Enteropathogens in acute diarrhea: a general practice-based study in a Nordic country.

The epidemiology of infectious diarrhea influences the microbiological investigation of the disease, and is best elucidated through prospective studies. We undertook such a study in a Nordic country. Patients of all age groups who had acute diarrhea were recruited prospectively from general practice clinics in Iceland. They completed a questionnaire and provided stool samples for the detection of pathogenic viruses, bacteria, and parasites. Of the 464 recruited patients, 211 (45%) had 224 infections. The most common pathogens were calici- and rotaviruses (23% and 18% of 224 infections, respectively), Campylobacter jejuni (17%), Cryptosporidium species (12%), and Salmonella serotypes (10%). Other agents found were Giardia lamblia, astro- and adenoviruses, and Yersinia enterocolitica. Viral pathogens were associated with vomiting, illness for ≤7 days, and younger age groups, while bacterial pathogens were associated with fever, rectal pain, and local or foreign travel, and parasitic pathogens with illness for >7 days. Detection rates for viral infections in the elderly and for Cryptosporidium species were higher than expected. Our study indicates the existence of regional differences in pathogen prevalence that should be taken into account when implementing guidelines for stool testing in patients with acute diarrheal disease.

Surveillance of influenza in Iceland during the 2009 pandemic.

In a pandemic setting, surveillance is essential to monitor the spread of the disease and assess its impact. Appropriate mitigation and healthcare preparedness strategies depend on fast and accurate epidemic surveillance data. During the 2009 influenza A(H1N1) pandemic, rapid improvements in influenza surveillance were made in Iceland. Here, we describe the improvements made in influenza surveillance during the pandemic , which could also be of great value in outbreaks caused by other pathogens. Following the raised level of pandemic influenza alert in April 2009, influenza surveillance was intensified. A comprehensive automatic surveillance system for influenza-like illness was developed, surveillance of influenza-related deaths was established and laboratory surveillance for influenza was strengthened. School absenteeism reports were also collected and compared with results from the automatic surveillance system. The first case of 2009 pandemic influenza A(H1N1) was diagnosed in Iceland in May 2009, but sustained community transmission was not confirmed until mid-August. The pandemic virus circulated during the summer and early autumn before an abrupt increase in the number of cases was observed in October. There were large outbreaks in elementary schools for children aged 6­15 years throughout the country that peaked in late October. School absenteeism reports from all elementary schools in Iceland gave a similar epidemiological curve as that from data from the healthcare system. Estimates of the proportion of the population infected with the pandemic virus ranged from 10% to 22%. This study shows how the sudden need for improved surveillance in the pandemic led to rapid improvements in data collection in Iceland. This reporting system will be improved upon and expanded to include other notifiable diseases, to ensure accurate and timely collection of epidemiological data.

[Herpes simplex esophagitis in immunocompetent individuals.].

OBJECTIVE: Infections by herpes simplex viruses (HSV) are common but esophageal involvement is relatively rare. It is most frequently diagnosed in immunocompromized patients. We describe four healthy, young men with HSV esophagitis and review the literature on the subject. MATERIAL AND METHODS: The diagnosis of HSV esophagitis was considered likely if three out of four of our criteria were met but definite if all four were fulfilled. IgM and IgG against HSV was measured with two different ELISAs. Viral culture was done in Vero and A-549 cells. Virus typing was done with ELISA. Histopathological exam was performed. A MEDLINE search of HSV esophagitis among otherwise healthy individuals was performed and the literature reviewed. RESULTS: Four young, healthy men were diagnosed with HSV esophagitis in 1997. Diagnosis was likely in two cases and definite in two. One patient was initially suspected of heart disease and another of gallbladder disease. All four patients were proven to have primary infection, were hospitalized, given intravenous hydration and treated with acyclovir. A MEDLINE search revealed 12 other cases of HSV esopha notgitis in otherwise healthy individuals. Including all 16 cases, the age ranged from 18 to 50 years (mean age 26 years). There were two women and 14 men. The most frequent symptom was odynophagia (69%). Eight patients (50%) had fever but only six (37.5%)had lesions in skin and/or mucosa on examination. Esophageal ulcers or inflammation were detected in all patients. The changes were in the distal esophagus (13/16), in the middle (2/16) or the entire organ (1/16). HSV-1 was cultured from 10 patients. Viral inclusions were seen in esophageal samples from eight patients. HSV antibodies were measured in 10 patients, six of which were proven to have primary infection. CONCLUSIONS: HSV esophagitis is rare in otherwise healthy individuals but probably underdiagnosed. Most cases are young men. Clues to the diagnosis such as visible lesions in skin or mucosae are frequently not present. Vigilance and endoscopy with biopsies and culture is needed for an accurate diagnosis.

[Prevalence of Chlamydia trachomatis in women applying for abortion in Oslo 1985-91]. / Prevalens av Chlamydia trachomatis hos abortsøkende kvinner i Oslo 1985-91.

The prevalence of Chlamydia trachomatis was investigated in a retrospective study of 17,215 women who requested termination of pregnancy at Ullevål and Aker hospitals in Oslo during the years 1985-89 and 1991. The overall prevalence of C trachomatis decreased from 11.3% (267/2,354) in 1985 to 3.8% (112/2,958) in 1991. The reduction was considerable from 1985 to 1989 but only slight at the end of the period. The prevalence was higher in younger women during the whole period. In women < 25 years old the prevalence decreased from 16.7% in 1985 to 6.3% in 1991, and in women > or = 25 years old from 5.9% in 1985 to 1.8% in 1991.