Chlamydia pneumoniae and myocarditis.

Sera from 20 male patients with a diagnosis suggestive of myocarditis, perimyocarditis or pericarditis were found significantly more often to have specific IgA antibodies to Chlamydia pneumoniae than sera from healthy blood donors of the same age and from the same time period. A less pronounced difference in IgG titres was found between patients and blood donors, and IgM antibodies were found only in one patient. A striking variation over time in the prevalence of specific antibodies to C. pneumoniae was seen in consecutive male blood donors over a 5-year observation period. The findings were discussed and it was concluded that C. pneumoniae may be associated with inflammatory heart disease.

An outbreak of Legionnaires' disease in a Swedish hospital.

We report a nosocomial outbreak of Legionella pneumophila serogroup (sg) 1 infection at the general hospital, Värnamo, Sweden. From December 1990 to February 1991, 28 patients and 3 staff fell ill with pneumonia and 3 died. L. pneumophila sg 1 together with several other Legionellae were isolated from the hot water supply to 17 of 20 hospital wards, probably being spread by aerosolization via shower nozzles. Raising the hospital's hot water temperature from 45 degrees C to 65 degrees C, together with heat disinfection of the shower equipment, arrested the outbreak within a week. Keeping the hot water temperature > or = 60 degrees C without chlorination eliminated L. pneumophila from > 75% of the wards. During a period of 2 years after the outbreak we have diagnosed only 1 case of nosocomial legionellosis at the hospital despite an active surveillance program.

Legionella urinary antigen in early disease.

The results of Legionella urinary antigen testing were correlated to the interval between onset of disease and sampling of urine in 134 patients in connection with a large outbreak of Legionnaires' disease at a Swedish hospital. In 17 patients with the disease, 5/7 sampled during the first 5 days of illness proved negative in the urinary antigen test. The risk of obtaining negative results during the first days of the disease is emphasized.

Absence of Helicobacter pylori in dental plaques in Helicobacter pylori positive dyspeptic patients.

To test the validity of reports on detection of Helicobacter pylori in the mouth, samples were obtained simultaneously from the gastric mucosa and dental plaques for culture in 94 patients examined consecutively by endoscopy. Histological examinations and serological tests were also performed. Helicobacter pylori was not found in the mouth of any of the patients including 52 who had culture-positive gastric biopsies. Thus earlier results could not be confirmed, however, other techniques such as the polymerase chain reaction might give different results.

Antibiotic susceptibility, serovars and auxotypes of gonococcal isolates in Stockholm. Relation to geographical origin of the infection.

The antibiotic susceptibility, serovars and auxotypes were investigated in gonococcal strains isolated from all patients with gonorrhoea during one year in Stockholm, Sweden. The results were correlated to geographical origin of the infection. A total of 394 gonococcal strains were isolated from 392 patients, 135 (34%) women and 257 (66%) men. Beta-lactamase-producing gonococcal strains (PPNG) were isolated from 5% of the women and 16% of the men. Men had acquired their infection abroad more often than women (54% vs 33%) (P < 0.001). The majority (81%) of the PPNG infections were imported. Some serovars and auxotypes were more common among imported strains than among indigenous ones. All strains were sensitive to spectinomycin and 2 strains had decreased susceptibility to norfloxacin and ciprofloxacin. Decreased susceptibility to benzylpenicillin, ampicillin, doxycycline and cefuroxime was related to the geographical origin of the strains with strains imported from regions other than Europe being the most resistant.

Value of confirmation of Chlamydiazyme enzyme immunoassay results in the detection of Chlamydia trachomatis.

The specificity of an EIA (Chlamydiazyme, Abbott) for detection of Chlamydia trachomatis was evaluated by means of a monoclonal antibody blocking reagent (Abbott) and a direct fluorescent antibody test (DFA) (Micro Trak, Syva). Of the 12,864 tested specimens from the urethra and cervix, 666 (5.2%) were positive. When retested with the same technique 625 (4.9%) were again positive. The result in 514 (4.0%) specimens was verified by means of the blocking reagent. Of specimens with absorbance values just below the established cut-off limit (0.07-0.114), 31 of 79 (39.2%) were specifically inhibited, increasing the rate of positive results by 0.25%. The results confirmed with the blocking reagent were in agreement with those obtained by DFA. The findings show that verification of positive Chlamydiazyme results is strongly advisable, in particular in specimens from the cervix.

Postoperative wound infection: relation to different types of operation and wound contamination categories in orthopaedic surgery.

During one year, 1,407 operations were performed on inpatients in an orthopaedic department. The presence or absence of postoperative wound infection was recorded during the hospital stay, at discharge and at follow up. Wound infections were linked to operations of different contamination categories and to the different types of operation performed. Better information about the risk for postoperative wound infection and the need for antibiotic prophylaxis was provided by considering the different operation types.

Evaluation of a bioluminescence assay for the detection of bacteriuria.

Bacteriuria defined with urine culture as the reference method was compared with bacterial adenosine triphosphate (ATP) measurements of cystoscopical urine samples from 216 men. Discrepant samples were studied by reculturing and microscopy of the sediment. Results show a good correlation (sensitivity 1.0 and specificity 0.95) between bacteriuria greater than or equal to 10(4) cfu/ml and bacterial ATP greater than 10 nmol/l measured by bioluminescence. Samples with macroscopic hematuria may influence the ATP value and give false positive results.

Diagnostic significance of pleural fluid lactate concentration in pleural and pulmonary diseases.

Pleural fluid samples from 198 patients were analysed in order to evaluate the usefulness of lactate concentration as a diagnostic test for separating infectious from non-infectious processes in the pleural cavity. Pleural fluid lactate was quantified by means of a gas chromatographic method. The highest lactate levels were found in patients with septic pleuritis. Significantly lower values were observed in cases with malignancies. With a cut off value of 10 mmol/l, the predictive value of a positive test was 0.94 and of a negative test 1.0. Because of the high predictive values of the test, measurement of lactate concentration in pleural fluid offers a rapid and useful information in the differentiation between infectious and non-infectious pleural disease.

Diagnosis of whooping cough--a comparison of culture, immunofluorescence and serology with ELISA.

Three methods for diagnosis of whooping cough--culture, immunofluorescence (IF) technique on nasopharyngeal secretion and serology with ELISA--were compared. 52 patients with symptoms of upper respiratory tract infection, which could not exclude pertussis as a differential diagnosis, were investigated. Pertussis infection was confirmed in 30 patients. Of these 16 (53%) were found by culture, 19 (63%) by IF and 28 (93%) by serology. It is concluded that IF analysis of nasopharyngeal secretion is a valuable tool for rapid diagnosis of whooping cough with a sensitivity similar to that of culture. Serodiagnosis with ELISA added a significant number of positive patients in which culture and IF were negative.

Case of Legionnaires' disease with deep venous thrombosis.

During the last three years many cases of Legionnaires' disease have been reported. Several cases reported had underlying disorders such as immunity deficiencies, or were undergoing immunosuppressive therapy. In this report we describe a previously healthy young man who acquired Legionnaires' disease and recovered after ampicillin-gentamicin treatment. During recovery he developed a lower leg thrombosis followed by pulmonary embolism.

Rapid diagnosis of meningitis with use of selected clinical data and gas-liquid chromatographic determination of lactate concentration in cerebrospinal fluid.

The usefulness of determination of lactate concentration in cerebrospinal fluid (CSF) for differentiation between various types of meningitis was evaluated. Lactate concentration in the CSF was assayed by gas-liquid chromatography for 115 patients, 17 of whom had serous meningitis and 38 had bacterial meningitis. The mean lactate concentration in the CSF of patients with bacterial meningitis was significantly higher than in the CSF of patients with serous meningitis and in a control group. The mean concentration in patients with serous meningitis was significantly higher than in controls. The highest lactate level in serous meningitis overlapped with the lowest level in bacterial meningitis. Elevated lactate concentrations in CSF were found also in patients with noninfectious disorders of the central nervous system. Misleading results may therefore be obtained if the lactate concentration in CSF alone is used to distinguish between serous and bacterial meningitis. The study suggests, however, that measurements of lactate levels in CSF, when combined with clinical and conventional laboratory observations, can increase the reliability of rapid diagnosis of bacterial meningitis.

A clinical study of co-trimazine in comparison with co-trimoxazole and sulphalene in urinary tract infections.

Co-trimoxazole, co-trimazine and sulphalene were tested in a controlled clinical trial of the treatment of urinary tract infections. Forty-three patients were treated with co-trimoxazole, 41 with co-trimazine, and 21 with sulphalene. During the study, sulphalene was found to be inferior to the other drugs and was excluded from further trials. The clinical efficacy of co-trimoxazole and co-trimazine was equal although the doses of trimethoprim and sulphonamide in co-trimoxazole were much higher than that in co-trimazine. In the latter sulphadiazine was used instead of sulphamethoxazole, the intention being to increase the concentration of active sulphonamide in the urine. Side effects tended to be less frequent in the patients treated with co-trimazine, although not significantly.

Co-trimoxazole and nitrofurantoin in urinary-tract infections: a controlled clinical study.

The clinical efficacies of co-trimoxazole and nitrofurantoin were compared in patients with urinary-tract infections associated with significant bacteriuria with coliform bacteria tested and found to be sensitive to both drugs. Of 27 patients treated with co-trimoxazole, 23 were cured after 10 days' treatment with 320 mg trimethoprim and 1600 mg sulphamethoxazole daily (85%). Of 18 patients treated with nitrofurantoin (200 mg/day for 10 days), 7 were cured (39%). Thus, cotrimoxazole was significantly superior (p less than 0.01) in this study. A significant (p less than 0.001) but temporary and modest rise of the serum-creatinine levels was noted after 5 days' treatment with co-trimoxazole. Such a rise was not observed in the nitrofurantoin group. Only a few minor side effects were noted in both groups.