The burden of pneumococcal meningitis in Austrian children between 2001 and 2008.

UNLABELLED: The present study was conducted to evaluate the burden of pneumococcal meningitis in Austrian children between 2001 and 2008. Clinical outcome was retrospectively analyzed both on discharge and on follow-up investigations. This study was based on a prospective multicentre surveillance study on hospitalized invasive pneumococcal infections in Austrian children with a total annual "study population" of about 399,000 children aged below 5 years per year. Between 2001 and 2008, 74 cases of pneumococcal meningitis were identified in children aged below 5 years. The mean annual incidence rate for pneumococcal meningitis was 2.3 per 100,000 children in this age group. In 57/74 children (mean age on admission 14.5 ± 13.3 months), outcome data on hospital discharge were available: 5 deaths (8.8%), 20 children (35.1%) with sequelae and 32 children (56.1%) without sequelae were observed. Sequelae on discharge included motor impairment in 8 children (14.0%), hearing impairment in 9 children (15.8%) and/or other complications in 14 children (24.6%). In 7/8 children with motor deficits, matching cerebral lesions were identified by neuroimaging: cerebral infarction in five children, cerebral vasculitis and cerebral abscess in one child each. In 40/57 children, long-term outcome (18.9 ± 20.2 months after discharge) could be assessed: 1 child (2.5%) died 9 months after hospital discharge, 11 children (27.5%) had one or two long-term sequelae and 28 children (70.0%) had no sequelae. Long-term sequelae included motor impairment in three children (7.5%), hearing impairment in nine children (22.5%) and other deficits in two children (5.0%). CONCLUSION: Our study confirms that pneumococcal meningitis causes high mortality and severe long-term sequelae. On long-term follow-up, we observed improvements of motor impairment, but not of hearing impairment.

What is the evidence for giving chemoprophylaxis to children or students attending the same preschool, school or college as a case of meningococcal disease?

We performed a systematic literature review to assess the effectiveness of chemoprophylaxis for contacts of sporadic cases of invasive meningococcal disease (IMD) in educational settings. No studies directly compared IMD risk in contacts with/without chemoprophylaxis. However, compared to the background incidence, an elevated IMD risk was identified in settings without a general recommendation for chemoprophylaxis in pre-schools [pooled risk difference (RD) 58·2/105, 95% confidence interval (CI) 27·3-89·0] and primary schools (pooled RD 4·9/105, 95% CI 2·9-6·9) in the ~30 days after contact with a sporadic IMD case, but not in other educational settings. Thus, limited but consistent evidence suggests the risk of IMD in pre-school contacts of sporadic IMD cases is significantly increased above the background risk, but lower than in household contacts (pooled RD for household contacts with no chemoprophylaxis vs. background incidence: 480·1/105, 95% CI 321·5-639·9). We recommend chemoprophylaxis for pre-school contacts depending on an assessment of duration and closeness of contact.

Update: Multinational listeriosis outbreak due to 'Quargel', a sour milk curd cheese, caused by two different L. monocytogenes serotype 1/2a strains, 2009-2010.

We previously reported an outbreak of listeriosis in Austria and Germany due to consumption of Quargel cheese. It comprised 14 cases (including five fatalities) infected by a serotype 1/2a Listeria monocytogenes (clone 1), with onset of illness from June 2009 to January 2010. A second strain of L. monocytogenes serotype 1/2a (clone 2) spread by this product could be linked to further 13 cases in Austria (two fatal), six in Germany (one fatal) and one case in the Czech Republic, with onset of disease from December 2009 to end of February 2010.

Listeriosis outbreak caused by acid curd cheese Quargel , Austria and Germany 2009.

We report an outbreak of listeriosis in Austria and Germany due to the consumption of Quargel cheese produced by an Austrian manufacturer. At the time of writing this report, the outbreak was known to account for 14 outbreak cases in 2009, including four cases with lethal outcome. On 23 January 2010, the cheese product was voluntarily withdrawn from the market.

Clostridium difficile in raw products of animal origin.

Prevalence of Clostridium difficile was examined in Austrian ground meat samples and bactofugates, following an evaluation of enrichment broths. Bactofugation is a centrifugation procedure used at sensitive dairies to lower the concentration of spores in raw milk before heat treatment. Among the five enrichment broths tested, C. difficile moxalactam norfloxacin boullion (CDMN) was the only one that allowed recovery of C. difficile from artificially spiked meat samples. Use of Tween 80 as a detergent in the enrichment of artificially contaminated bactofugates improved recovery of C. difficile. Following the enrichment procedures (meat without the use of TWEEN 80), one hundred ground meat samples and fifty bactofugates were enriched for 10-15days in CDMN and presumed positive colonies were isolated and identified by Gram staining, observation of colony fluorescence and ID 32 A ribotyping. Subsequently PCR ribotyping, PCR-based identification of toxin genes (tcdA, tcdB) and antimicrobial drug susceptibility testing to metronidazole, vancomycin, clindamycin and moxifloxacin were performed. C. difficile was isolated from three (3%) of the one hundred retail ground meat samples. Two C. difficile isolates of the same rare ribotype AI-57 were toxin gene-negative and sensitive to all antibiotics tested. One isolate was assignable to one of the most prevalent clinical ribotypes isolated in Austria and harboured the tcdA and tcdB genes. This isolate was also resistant to clindamycin and moxifloxacin. None of the fifty bactofugates tested were positive for C. difficile. The presence of an isolate of human origin could indicate contamination by human shedders during food processing rather than evidencing zoonotic potential. Bactofugates, although constituting concentrated spore suspensions, were not contaminated with C. difficile spores. This finding excludes raw milk as a major source of food contamination. In conclusion, C. difficile recovery rates found in our study were lower than expected from the literature. Sources other than zoonotic origin must be considered when studying the epidemiology of community acquired infections with this bacterium.

A European survey on public health policies for managing cases of meningococcal disease and their contacts.

In 2007, a European survey was conducted to compare national policies on public health management of cases of meningococcal disease and their contacts. The results revealed differences in definitions of close contacts and prophylactic regimens between countries. These differences can be attributed to a lack of evidence on optimal prevention and treatment strategies. The development of guidance for best practice in priority areas, based on evidence or consensus, is therefore recommended.

Outbreak of acute gastroenteritis in an Austrian boarding school, September 2006.

An outbreak of acute gastroenteritis occurred in September 2006 in a boarding school in eastern Austria. Of 113 cases, 101 were hospitalised. In order to identify the outbreak source, a retrospective cohort study on the group at risk was performed, including 222 pupils and 30 staff members. Food exposure in the canteen of the school was identified as the most relevant common link among the cases in the case series investigation. Although the preliminary microbiological investigation made Norovirus infections possible, an in-depth descriptive epidemiological investigation later pointed to food intoxication rather than a viral infection as the cause of the outbreak. The analytical epidemiological investigation implicated boiled rice and chicken wings served in the canteen as the most likely source of the outbreak. Staphylococcus aureus was identified as the causative agent. Further molecular characterisation revealed that the predominant S. aureus type in this outbreak was a new spa type, t2046. The same spa type was isolated from stool specimens of the majority of the cases investigated, from samples of the incriminated boiled rice, and also from a swab of a palmar skin lesion of one of the healthy kitchen workers, who is therefore the most likely source of contamination. This outbreak underlines again the importance of compliance with the basic guidelines for kitchen hygiene.

Effectiveness of different policies in preventing meningococcal disease clusters following a single case in day-care and pre-school settings in Europe.

National policies for chemoprophylaxis after single cases of meningococcal disease in day-care or nursery settings vary across Europe. We carried out a multi-national retrospective study to compare the effectiveness of different policies. Countries were divided into those recommending chemoprophylaxis only to close contacts (policy A, close) and those recommending chemoprophylaxis for all children in the same nursery (policy B, mass). Country-specific relative risk (RR) of a cluster was defined as the ratio of the number of clusters observed to the number of clusters expected by chance. In total, 37 clusters were identified between 1 January 1993 and 31 December 2002. After adjusting for marked heterogeneity in RR by country, the ratio of RR between countries suggested possible benefit from mass prophylaxis (RR ratio 3.8, 95% CI 0.7-22.0), although the difference was not statistically significant (P=0.22). The costs of this approach and the low risk of clustering need to be taken into account when deciding national policy.

Ascertainment of meningococcal disease in Europe.

Meningococcal disease surveillance in most countries is based upon a combination of statutory notification systems and laboratory reporting, both of which are recognised to underestimate the true burden of disease. The incidence of meningococcal disease varies throughout Europe, and although there are many reasons for this, it is important to quantify the degree of under-ascertainment in order to validate international comparisons. Here, we review the literature on the ascertainment of meningococcal disease in Europe and the available methods for estimating the degree of under-reporting. We found that the sensitivity of surveillance varies between countries and over time, with estimates ranging from 40% to 96%. We identified five methods suitable for conducting ascertainment studies, from simple comparative studies to more complicated capture-recapture and regression analyses. Studies of ascertainment may be used to identify weaknesses and biases in surveillance data, and facilitate the improvement of these systems. These findings are relevant to the surveillance of other infectious diseases, particularly those with lower mortality and a lower public profile than meningococcal disease, for which ascertainment may be worse.

Ascertainment of meningococcal disease in Europe.

Meningococcal disease surveillance in most countries is based upon a combination of statutory notification systems and laboratory reporting, both of which are recognised to underestimate the true burden of disease. The incidence of meningococcal disease varies throughout Europe, and although there are many reasons for this, it is important to quantify the degree of under-ascertainment in order to validate international comparisons. Here, we review the literature on the ascertainment of meningococcal disease in Europe and the available methods for estimating the degree of under-reporting. We found that the sensitivity of surveillance varies between countries and over time, with estimates ranging from 40% to 96%. We identified five methods suitable for conducting ascertainment studies, from simple comparative studies to more complicated capture-recapture and regression analyses. Studies of ascertainment may be used to identify weaknesses and biases in surveillance data, and facilitate the improvement of these systems. These findings are relevant to the surveillance of other infectious diseases, particularly those with lower mortality and a lower public profile than meningococcal disease, for which ascertainment may be worse.

Structure determination of a novel 3(6H)-pyranone chromophore and clarification of its formation from carbohydrates and primary amino acids.

An intensely orange compound, which has recently been evaluated as one of the main colored compounds formed in Maillard reactions of hexoses, could be unequivocally identified as (Z)-2-[(2-furyl)methylidene]-5,6-di(2-furyl)-6H-pyran-3-one (1) by application of several NMR and LC-MS experiments. To clarify its formation, the effectiveness of certain carbohydrate degradation products as precursors of 1 was studied in a quantitative experiment demonstrating hydroxy-2-propanone, furan-2-aldehyde, and 3-deoxy-2-hexosulose as precursors of the colorant. Site-specific labeling experiments with D-1-[(13)C]glucose and D-6-[(13)C]glucose, respectively, were performed to elucidate the formation pathway of 1 involving a cleavage of the hexose skeleton between carbon atoms C(5) and C(6). In addition, pentoses could be shown to generate 1 via a similar formation pathway involving the 3-deoxy-2-pentosulose.

Release of neurotensin from rat spinal cord in vitro.

The release of immunoreactive neurotensin (I-NT) from the dorsal half of the rat spinal cord was studied in vitro. A basal release in the order of 0.03-0.06% per min of tissue content was found. Depolarization with K+ caused a dose-dependent increase, with 60 mM K+ causing a 7.7-fold stimulation of release. This K+-evoked release was strictly calcium-dependent. Veratridine (50 microM) produced a 4.9-fold increase which was inhibited by 0.3 microM tetrodotoxin. Noradrenaline, 5-hydroxytryptamine, glutamate, kainic acid, N-methyl-D-aspartate, or quisqualate did not stimulate release of I-NT. The results support a role of NT as a neurotransmitter or modulator in the spinal cord.

The effects of the bradycardia-producing compound alinidine on action potentials and tension development in cardiac fibres.

Alinidine (ST 567, N-Allyl-Clonidine) exerted concentration-dependent negative chronotropic effects in isolated, spontaneously-beating sinus node cells and Purkinje fibres of guinea pigs and in ventricular strips of chick embryonic myocardium. Reduction of beat frequency by 30% was found after addition of 8.6 mumol/l alinidine in the former. A chronotropic effect was not seen during Ba2+-induced automaticity or triggered activity in guinea-pig papillary muscles and in enzymatically disaggregated cells of embryonic chick myocardium, which lose the beta-adrenoceptor responsiveness of the intact embryonic ventricle. In contrast to alinidine, D600 showed very pronounced and quinidine minor negative chronotropic effects in these latter experiments. Reduction of excitability, rate of rise of the action potential and velocity of repolarization as well as prolongation of the refractory period were seen after applications of very high concentrations of alinidine (285 mumol/l). In electrically-driven atria isometric peak tension was only slightly changed (increased by 85.5 mumol/l, decreased by 285 mumol/l) but it was reduced (to 36.8%) by alinidine (85.5 mumol/l) in papillary muscles. Both in atria and in papillary muscles, the maximum rate of rise of the action potential was unchanged by alinidine up to 85.5 mumol/l and the slight reduction following 285 mumol/l alinidine application was independent of the rate of stimulation. The present findings confirm the selectivity of the bradycardic effects of alinidine which has a main mode of action different to that of membrane stabilizing compounds or inhibitors of the slow inward current.

Topical anesthesia in preendoscopic medication: spray versus lozenges.

Patients' acceptance of upper fiberpanendoscopy was significantly (p less than 0.001) better when topical anesthesia with oxybuprocaine was performed with a spray than with a lozenge.