Diagnostic examination of human intestinal spirochetosis by fluorescent in situ hybridization for Brachyspira aalborgi, Brachyspira pilosicoli, and other species of the genus Brachyspira (Serpulina)

Human intestinal spirochetosis, characterized by end-on attachment of densely packed spirochetes to the epithelial surface of the large intestines as a fringe has been associated with the weakly beta-hemolytic spirochetes Brachyspira aalborgi and Brachyspira (Serpulina) pilosicoli. In this study, fluorescent in situ hybridization with oligonucleotide probes targeting 16S or 23S rRNA of B. aalborgi, B. pilosicoli, and the genus Brachyspira was applied to 40 sections of formalin-fixed, paraffin-embedded intestinal biopsy specimens from 23 Danish and 15 Norwegian patients with histologic evidence of intestinal spirochetosis. Five biopsy specimens from patients without intestinal spirochetosis and three samples from pigs with experimental B. pilosicoli colitis were examined as well. In addition, the 16S ribosomal DNAs of two clinical isolates of B. aalborgi were sequenced, and a PCR procedure was developed for the identification of B. aalborgi in cultures. The genotypic characteristics of the two clinical isolates showed very high (99.5%) similarity with two existing isolates, the type strain of B. aalborgi and a Swedish isolate. Hybridization with the Brachyspira genus-specific probe revealed a brightly fluorescing fringe of spirochetes on the epithelia of 39 biopsy specimens, whereas 1 biopsy specimen was hybridization negative. The spirochetes in biopsy specimens from 13 Danish and 8 Norwegian patients (55.3%) were identified as B. aalborgi. The spirochetes in the biopsy specimens from the other 17 patients hybridized only with the Brachyspira probe, possibly demonstrating the involvement of as-yet-uncharacterized Brachyspira spirochetes in human intestinal spirochetosis.

Antibiotic resistance patterns among blood culture isolates in a Danish county 1981-1995

All episodes of bacteraemia during a 15-year period (1981-1995) in the County of Northern Jutland, Denmark, were analysed with regard to antibiotic resistance. A total of 8840 isolates from 7938 episodes of bacteraemia was identified. Over time, no changes in bacterial aetiology were noted. Three isolates of Staphylococcus aureus were methicillin resistant (0.2%) and six were gentamicin resistant (0.4%). Among coagulase-negative staphylococci a 14% increase in resistance to penicillin was observed (95% confidence intervals, CI: 2-26%). Likewise, the frequency of resistance to methicillin, gentamicin and erythromycin increased, the corresponding figures being 38% (CI: 26-50%), 26% (CI: 14-38%) and 32% (CI: 16-50%), respectively, whereas a 14% decrease in resistance to streptomycin was recorded (CI: 4-24%). A 20% (CI: 2-37%) increase of coagulase-negative staphylococci resistant to three or more antibiotics was observed. The frequency of ampicillin resistance increased by 9% among Escherichia coli (CI: 4-13%) and by 10% (CI: 6-14%) in all Enterobacteriaceae. Among Enterobacteriaceae the level of resistance to third-generation cephalosporins, carbapenems, aminoglycosides and fluoroquinolones remained low (<1%). The frequency of resistance to three or more antibiotics remained fairly stable among Enterobacteriaceae, although a slight increase was noted among E. coli (5%; CI: 0-10%) The recommended regimen for empirical antibiotic treatment in this region (a combination of penicillin G or ampicillin and an aminoglycoside) provided an overall coverage of 94% (CI: 94-95%), although a slight decrease was noted at the end of the period. In conclusion, acquired antibiotic resistance was maintained at a low level compared with most other European countries and regions during the 15-year period studied.

[Yellow fever vaccination as prophylaxis of herpes labialis]

At some vaccination centres, it seems to be a clinical observation, that there is a reduction in the number of attacks of herpes labialis following yellow fever vaccination. We therefore conducted a double blind, prospective, randomized study to evaluate the efficacy of yellow fever vaccination against recurrent herpes labialis. Twenty-four patients with culture proven herpes labialis were allocated to either yellow fever vaccination or placebo (saline), with 12 persons in each group. After vaccination/ placebo the patients were followed for one year. The patients returned a letter every other month with information concerning the number of attacks during the period. Comparison of the data from the two groups after one year revealed no significant difference in the number of attacks between the two groups. In conclusion evaluation of the data from this study does not confirm the clinical observation that yellow fever vaccination may act as prophylaxis against herpes labialis.

Prevalence and antibiotic sensitivity of Danish versus other European bacterial isolates from intensive care and hematology/oncology units

The prevalence and antibiotic sensitivity patterns of bacteria collected consecutively from medical and surgical intensive care units (ICUs) and from hematology/oncology units in nine hospitals in Denmark were determined and compared to data collected simultaneously in 12 other European countries. Bacterial isolates from 794 Danish patients were tested and compared to 8,625 isolates from European patients. The minimal inhibitory concentrations of eight different antibiotics were determined using a microdilution plate. Similar to findings in European countries, the most common source of bacterial isolates in Danish units was the respiratory tract (49%), followed by blood (18%), urinary tract (14%) and surgical wounds (10%). Staphylococcus aureus was the most prevalent respiratory organism in Danish units, whereas Enterobacteriaceae and Pseudomonas aeruginosa dominated in other countries. In blood, Escherichia coli was most prevalent in Denmark while coagulase-negative staphylococci were predominant in other countries. Urinary tract isolates were dominated by Escherichia coli in both Denmark and the other countries, but Enterococcus faecalis and Pseudomonas aeruginosa were more frequently isolated in the other countries. Staphylococcus aureus was the most frequent wound isolate in Denmark, while Enterobacteriaceae other than Escherichia coli dominated in other European countries. Thus, in Denmark Escherichia coli and Staphylococcus aureus, followed by Pseudomonas aeruginosa and Klebsiella spp. (from ICUs) or Enterococcus spp. and Klebsiella spp. (from hematology/oncology units), are the most prominent pathogens in these units today. Indicator organisms of antibiotic consumption (Pseudomonas aeruginosa and methicillin-resistant coagulase-negative staphylococci and Staphylococcus aureus) were more frequent in other European countries than Denmark. In general the Danish isolates were more sensitive to antibiotics than the European isolates.(ABSTRACT TRUNCATED AT 250 WORDS)

Protease activity of outer membrane protein OmpT in clinical E.coli isolates--studies using translation initiation factor IF2 as target protein

During purification of the translation initiation factor IF2 from ompT+ strains of Escherichia coli the IF2 is partially degraded in the presence of membrane debris during the first steps of purification. This is a result of proteolytic cleavage by outer membrane protease OmpT [1]. Here we have investigated the activity of OmpT in 51 clinical E. coli isolates of human origin, by a time dependent OmpT activity assay using IF2 as target protein. The activity of OmpT in the outer cell membrane is highly variable among wild type E.coli strains, ranging from no detectable activity in 65% of the strains to a very high activity in 5 strains (10%). The OmpT activity is closely related to the assay temperature and to the growth temperature of the cells, and can be reduced or even eliminated by lowering the temperature of growth. The results open the possibility of using non-denaturing gel electrophoresis of crude cell lysates as a screening method in population genetic studies of initiation factor IF2 and other cytoplasmic proteins which are cleaved by OmpT.

[Gentamycin resistant Enterobacteriaceae at a neonatal care unit]

A case of septicaemia in a seven-day-old infant with a gentamicin-resistant strain of Enterobacter cloacae prompted an epidemiological survey in a neonatal unit. Another 18 patients harboured gentamicin-resistant Enterobacteriaceae without symptoms. Control of the outbreak was achieved by cohort nursing, strict hygiene and reduction of aminoglycoside consumption by 50%. Efficiency of the measures was monitored by weekly faecal samples from all patients. All strains produced the aminoglycoside modifying enzyme AAC(3)II. The resistance was plasmid-mediated.

[Viral encephalitis after tick bite]

TBE is caused by a Flavivirus and is endemic in certain areas of Central and Eastern Europe, such as Austria, the south of Germany, Hungary, Czechoslovakia, Poland, the former Yugoslavia and SNG and certain areas of Sweden and Finland. Recent developments in the Eastern European countries have made them popular with Danish travellers, who are thus exposed to infection. Until now TBE has been a very rare disease in Denmark. The clinical course is biphasic being preceded by an incubation period of ten days. After the initial phase with uncharacteristic symptoms, a period af about five days follows where the patient has no symptoms. About one-third of the patients develop meningo-encephalitis where paresis can be seen. The course of the disease is often prolonged. The prognosis is good in terms of full recovery and low mortality. The diagnosis is made serologically with haemagglutination-inhibition test or ELISA-technique. Differential diagnosis includes other causes of viral encephalitis and Lyme disease with neurological manifestations, when there is a history of tick-bites. Vaccination provides good protection and is recommended for certain travellers with trips of some duration in endemic areas.

Spread of Staphylococcus aureus strains of phage-type 95 in Denmark 1968–1989

The spread of Staphylococcus aureus strains of phage-type 95 was traced retrospectively in Denmark by the review of more than 15,000 S. aureus bacteraemia isolates (1957-88) and from data collected by phage-typing of c. 260,000 isolates from all body sites (1977-89). The first two type 95 strains had been isolated from blood in 1968, and after an interval of 3 years there was a steady increase of bacteraemia strains all over Denmark. From 1977 to 1989 the incidence of type 95 strains among isolates from all body sites increased from 3.8 to 18.8%. Different patterns of increase were recorded in 13 major hospitals and in various clinical departments of two hospitals and these were further analysed. Conjunctival swabs gave the highest percentage of type 95 strains and those from abscesses gave the lowest percentage. Of the type 95 bacteraemia strains 90.4% were resistant to penicillin, but neither methicillin nor gentamicin resistance was recorded.

Gardnerella vaginalis in posthysterectomy infection

Eighty-six women were admitted for abdominal hysterectomy. Preoperatively, 43 women were culture-positive for Gardnerella vaginalis from the cervical os, and 43 women were culture-negative. Postoperatively, 18 patients developed inflammation; among those 14 patients from the culture-positive group were infected, whereas only 4 patients from the culture-negative group developed inflammation. The difference between occurrence of G. vaginalis and the absence of the bacteria in patients with postoperative infection is highly significant. No such increased risk of postoperative infection was correlated to the isolation of any other microorganism looked for viz. aerobic and anaerobic bacteria, yeasts, viruses or chlamydiae. G. vaginalis may play a causative role in the development of posthysterectomy infection.

Fleroxacin in the treatment of uncomplicated acute cystitis in women

Twenty-four women with uncomplicated acute lower urinary tract infections proven by significant pretreatment bacteriuria (greater than or equal to 10(5) cfu/ml) were treated with a single oral dose of either 200 or 400 mg fleroxacin. Patients were checked for response to treatment five to nine days post therapy. Of the 24 patients initially included in the study, five were not available for assessment of efficacy. In 17 of the remaining 19 women bacteriological cure was achieved.

Isolation of Gardnerella vaginalis in pure culture from the uterine cavity of patients with irregular bleedings

Hysterectomy was performed in three patients because of persistent irregular vaginal bleeding. Before the operation samples were taken from the cervical os for cultivation of Gardnerella vaginalis, yeasts, viruses, Chlamydia trachomatis, and aerobic and anaerobic bacteria. Immediately after the operation, the uterus was opened under sterile conditions and samples obtained from the isthmus and fundus of the uterine cavity were examined microbiologically. In all three patients G. vaginalis was grown in pure culture from the fundus. Serum antibody titres against G. vaginalis were significantly raised in all three patients, and histology revealed mononuclear cells in the endometrium. The isolation of G. vaginalis from the endometrium of patients with clinical and histological signs of inflammation and with antibodies to G. vaginalis in serum indicates that the organism may play a causative role in endometritis.

Microbiology of vaginal discharge in general practice

Three groups of women were examined by culture for Gardnerella vaginalis and Candida. Group I consisted of 427 women, who complained spontaneously of vaginal discharge, group II of 311 women who did not complain of vaginal discharge until questioned prior to gynaecological examination, and group III of 100 women who denied vaginal discharge. Groups I and II also had cultures made for Trichomonas vaginalis and Neisseria gonorrhoica. In group I with spontaneous complaints the one-year prevalence rate of vaginal discharge was 3.4%. Candida, Trichomonas vaginalis and Neisseria gonorrhoica were cultured in 24%, 8% and 1% respectively. Gardnerella vaginalis was cultured in half of the women in all groups. A characteristic discharge or a positive microscopic finding was related to high concentration of Gardnerella vaginalis. A characteristic discharge even without spontaneous complaints of vaginal discharge was related to a high prevalence of Gardnerella vaginalis. Women complaining from discharge had higher concentrations of Gardnerella vaginalis than non-complaining. This leads to the conclusion that clinical disease may not be present unless concentrations of Gardnerella vaginalis have risen above some minimum level. The Gardnerella vaginalis syndrome defined by positive culture, clinical finding and microscopy was found in 20% of symptomatic women.

Legionnaires' disease imported to Denmark from Italy

Three cases of imported Legionnaires' disease are reported. All 3 patients became ill after their return to Denmark from a holiday tour in northern Italy. High titers of antibodies to Legionella pneumophila in the indirect immunofluorescence (IF) test confirmed the diagnosis. The fact that the onset of illness was within 10 days of the last day the patients spent in Italy strongly suggests that the disease was imported to Denmark from Italy. 10 of the 77 tourists who participated in the study had IF titers of at least 256. Of these 6 had clinical signs of Legionnaires' disease. An additional case of legionella infection occurred months after the case described in this report and was probably contracted in Italy.

Bacteremia after renal transplantation

Of 291 patients who received renal allotransplants in 1964-74, 94 patients developed 121 bacteremic episodes within the first 6 months after transplantation. The death rate was 38%. The bacteremic episodes occurred mainly during the first 2-3 months after transplantation. In 65% of the episodes bacteremia was secondary to urinary tract infections. The bacteria fourn were most often gram-negative rods such as Escherichia coli, Klebsiella and Proteus. Predisposing factors were ureteral complications such as leakage or necrosis of the ureter, leucopenia, immunosuppression, and source of the kidney. The frequency of bacteremia was the same in patients with infectious and non-infectious primary renal disease.

Renal excretion of vancomycinin in kidney disease

The renal climination of vancomycin has been determined in 18 patients. In 4 anuric patients in intermittent haemodialysis the dosage of vancomycin necessary to treat infection with penicillin-resistantstrains of Staphylococcus aureus was determined. In 14 patients with varying degrees of renal insufficiency vancomycin, creatinine and 125-iothalamate clearances were measured and found to be closely correlated. After administration of the initial vancomycin dose and attainment of the serum concentration desired, the maintenance dose can be calculated on the basis of the GFR.

Herpesvirus hominis infections in renal transplant recipients

A longitudinal, prospective study of herpesvirus hominis (HVH, herpes simplex virus) was carried out in immunosuppressed renal allograft recipients using serologic, virologic and clinical techniques. The final study group consisted of 37 patients of which 31 were followed for at least 2 months and 26 for more than 1 year. A 4-fold rise or more in HVH complement-fixing antibody in relation to titers measured at the time of transplantation was found in 11 patients. Eight of these 11 patients had clinically recognizable herpetic lesions. An additional 9 patients had lesions without titer rise being demonstrable. The 20 of the 37 patients studied (54%) had evidence of active infection with HVH. Because of pain and discomfort herpetic sores were of clinical importance in 11 patients and lasted for 1 month or more in 9. Herpetic keratitis was seen in 3 and left permanent damage to sight in 2. Multiple, extensive, prolonged and sometimes destructive herpetic lesions affected 5 (16%) of all patients studied.