacteria was observed. The microflora was normalized in all volunteers after 35 d. Amoxicillin/clavulanic acid administration caused increased numbers of enterococci and Escherichia coli in the aerobic intestinal microflora while numbers of bifidobacteria, lactobacilli and clostridia decreased significantly. Clostridium difficile strains were recovered from 3 of the volunteers. At the last visit, the intestinal microflora of the volunteers had returned to normal levels. The administration of linezolid mainly had an impact on the gram-positive bacteria and linezolid thus had an ecological profile different from that of amoxicillin/clavulanic acid.
90 citations
TL;DR: It is concluded that i.v. linezolid may be a useful option for treating VRE meningitis and achieved sufficient CSF concentrations to bring about clinical and bacteriological cure.
Abstract: Vancomycin-resistant enterococci (VRE) are a rare cause of meningitis, occurring primarily in patients who have undergone neurosurgical procedures. We describe the first reported case of VRE meningitis successfully treated with linezolid. A 56-y-old female with subarachnoid hemorrhage underwent ventriculostomy and embolization of cerebral aneurysms. Her postoperative course was complicated by multiple infections needing repeated antibiotic courses, culminating in the development of VRE meningitis. She was treated with 600 mg of i.v. linezolid (MIC < 0.75 microg/ml) every 12 h for 6 weeks. After the fourth dose, peak and trough linezolid concentrations were 11.45 and 0.14 microg/ml in serum and 3.19 and 2.39 microg/ml in cerebral spinal fluid (CSF). On Day 19 of linezolid therapy, serum and CSF trough concentrations were 1.53 and 2.98 microg/ml, respectively. Linezolid achieved sufficient CSF concentrations to bring about clinical and bacteriological cure. We conclude that i.v. linezolid may be a useful option for treating VRE meningitis. We also present findings of a literature review, which identified 11 cases of VRE meningitis treated with other pharmacologic agents with mixed success.
89 citations
TL;DR: During an 8-month period, 55 episodes of nosocomial bacteremia caused by Enterobacteriaceae species were identified in a tertiary medical center, of which 26 (47%) were caused by extended-spectrum beta lactamase (ESBL)-producing organisms.
Abstract: During an 8-month period, 55 episodes of nosocomial bacteremia caused by Enterobacteriaceae species were identified in a tertiary medical center, of which 26 (47%) were caused by extended-spectrum beta lactamase (ESBL)-producing organisms. ESBL production was associated with resistance to aminoglycosides, fluoroquinolones, tetracycline and co-trimoxazole compared with non-ESBL-producing organisms (p 0.5).
85 citations
TL;DR: It is suggested that detection of LAM in the urine of TB patients may improve case finding and that diagnostic tests based on this principle may serve as valuable supplemental tools in TB control.
Abstract: Direct capture enzyme-linked immunosorbent assay (ELISA) for lipoarabinomannan (LAM) was performed on urine samples from 200 tuberculosis (TB) patients and 800 non-TB patients routinely diagnosed among consecutive suspects in an Ethiopian TB centre. 50 healthy Ethiopians, 50 healthy individuals and 100 non-TB patients from Norway served as controls. Of the TB patients, 139 (69.5%) were positive for acid-fast bacilli (AFB). In the remaining cases the diagnosis was based on suggestive clinical findings. All Ethiopian non-TB patients were AFB negative and showed no clinical evidence of TB. In the Ethiopian groups, 148 (74%) of the TB patients, 105 (13.1%) of the non-TB patients and 5 (10%) of the healthy controls were positive by the LAM-ELISA. 113 (81.3%) of AFB positives and 35 (57.4%) of AFB-negative TB patients had positive LAM-ELISA. In the Norwegian groups all were LAM negative. The sensitivity and specificity of the LAM-ELISA for TB patients versus Ethiopian non-TB patients were 74% and 86.9%, respectively; the positive and negative predictive values were 58.5% and 93.0%. This study suggests that detection of LAM in the urine of TB patients may improve case finding and that diagnostic tests based on this principle may serve as valuable supplemental tools in TB control.
82 citations
TL;DR: The presence of H. pylori in the wells correlated with infection in consumers and with the presence of Escherichia coli, indicating fecal contamination, and consumption of untreated well water should be considered a risk factor for H.pylori infection.
Abstract: Helicobacter pylori was detected using molecular methods in untreated well water. The presence of H. pylori in the wells correlated with infection in consumers and with the presence of Escherichia coli, indicating fecal contamination. Consumption of untreated well water should be considered a risk factor for H. pylori infection.
77 citations
TL;DR: A young man who ate large quantities of probiotic yogurt developed endocarditis and septic arthritis caused by Lactobacillus rhamnosus, and only by using more appropriate methodology, including PCR, the pathogen could be distinguished from the yogurt isolate.
Abstract: A young man who ate large quantities of probiotic yogurt developed endocarditis and septic arthritis caused by Lactobacillus rhamnosus. The pathogenic isolate could not be distinguished from the yogurt microflora using methods routinely used in the clinical microbiology laboratory. Only by using more appropriate methodology, including PCR, the pathogen could be distinguished from the yogurt isolate.
75 citations
TL;DR: In order to identify the incidence, risk factors and prognostic indicators of postneurosurgical bacterial meningitis, a 9-y retrospective cohort study was performed and indicated that duration of ventriculostomy with external drainage and increasing value of the APACHE III score were independent risk factors for development ofMeningitis.
Abstract: In order to identify the incidence, risk factors and prognostic indicators of postneurosurgical bacterial meningitis, a 9-y retrospective cohort study was performed. The cohort comprised 3580 individuals who underwent neurosurgical operations at the Department of Neurosurgery of Catholic University, Rome, a 1,700-bed university hospital. We observed 52 episodes of postneurosurgical meningitis, with infection rates of 1.4/100 patients, 0.8/100 operations for craniotomies and 2.6/100 operations for internal cerebrospinal fluid (CSF) shunt or ventriculostomy with external drainage. The overall infection rate decreased from 2.5/100 operations in 1989 to 0.9/100 in 1997 (p = 0.03). Logistic regression analysis indicated that duration of ventriculostomy with external drainage [p < 0.01; odds ratio (OR) = 9.67; 95% confidence interval (CI) = 2.44-38.321 and increasing value of the APACHE III score (p <0.01; OR = 8.51; 95% CI = 2.15-33.68) were independent risk factors for development of meningitis. The overall case fatality rate was 8%. Predictors of mortality were low ( < 1.66 mmol/l) CSF glucose concentration (p = 0.001), increasing value of the APACHE IIl score (p = 0.002) and Gram-negative aetiology (p = 0.003).
TL;DR: The findings show that the incidence of candidemia rose steadily prior to the fluconazole era and then stabilized in spite of a shift towards non-albicans species, which is in contrast to previous work which showed that it was rare not to give antifungal treatment.
Abstract: The characteristics of candidemia before and after the introduction of fluconazole were compared at our institution. In the pre-fluconazole era (1986-89), the incidence of candidemia rose from 0.02% to 13% over the course of 4 y. Candida albicans accounted for 44/66 isolates (67%) and C. glabrata and C. parapsilosis were the predominant non-albicans species (9% each). In one-third of cases antifungal therapy was not given and the overall mortality rate was 55%. During the fluconazole era (1994-97), the incidence of candidemia remained constant between 1994 and 1996 at 0.09-0.11% and dropped to 0.06% in 1997. Bloodstream infection associated with neutropenia increased significantly but only accounted for 13% of cases; antifungal prophylaxis was not employed. The isolation of C. albicans decreased (n parapsilosis (n 23; 24%) and C. tropicalis (n 16; 16%) increased. The vast majority of patients received antifungal therapy and the overall mortality rate was 39%. These findings show that the incidence of cand...
TL;DR: It is unlikely that the combination of amoxicillin/clavulanic acid has an important place in the treatment of tuberculosis with the exception of those patients with multidrug-resistant tuberculosis who are otherwise therapeutically destitute.
Abstract: The early bactericidal activity (EBA) of an antituberculosis agent is the rate of decrease in viable colony-forming units (CFU) per milliliter of sputum during the first 2 d of treatment of patients with previously untreated smear-positive pulmonary tuberculosis. The objective of this open randomized study was to evaluate the EBA of the combination of amoxicillin 3 g and clavulanic acid 750 mg. Ten patients with a mean age of 34 y and a mean weight of 56 kg received amoxicillin/clavulanic acid and 5 patients with a mean age of 34 y and a mean weight of 57 kg received no drug. In the patients receiving 1 dose of amoxicillin/clavulanic acid daily for 2 d the mean log10CFU/ml of sputum before treatment was 6.7402 (SD 0.539) and after 2 d of treatment 6.7046 (SD 0.609); the corresponding values in patients receiving no drug were 6.7823 (SD 0.563) and 6.7502 (SD 0.673), respectively. The EBA of 0.018 (SD 0.130) in patients receiving amoxicillin/clavulanic acid did not differ significantly from that of 0.016 (S...
TL;DR: The findings suggest that the incidence of HCV among young injectors continued to decrease during the 1990s--the era of needle/syringe exchange and other interventions--but is still too high.
Abstract: In 1998, we reported that anti-HCV prevalence among injectors from Glasgow had declined between 1990 and 1995. We set out to ascertain if the anti-HCV prevalence among injectors from Edinburgh had declined similarly during this period and if there had been any trend in prevalence among injectors from both cities since 1995. Residual sera from both cities' injecting drug users who had undergone named HIV testing were identified, linked to age band and gender information and tested anonymously for anti-HCV. Among Edinburgh's injectors, significant (p or = 25 y, respectively. Among Glasgow's injectors, a significant (p < 0.0001) decrease in prevalence from 91% (1990) to 43% (1997) was seen only among those aged < 25 y. Of both cities' 15-19 y olds, sampled during 1995-97, 17% (24/139) were anti-HCV-positive. The findings suggest that the incidence of HCV among young injectors continued to decrease during the 1990s--the era of needle/syringe exchange and other interventions--but is still too high. Further investigative and preventive work is required.
TL;DR: These findings support the current concept of designing novel vaccination strategies which elicit not only CD4 + T helper cells, but also CD8 + CTL with direct antibacterial activity, and suggest the relevance of this pathway for protection against intracellular pathogens.
Abstract: Cytolytic T cells (CTL) are of paramount importance in immune defense against tumors and viruses. Work over the past decade has revealed that lysis of infected cells is also involved in protective immunity to bacteria and parasites, including Mycobacterium tuberculosis. Experiments involving gene-deleted mice and the characterization of CTL lines derived from tuberculosis patients suggest an important role of CTL in immunity to tuberculosis. More recently, the identification of an effector pathway of human CTL provided evidence for direct antimicrobial activity of CTL. This pathway involves the combined action of the pore-forming perforin and the antibacterial granulysin, both expressed in the granules of CTL. Granulysin binds to the bacterial cell surface, thereby disrupting the membrane and causing osmotic lysis. The relevance of this pathway for protection against intracellular pathogens is suggested by the expression of high amounts of granulysin in tissue from patients with tuberculoid leprosy, which are able to contain the spread of the bacilli. These findings support the current concept of designing novel vaccination strategies which elicit not only CD4 + T helper cells, but also CD8 + CTL with direct antibacterial activity.
TL;DR: The cell-mediated immune responses in natural HIV-1 infection and the induction by DNA vaccination in humans are reviewed, showing DNA vaccination to be effective for the induction of both cellular and humoral immune responses as well as for protection from infectious challenge.
Abstract: By eliminating infected cells, virus-specific cytotoxic T-lymphocytes (CTL) play a central role in host protection. Many studies to date seem to support the concept that human immunodeficiency virus (HIV)-specific CTL responses contribute to the control of viral replication, and thus delay the onset of disease. The feasibility of improving the virus-specific T-cell immunity by immunizing during the asymptomatic phase of infection has been studied in man. DNA vaccination is a novel strategy, involving direct inoculation of genetic material that is capable of producing antigen intracellularly for presentation to CTL. Such DNA-based immunization has been shown in animal models to be effective for the induction of both cellular and humoral immune responses as well as for protection from infectious challenge. This article reviews the cell-mediated immune responses in natural HIV-1 infection and the induction by DNA vaccination in humans.
TL;DR: Genomic analysis of BCG vaccines demonstrates that during the half-century of ongoing passage ofBCG vaccines in vitro there have been numerous genetic changes, comprising single nucleotide polymorphisms, duplications and deletions, which suggest a trend towards decreasing efficacy with increased passage in the laboratory.
Abstract: Between the derivation of bacille Calmette-Guerin (BCG) vaccine in 1921 and the lyophilization of BCG daughter strains in the 1960s, a number of clinical trials were performed looking at the protective efficacy of BCG vaccination against tuberculosis. These trials differed from one another in a number of ways: they employed different methodologies for delivering the vaccine and interpreting outcomes; they were performed on populations with different genetic backgrounds and different levels of exposure to environmental Mycobacteria; and, finally, they used different BCG vaccine strains. The results of these trials were estimates of protective efficacy against pulmonary tuberculosis ranging from about 80% to nil. Because of the differences in outcomes and confounding variables, it is difficult to conclude whether differences in interventions alone may have contributed to the remarkably variable results. Analysis of BCG vaccines used in clinical trials suggests a trend towards decreasing efficacy with increased passage in the laboratory; however, trials that used relatively "older" BCG strains were generally performed at different sites than trials which used "younger" BCG strains. Genomic analysis of BCG vaccines demonstrates that during the half-century of ongoing passage of BCG vaccines in vitro there have been numerous genetic changes, comprising single nucleotide polymorphisms, duplications and deletions. The impact of these changes in the BCG genome on the protective efficacy observed in field trials remains to be determined.
TL;DR: In conclusion, antimicrobial agents are still used excessively in Finland, particularly for the treatment of acute bronchitis, and the selection of drugs for treating sinusitis and otitis media is non-optimal; macrolides and cephalosporins are frequently chosen unnecessarily.
Abstract: The aim of this study was to survey current treatment practices for common infections in primary care as a basis for implementation of recently released evidence-based guidelines for community-acquired infections. A point-prevalence survey was conducted in 30 health centres in the Finnish primary care system with a population base of 819,777. All patients consulting the health centres for an infection during a 1-week period were included in the study. The main outcome measures were the prevalence of antibiotic prescription and the selection of drugs by infection diagnosis. Of the 7777 recorded consultations, 85% were with a physician and the rest with a nurse. The most common cause for a visit was respiratory tract infections (74%), followed by skin/wound infections and urinary tract infections (both 6%). The infection panorama varied markedly according to age: in the youngest children ( 65 y was 50%; the proportions of visits for urinary tract infections in these age groups were 7% and 26%, respectively. Of the patients with acute bronchitis, 70% were treated with antimicrobial agents, mostly macrolides (39%) and doxycycline (36%). Of the otitis media patients, 53% were treated with amoxicillin, 16% with macrolides and 16% with sulphatrimethoprim. Macrolides were mostly used to treat otitis media (31%), acute bronchitis (26%) and sinusitis (20%). In conclusion, antimicrobial agents are still used excessively in Finland, particularly for the treatment of acute bronchitis. Moreover, the selection of drugs for treating sinusitis and otitis media is non-optimal; macrolides and cephalosporins are frequently chosen unnecessarily. Knowledge of the indication-based prescription practices for antimicrobial agents is essential in order to improve the treatment habits of primary care physicians. The data obtained in this study provide a unique tool for the active and targeted implementation of evidence-based guidelines for primary care physicians.
TL;DR: Data show that an infectious disease consulting service optimizes antibiotic usage, and is cost-effective as a result of a significant cost reduction in hospitals, while not interfering with the quality of medical care.
Abstract: An infectious disease consulting service was set up at a large tertiary university hospital in 1996 to evaluate and to improve antibiotic prescription patterns. Treatment guidelines for the most common bacterial infections were implemented. On daily ward rounds antibiotic therapies without evidence of an infectious disease were stopped and inappropriate regimens were changed by an infectious disease specialist. During a 6-month prospective intervention period, 3,528 patients were studied on 13 wards of the department of internal medicine; 513 of these patients (14.5%) received antibiotic therapy. These treatment courses were evaluated as adequate in 394 cases (76.8%) and incorrect in 119 cases (23.2%). Inadequate antibiotic substances were chosen in 72 out of 119 cases (60.5%) and there was no indication for treatment in 38 out of 119 cases (32%). Pathogen-specific therapies were inadequate significantly more often than empirical antimicrobial therapies (p < 0.001). In addition, the duration of the perioperative prophylaxis could be limited to 1 d. Comparing the intervention period with a 3-month control interval without an infectious disease consulting service, a total of 31,510 Euro (including the costs for the infectious disease specialist) could be saved. No increase in infection-related mortality or length of stay was observed. These data show that an infectious disease consulting service optimizes antibiotic usage, and is cost-effective as a result of a significant cost reduction in hospitals, while not interfering with the quality of medical care.
TL;DR: It is suggested that Bartonella-induced silent subacute myocarditis, eventually leading to electric instability, caused the increased SUCD rate among the Swedish orienteers and may be a major pathogenetic factor in the development of ARVC-like disease.
Abstract: During the period 1979-92, an increasing number of sudden unexpected cardiac deaths (SUCD) occurred in young, Swedish, male elite orienteers. Myocarditis was the most common diagnosis in the 16 victims, and in 4 cases was also associated with fatty infiltration mimicking arrhythmogenic right ventricular cardiomyopathy (ARVC). Tissues from autopsies of 5 orienteers were tested for Bartonella by PCR targeting the gltA (citrate-synthase) gene. The products were then sequenced. Antibodies to B. henselae, B. quintana and B. elizabethae were measured by indirect fluorescence antibody assay. Bartonella spp. DNA was detected in the hearts of 4 deceased orienteers, and in the lung of a fifth deceased case. The sequences were close to B. quintana in 2 cases and identical to B. henselae in 3. Four of these 5 cases, as well as 2 additional cases of elite orienteers with ARVC, indicated antibodies to Bartonella. It is suggested that Bartonella-induced silent subacute myocarditis, eventually leading to electric instability, caused the increased SUCD rate among the Swedish orienteers. It is further suggested that Bartonella infection may be a major pathogenetic factor in the development of ARVC-like disease. Although the mode of transmission is unknown, both zoonotic/vector-borne and parenteral person-to-person transmission may be involved.
TL;DR: Staphylococcus sciuri and Escherichia vulneris were isolated concurrently in a blood sample from a patient with septic shock, which was probably associated with an indwelling catheter, and showed that S. sciuri is an important reservoir of genetic determinants of beta-lactam resistance as a human pathogen carrying the mecA and beta- lactamase genes.
Abstract: Staphylococcus sciuri and Escherichia vulneris were isolated concurrently in a blood sample from a patient with septic shock, which was probably associated with an indwelling catheter. Our results also showed that S. sciuri is an important reservoir of genetic determinants of β-lactam resistance as a human pathogen carrying the mecA and β-lactamase genes.
TL;DR: A novel approach to quantitative nested reverse transcriptase-polymerase chain reaction has revealed that the largest cytokine change in tuberculosis is a 1-2 log increase in copy number for mRNAs encoding IL-4 and IL-13, accompanied by a small decrease in expression of mRNA encoding interferon-gamma.
Abstract: The dominant view has been that there is little or no activation of Type 2 cytokine production in human tuberculosis. A novel approach to quantitative nested reverse transcriptase-polymerase chain reaction has revealed that this conclusion was based on technical inadequacies of earlier studies, particularly the failure to discriminate between IL-4 and the IL-4 splice variant, IL4 d 2. A new approach reveals that the largest cytokine change in tuberculosis is a 1-2 log increase in copy number for mRNAs encoding IL-4 and IL-13, accompanied by a small decrease in expression of mRNA encoding interferon-g. The increased IL-4 level correlates with disease severity and with serum levels of IgE and soluble CD30, and may be attributable to the recently observed increase in conversion of cortisone into cortisol in tuberculous lesions. The implications of these findings for pathogenesis, vaccine design and immunotherapy are discussed, as effective reagents will need to downregulate this inappropriate Th2 component.
TL;DR: Oral doxycycline seems to be an effective, convenient and inexpensive alternative for the treatment of Lyme neuroborreliosis.
Abstract: The clinical outcome for 69 patients treated with oral doxycycline for Lyme neuroborreliosis was studied retrospectively. The clinical follow-up time was 14 d to 2 y (median 7 months). All patients improved during and after treatment. A complete recovery was seen in 56 patients by 14 d to 9 months (median 6 weeks) after therapy, while 13 patients (19%) still had persistent sequelae 1 y after antibiotic treatment. Six patients were retreated because of new or persistent symptoms, but in no patient was a treatment failure proven. A questionnaire was sent to each patient, asking for time to recovery, sequelae and relapse of symptoms. No patient had experienced relapse of symptoms associated with Lyme neuroborreliosis when answering the questionnaire 2-9 y after treatment. Oral doxycycline seems to be an effective, convenient and inexpensive alternative for the treatment of Lyme neuroborreliosis.
TL;DR: Clinical nor experimental studies have confirmed that fluid restriction reduces the cerebral oedema in meningitis, and compared with maintenance therapy, fluid restriction did not improve outcome in a randomized controlled study, so there is no evidence to support the use of fluid restriction in patients withMeningitis.
Abstract: In patients with meningitis, fluid restriction is recommended to counter the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and to reduce cerebral oedema. However, any effects of an increased plasma level of ADH upon cerebral oedema would be due not to fluid retention but to hypoosmolality. In a literature review of fluid and electrolyte disturbances and the effect of fluid therapy in bacterial/tuberculous meningitis, the prevalence of hyponatraemia, hypoosmolality and SIADH varied considerably; apparently, non-osmotic stimuli for the secretion of ADH, e.g. intracranial hypertension and hypovolaemia, were present in most patients. Neither clinical nor experimental studies have confirmed that fluid restriction reduces the cerebral oedema in meningitis. Furthermore, compared with maintenance therapy, fluid restriction did not improve outcome in a randomized controlled study. Thus, we find no evidence to support the use of fluid restriction in patients with meningitis. Fluid therapy in acute bacterial meningitis should aim at avoiding hypovolaemia and hypoosmolality based on the assumptions that (i) ADH is increased by non-osmotic stimuli; (ii) elevated ADH is less important for cerebral oedema than severe hypoosmolality, which may in itself induce or aggravate oedema; (iii) maintenance fluid therapy aiming at isoosmolality will not worsen neurological outcome; and (iv) hypovolaemia is difficult to detect, and detrimental for cerebral perfusion, in these patients.
TL;DR: A 6-y-old HIV-infected girl with severe immune deficiency who failed to respond to intramuscular pre-exposure rabies vaccination using human diploid cell rabies vaccine is reported.
Abstract: We report the case of a 6-y-old HIV-infected girl with severe immune deficiency who failed to respond to intramuscular pre-exposure rabies vaccination using human diploid cell rabies vaccine on days 0, 7 and 28. She also failed to respond to an intradermal postexposure rabies regimen using purified verocell rabies vaccine at 4 sites on days 0, 3 and 7 and at 2 sites on days 30 and 90 (double the usual regimen). Sequentially monitored rabies neutralizing antibody titers were below the WHO minimum acceptable level (> 0.15 IU/ml) in all specimens. Rabies prevention in HIV-infected persons with severe immune suppression requires further study.
TL;DR: A case of aggressive P. acnes endocarditis in a healthy 36-y-old man which infected a native aortic valve and was complicated by an aortIC root abscess is described.
Abstract: Propionibacterium acnes is a constituent of the normal skin flora It has been described as causing infection on prosthetic valves but very rarely on native valves We describe a case of aggressive P acnes endocarditis in a healthy 36-y-old man which infected a native aortic valve and was complicated by an aortic root abscess and review the literature
TL;DR: Results from laboratory confirmation included a fourfold change in anti-Ehrlichia equi IFA titre and a positive PCR confirmed by gene sequence analysis, which confirmed the patient had granulocytic ehrlichiosis in Scandinavia.
Abstract: A clinical case of human granulocytic ehrlichiosis in Scandinavia is presented. The patient developed high fever, myalgia, headache and dyspnoea. Doxycycline treatment resulted in a dramatic improvement. Laboratory confirmation included a fourfold change in anti-Ehrlichia equi IFA titre and a positive PCR confirmed by gene sequence analysis.
TL;DR: It proved possible to reduce the use of broad-spectrum antibacterial and antifungal agents, with significant cost savings, and point-prevalence studies may be a useful tool to detect deviations from guidelines and provide physicians with educational feedback.
Abstract: The object of this study was to improve the use of antibiotics at Aker University Hospital, a 600-bed university hospital. We developed and implemented guidelines for antibiotic treatment and prophylaxis. We describe the impact of these guidelines on the use and cost of antibiotics and evaluate compliance with the guidelines. From 1994 to 1996 there was an 11% reduction in the use of antibacterial agents and a 42% reduction in the use of antifungal agents. The use of broad-spectrum antibiotics was reduced by 23%. The use of penicillin V and G increased by 5%, dikloxacillin/kloxacillin by 46% and erythromycin by 33%. Compared with 1994 values there was a 27% reduction in antibiotic costs in 1995, amounting to US$ 319,300, and a 32% reduction in antibiotic costs in 1996, amounting to US$ 380,000. A point-prevalence investigation conducted 18 months after the introduction of the guidelines indicated that compliance was > 95%. It proved possible to reduce the use of broad-spectrum antibacterial and antifungal agents, with significant cost savings. Point-prevalence studies may be a useful tool to detect deviations from guidelines and provide physicians with educational feedback.
TL;DR: D-Lfcin B(17-31) was the most efficient peptide against E. coli and Staphylococcus aureus and implies that the simple thesis of I antibacterial target is not valid for lactoferricin.
Abstract: Bovine lactoferricin is an antimicrobial, cationic peptide generated upon gastric pepsin cleavage of bovine lactoferrin. We investigated the bactericidal effects of native lactoferricin [Lfcin B(17-41)], a shortened derivative [Lfcin B(17-31)] and the all-D-amino acid counterpart of Lfcin B(17-31) against Escherichia coli and Staphylococcus aureus. The results revealed different activities for the peptides against Gram-positive and -negative bacteria. D-Lfcin B(17-31) was the most efficient peptide against E. coli. The same peptide showed improved activity against S. aureus, D-Lfcin B(17?31) showed a significant better efficacy when compared to the L-form, but not when compared to Lfcin B(17?41). There was no correlation between the bactericidal concentrations and the time needed to achieve maximum effect. This indicates the importance of structural differences between the peptides and/or bacteria and implies that the simple thesis of 1 antibacterial target is not valid for lactoferricin.
TL;DR: It is reported the first case of an infected cyst and liver abscess caused by Clostridium difficile that recurred 11 months later, despite therapy with vancomycin and percutaneous drainage.
Abstract: We report the first case of an infected cyst and liver abscess caused by Clostridium difficile. It recurred 11 months later, despite therapy with vancomycin and percutaneous drainage. Administration of metronidazole following percutaneous drainage achieved a favorable outcome.