Clonal diversity of Cutibacterium acnes (formerly Propionibacterium acnes) in prosthetic joint infections.

Prosthetic joint infections (PJIs) are rare but feared complications following joint replacement surgery. Cutibacterium acnes is a skin commensal that is best known for its role in acne vulgaris but can also cause invasive infections such as PJIs. Some phylotypes might be associated with specific diseases, and recently, a plasmid was detected that might harbour important virulence genes. In this study, we characterized C. acnes isolates from 63 patients with PJIs (n = 140 isolates) and from the skin of 56 healthy individuals (n = 56 isolates), using molecular methods to determine the phylotype and investigate the presence of the plasmid. Single-locus sequence typing and a polymerase chain reaction designed to detect the plasmid were performed on all 196 isolates. No statistically significant differences in sequence types were seen between the two study groups indicating that the C. acnes that causes PJIs originates from the patients own normal skin microbiota. Of the 27 patients with multiple tissue samples, 19 displayed the same sequence types among all their samples. Single-locus sequence typing identified different genotypes among consecutive C. acnes isolates from four patients with recurrent infections. The plasmid was found among 17 isolates distributed in both groups, indicating that it might not be a marker for virulence regarding PJIs. Patients presenting multiple sequence types in tissue samples may represent contamination or a true polyclonal infection due to C. acnes.

The role of Th17/Tc17 peripheral blood T cells in psoriasis and their positive therapeutic response.

It is known that NB-UVB therapy can suppress a broad range of immune cells, but the additional effect of bathing in geothermal seawater still remains unclear. To study the influence of treatment on the expression of circulating immune cells contributing to the pathogenesis of psoriasis, six patients with psoriasis were treated with bathing in geothermal seawater two times daily combined with NB-UVB five times/week for 2 weeks and six patients were treated with NB-UVB therapy three times/week for 8 weeks. Disease severity (Psoriasis Area and Severity Index, PASI), chemokines, inflammatory cytokines, T cells and Toll-like receptors in the blood and skin samples were evaluated on enrolment (W0) and at 1 (W1), 3 (W3) and 8 (W8) weeks. Compared with healthy controls, psoriasis patients with active disease had significantly higher proportion of peripheral CLA+ T cells expressing CCR10 and CD103 and T cells with both Th1/Tc1 (CD4+/CD8+ IFN-γ+ or TNF-α+ cells) and Th17/Tc17 (CD4+CD45R0+IL-23R+, CD4+/CD8+ IL-17A+ or IL-22+ cells) phenotypes. Both treatments gave a significant clinical effect; however, bathing in geothermal seawater combined with NB-UVB therapy was more effective than NB-UVB therapy alone. This clinical improvement was reflected by a reduction in circulating CLA+ peripheral blood T cells and by a decreased Th1/Th17 and Tc1/Tc17 inflammatory response. These findings suggest that the inflammatory response in psoriasis is predominantly driven by both CD4+ and CD8+ skin-homing tissue retaining T cells of the Th17/Tc17 lineages.

Self-reported stress reactivity and psoriasis-related stress of Nordic psoriasis sufferers.

OBJECTIVES: The purpose of the study was to investigate the perceived influence of stress on psoriasis onset and disease severity in a large sample of psoriatics and to compare stress reactors and non-reactors with respect to psoriasis-related stress, disease severity, family history of psoriasis and sociodemographic factors. PATIENTS/METHODS: A total of 5795 members of the Nordic psoriasis associations and 702 patients recruited from Nordic dermatologists or university clinics were asked whether their first outbreak of psoriasis occurred during times of worry and stress. They were also asked to rate the degree to which their psoriasis was influenced by stress and to complete the Psoriasis Life Stress Index, the Psoriasis Disability Index and a number of additional questions concerning sociodemographic factors. RESULTS: Seventy-one per cent of the members and 66% of the patients reported that their psoriasis was exacerbated by stress, and 35% in both groups reported that the onset of their psoriasis occurred during a time of worry and stress. Stress reactors, scoring above the median on stress reactivity, reported greater disease severity, psoriasis-related stress and impairment of disease-related quality of life. They also reported more frequent use of tobacco, tranquillizers and antidepressants. More women than men were stress reactors, and stress reactors were more likely to have a family history of psoriasis. CONCLUSION: Our findings confirm and extend the results of previous studies and indicate that a subgroup of psoriatics may be more psychologically reactive to their disease and its influence on everyday life. Whether this group is also physiologically more reactive to psychosocial stress remains to be investigated.

Quality of life in 6497 Nordic patients with psoriasis.

BACKGROUND: Disease-specific psoriasis-related quality of life (QOL) measures have recently been developed and used in several hospital-based investigations. However, little is known about the impact of psoriasis on QOL in people with psoriasis who are not referred by dermatologists. OBJECTIVES: The purpose of the study was to investigate psoriasis-related QOL in a large sample of members of the psoriasis associations from the Nordic countries, and to compare the results with those from psoriasis patients recruited from Nordic dermatologists or Nordic University clinics. PATIENTS AND METHODS: A total of 5795 association members and 702 patients rated their psoriasis severity and completed the Psoriasis Disability Index and the Psoriasis Life Stress Index. RESULTS: Patients reported greater disease severity and greater impairment of QOL than members of associations, and Norwegian participants reported greater disease severity and greater impairment of QOL than participants from the remaining Nordic countries. Older and married participants reported less impairment of QOL than younger participants and those living alone. When controlling for the influence of these and other demographic and socio-economic factors, self-reported severity emerged as the most significant predictor of psoriasis-related QOL, explaining 32-26% of the variation in QOL scores, with the remaining factors only accounting for 4-5% of the variation. Although correlated with self-reported severity, Psoriasis Area and Severity Index scores were not a significant predictor of QOL in the patient sample. CONCLUSIONS: Though self-reported severity may be the most important predictor, further research is needed to determine factors explaining the remaining variance in psoriasis-related QOL.

Treatment of psoriasis in the Nordic countries: a questionnaire survey from 5739 members of the psoriasis associations data from the Nordic Quality of Life Study.

The data from a questionnaire-based study of 5,739 members of the psoriasis associations of Denmark, Finland, Iceland, Norway, Sweden and the Faeroe Islands showed that the two most commonly used active agents were topical steroids (89.7% total use and 49.4% present use) and calcipotriol (73.1% total use and 35.8% present use), with only small variations between the countries. Marked differences between the countries were, however, found within all other types of psoriasis therapy, including the so-called alternative treatments. Significant priorities varied between the different countries. The use of dithranol in Finland was almost twice the average. While 14.2% of Danish members had received grenz-rays within the last week only 0.1% of the Finns had been given the same treatment. Psoralen plus ultraviolet A (PUVA) was being used by 13.1% of the Finnish psoriatics compared with 3.8% of Danes, while PUVA was almost non-existent on the Faeroe Islands. The use of non-PUVA phototherapy was highest in Norway and Sweden. Almost 10% of the Danes were presently on methotrexate, which was used far more than etretinate/acitretin or cyclosporine. In contrast, Finnish patients more often received etretinate than other systemic agents, and in Iceland there was a higher present use of cyclosporine than of etretinate. The popularity of alternative therapies was highest in Iceland, where 26.6% had taken such medication during the last week. The results of the study suggest that different treatment patterns should be taken into consideration when discussing the prognosis of psoriasis in different countries.

Comparison of Roche Cobas Amplicor and Abbott LCx for the rapid detection of Chlamydia trachomatis in specimens from high-risk patients.

OBJECTIVE: To evaluate two automated amplification systems for the detection of Chlamydia trachomatis in urogenital specimens, the Cobas Amplicor (Roche Diagnostic Systems, Branchburg, NJ) and the LCx (Abbott Laboratories, Abbott Park, IL). STUDY DESIGN: The two systems were compared testing specimens from 302 high-risk patients, including 98 female cervical swab specimens and 204 male urine specimens. The patients attended the state STD clinic in Reykjavik, Iceland, either because of symptoms or as a result of contract tracing. RESULTS: The prevalence of C. trachomatis infection was 15.3% in women and 13.2% in men. For the male urine specimens, the sensitivity and specificity were 100% and 99.4% for the Cobas Amplicor and 74.1% and 100% for the LCx. In the cervical swabs, both systems detected all 15 true-positive specimens. The internal control used with the Cobas Amplicor detected inhibition in 2% of the male urine and 20% female cervical swabs, respectively. CONCLUSION: The Cobas Amplicor demonstrated slightly better sensitivity than LCx in male urine specimens. Both systems offer the benefits of automation for routine diagnostic testing.

[Cutaneous leishmaniasis. A case report.].

Cutaneous leishmaniasis is a common infection in South America and the Middle East. A 20 year Icelander was infected with leishmaniasis while travelling in South America. Treatment with the antimonial sodium stibogluconate was successful. With increased travelling to tropical and subtropical countries a rising incidence of tropical infectious diseases can be expected in Iceland.

Sustained forearm vasodilation in humans during mental stress is not neurogenically mediated.

To evaluate the possible neurogenic influence on forearm vasodilation during mental stress (Stroop's colour word conflict test), haemodynamic and catecholamine responses were registered in 12 healthy men after axillary blockade. Forearm blood flow was measured with venous occlusion plethysmography and forearm vascular resistance was calculated, with intraarterial blood pressure data. Blood samples for arterial and venous adrenaline and noradrenaline determinations were collected. Basal forearm blood flow increased markedly after axillary blockade, but the relative responses of forearm blood flow and forearm vascular resistance to mental stress were the same as in previously studied unblocked individuals (about +125% and about -40%, respectively). There was no increase in noradrenaline overflow from the forearm during mental stress in the nerve blocked arm. Heart rate and arterial systolic pressure responses as well as catecholamine responses to mental stress were augmented in the nerve blocked group, presumably due to a certain arousal caused by the experimental procedure. Increases in forearm blood flow and decreases in forearm vascular resistance during infusion of adrenaline were similar in the nerve blocked and in the control arm. In conclusion, vasodilation in the forearm during mental stress occurs in the absence of nervous control of the vascular bed. The reactivity of the vascular bed to an exogenous vasodilator (adrenaline) remains unchanged after axillary blockade.

Diagnosis of Chlamydia trachomatis infection in high-risk females with PCR on first void urine.

Recently the polymerase chain reaction (PCR) has been shown to be more sensitive than older methods in detecting Chlamydia trachomatis, when performed on endocervical swabs. A total of 203 high-risk females were enrolled in a comparative study of 3 methods for diagnosing C. trachomatis infections: McCoy cell culture and Amplicor PCR on endocervical swabs, and urine. Thirty-four had positive cultures, 38 positive PCR from cervix and 37 had positive PCR on urine specimens. When discrepancy occurred, the leftover Amplicor specimen was retested by Roche with Amplicor and a primer for the major outer membrane protein (MOMP) gene. In all three tests, 32 were positive. The sensitivity of culture was 87%, 92% in cervical PCR and 95% in urinary PCR. The specificity was 100% in both culture and urinary PCR but 98% in cervical PCR. Amplicor PCR performed on female urine is at least as sensitive and specific as cell culture.

[Diagnosis of chlamydia trachomatis infections in women: urinary PCR compared to cervical culture and PCR on cervical swabs in high risk females.].

Diagnosis of Chlamydia trachomatis infections in women has traditionally depended on cell culture or enzyme linked immunoassay. Recently Polymerase Chain Reaction (PCR) has been shown to be more sensitive than these methods when performed on endocervical swabs. A total of 203 high risk females were enrolled in a comparative study of three methods for diagnosing C. trachomatis infections: McCoy cell culture and Amplicor(R) PCR on endocervical swabs and urine. Thirty four had positive cultures, 38 positive PCR from cervix and 37 had positive PCR on urine specimens. When discrepancy occurred, the leftover Amplicor(R) specimen was retested by Roche with Amplicor(R) and a primer for the Major Outer Membrane Protein (MOMP) gene. None was false positive in cell culture or in urinary PCR but two were false positive in cervical PCR. In all three tests, 32 were positive. The sensitivity of culture was 87%, 92% in cervical PCR and 95% in urinary PCR. The specificity was 100% in both culture and urinary PCR but 98% in cervical PCR. The results show that Amplicor(R) PCR performed on female urine is more sensitive and as specific as cell culture.

[Clinical evaluation of two immunoassay methods for the rapid detection of chlamydia trachomatis: antigen in endocervical specimens from high risk female patients.].

Two rapid immunoassay methods, QuickVue-Chlamydia (Quidel Corp., San Diego California) and Kodak Surecell (Kodak Corp. Rochester, N.Y.) were evaluated for the detection of Chlamydia trachomatis antigen in endocervical swabs from high risk females attending a sexually transmitted disease clinic. The results were compared to McCoy cell culture and a polymerase chain reaction assay (Amplicor(R)-PCR, Roche Molecular Systems). Of the 240 females enrolled in the study 45 were considered infected (18.8%). Sensitivity, specificity, predictive value of a positive (PVP) and predictive value of a negative (PVN) of the QuickVue-Chlamydia assay were 96%, 99%, 96% and 99% respectively. Sensitivity, specificity, PVP and PVN of the Surecell assay were 96%, 100%, 100% and 99% respectively. The performance of the two immunoassay methods was similar, the sensitivity was the same and the specificity of the Kodak Surecell was slightly better than that of the QuickVue. On the other hand, the QuickWVL-Chlamydia assay was considerably simpler to perform (fewer steps) than the Kodak Surecell assay and took significantly less of technologists time.

[Prevalence of genital chlamydia trachomatis infections in college students.].

UNLABELLED: Sexually transmitted Chlamydia infection is the most common venereal disease in Iceland. Although considerable information is available on the epidemiology of these infections, the true prevalence of C. trachomatis infections in Iceland is unknown because all the studies have been conducted on selected populations. The purpose of the present study was twofold: To investigate the prevalence of Chlamydia infection in an unselected group of people in the age group at high risk, and to investigate the usefulness of collecting urine samples from college students as a screening method for Chlamydia. All students, aged 18-21, in the senior classes in a college in Reykjavik were requested to submit a first void urine (FVU) specimen taken in the morning and asked to fill out a short questionnaire. The urine samples were tested with a polymerase chain reaction assay, the Amplicor(R) PCR. One hundred eighty three students received urine collection kits. One hundred sixty (87.4%) delivered specimens. Seventy three males and 110 females received the containers. Sixty males (82%) and 100 (91%) females returned the samples. Three samples turned out to be positive (2%), all of them from females. For those who were sexually active (one or more partners for the last six months) the prevalence was 2.6% (117/160). IN CONCLUSION: The prevalence of asymptomatic Chlamydia infection in college students in this school was low, probably too low for screening to be cost effective. The procedure was not satisfactory because of the low percentage that enquired about their tests. It is therefore unsuitable in a screening program.

Carotid baroreflexes during hemodialysis.

In 9 regular hemodialysis patients, the carotid baroreceptor reflex was studied using standardized carotid sinus stimulation by neck suction. All patients were studied during predialysis conditions (recirculation), and during dialysis using dialyzate sodium concentrations of 145 and 133 mmoles/l. Baroreceptor stimulation was performed during the recirculation period and after 120-266 minutes of combined dialysis and ultrafiltration. Dialysis alone with either sodium concentration tended to decrease blood pressure. Heart rate as well as plasma renin activity increased significantly during dialysis with either procedure. In contrast to the findings in healthy subjects, heart rate was not influenced by neck suction, possibly reflecting a vagal neuropathy in uremic patients. However, carotid sinus stimulation decreased systolic pressure during recirculation to the same extent as has been found in healthy subjects. Furthermore, the blood pressure response to neck suction was enhanced during dialysis. These findings suggest that the blood pressure decrease during dialysis can not be explained by defective blood pressure control by the carotid sinus baroreceptors.