Pre-hospital parenteral antibiotic treatment of meningococcal disease and case fatality: a Danish population-based cohort study.

OBJECTIVES: Studies about the efficiency of pre-hospital antibiotic treatment of meningococcal disease are conflicting. We examined the case fatality rate in patients with meningococcal disease treated with pre-hospital antibiotics. METHODS: A cohort study of 534 patients hospitalized with meningococcal disease from two Danish counties. Clinical data were obtained from referral letters from general practitioners and hospital records. Complete follow-up for all patient until death or discharge. RESULTS: Seventy-seven patients (16% of the patients seen by a general practitioner) received parenteral antibiotics before hospital admission; 9 (12%) of them died. Of 402 patients who did not receive pre-hospital parenteral antibiotics, 26 (7%) died. The overall risk of case fatality among antibiotic-treated patients was increased with adjusted odds ratio (OR) = 2.4 (95% CI, 1.0-5.6). Meningococcus serogroup B was associated with increased case fatality in patients who received pre-hospital parenteral antibiotics (OR = 2.6; 95% CI, 0.8-8.3) in contrast to other serogroups. In Aarhus County there were no deaths in patients who received pre-hospital parenteral antibiotics, but in North Jutland County the case fatality was high (OR = 2.9; 95% CI, 1.2-6.8). CONCLUSIONS: The efficiency of pre-hospital parenteral antibiotic treatment seems to be dependent on hospital care and may vary with the serogroup.

Period prevalence and case-fatality rate associated with distinctive clone complexes of Neisseria meningitidis serogroups B and C.

In a recent 20-year Danish survey, Neisseria meningitidis phenotypes B:15:P1.7,16 and C:2a:P1.2,5 were associated with an increased case-fatality rate of meningococcal disease - 15% and 23% - compared to the case-fatality rate of 8% for any other strain. The aim of the present study was to investigate (i) the mutual genetic relatedness of strains with phenotype B:15:P1.7,16, phenotype C:2a:P1.2,5 or serologically related phenotypes; (ii) the changes in the prevalence of distinctive clone complexes over time; and (iii) whether distinctive clone complexes are associated with an increased case-fatality rate. During the period 1980-1999, 181 of a total of 315 invasive strains obtained in North Jutland County, Denmark, were chosen on the basis of serological characteristics for characterization by multilocus enzyme electrophoresis and ribotyping. Two major complexes were identified on the basis of electrophoretic type (ET): the ET-4/23 complex ( n=111), which included all B:15:P1.7,16 strains ( n=100), and the ET-15/25 complex ( n=44), which included all C:2a:P1.2,5 strains ( n=31). Two ribotype complexes were identified within the ET-4/23 complex and one within the ET-15/25 complex, all of which were designated clone complexes. All three clone complexes were associated with an increased case-fatality rate (13-20%). The results show that, among invasive Neisseria meningitidis B:15:P1.7,16, C:2a:P1.2,5 and phenotypically related strains, three distinctive clone complexes are more virulent than any other ET/ribotype combination.

Birth outcome of 1886 pregnancies after exposure to phenoxymethylpenicillin in utero.

OBJECTIVE: To examine the risk of congenital abnormalities, preterm birth and low birth weight after exposure to phenoxymethylpenicillin in utero. METHODS: A population-based follow-up study in the County of North Jutland, Denmark. Birth outcome for 1886 women, who redeemed prescriptions for phenoxymethylpenicillin during pregnancy was compared with the outcome for 9263 women who did not redeem any prescription during pregnancy. RESULTS: The prevalence of congenital abnormalities in 654 users of phenoxymethylpenicillin with or without other drugs during the first trimester was 4.6% compared with 3.6% in the reference group, giving a prevalence odds ratio of 1.25 (95% CI: 0.84-1.86). The prevalence odds ratio was 1.35 (95% CI: 0.59-3.08) in 131 women who were exposed to phenoxymethylpenicillin only. Nine cardiovascular abnormalities were found, giving an adjusted prevalence odds ratio of 1.74 (95% CI: 0.83-3.65). The prevalence odds ratios of preterm birth and low birth weight were 0.83 (95% CI: 0.66-1.04) and 1.02 (95% CI: 0.71-1.47), respectively. CONCLUSION: We found no significantly increased risk of congenital abnormalities, including cardiovascular abnormalities, preterm birth, or low birth weight in women who purchased phenoxymethylpenicillin during pregnancy.

Evaluation of the pathology, pathogenesis and aetiology of auricular elephantiasis in slaughter pigs.

Ears from slaughter pigs with auricular elephantiasis (n = 24) and the corresponding lymph nodes (lnn.) (n = 26) were grossly, histopathologically and microbiologically examined. Immunostaining for IgM, IgG, Cd3epsilon and bacterial antigens of Arcanobacterium pyogenes and Staphylococcus aureus was performed by indirect enzyme-based techniques. Ears were variably thickened depending on the sampled area (basis, centre and apex). However, at all locations the thickness, the length from basis to apex and the weigh of whole ears with elephantiasis were significantly increased (P < 0.01). The corresponding lnn., that is, ln. parotideus superficialis and profundus, had also increased significantly (P < 0.01) in volume. Histopathologically, lesions of the ears and the corresponding lnn. revealed changes characterized by diffuse fibrosis intermingled with multiple pyogranulomatous foci containing asteroid bodies. In the majority of lesions, four distinct zones due to different cellular infiltrates encircled the central core of the asteroid bodies. In several lesions, the pyogranulomatous foci were contained within the lymph vessels. Immunohistochemically, only the bacterial antigen of S. aureus was detected within the cytoplasm of the macrophages and/or in the asteroid bodies of the ears (41.5%) and in the regional lnn. (30.8%). An abundant number of IgM, IgG and CD3epsilon-positive cells were present in all the pyogranulomatous lesions, whereas a positive IgG-staining was observed only in a single asteroid body. Thus, porcine auricular elephantiasis is a chronic pyogranulomatous inflammation that is frequently positive for S. aureus and is lymphogenically spread. Therefore, the lesions of the ears with auricular elephantiasis and the corresponding lnn. should be termed auricular botryomycosis and botryomycotic lymphadenitis, respectively. Moreover, as the disease is observed frequently in slaughter pigs it must also be considered according to the welfare of the animals and in relation to post-mortem meat inspection.

Influence of plant growth on degradation of linear alkylbenzene sulfonate in sludge-amended soil.

Widespread application of sewage sludge to agricultural soils in Denmark has led to concern about the possible accumulation and effects of linear alkylbenzene sulfonate (LAS) in the soil ecosystem. Therefore, we have studied the uptake and degradation of LAS in greenhouse pot experiments. Sewage sludge was incorporated into a sandy soil to give a range from very low to very high applications (0.4 to 90 Mg dry wt. ha(-1)). In addition, LAS was added as water solutions. The soil was transferred to pots and sown with barley (Hordeum vulgare L. cv. Apex), rape (Brassica napus L. cv. Hyola 401), or carrot (Daucus carota L.). Also, plant-free controls were established. For all additions there was no plant uptake above the detection limit at 0.5 mg LAS kg(-1) d.w, but plant growth stimulated the degradation. With a growth period of 30 d, LAS concentrations in soil from pots with rape had dropped from 27 to 1.4 mg kg(-1) dry wt., but in plant-free pots the concentration decreased only to 2.4 mg kg(-1) dry wt. When LAS was added as a spike, the final concentration in soil from planted pots was 0.7 mg kg(-1) dry wt., but in pots without plants the final concentration was much higher (2.5 mg kg(-1) dry wt.). During degradation, the relative fraction of homologues C10, C11, and C12 decreased, while C13 increased.

Casein and soya-bean protein have different effects on whole body protein turnover at the same nitrogen balance.

The present study examined whether different proteins have different effects on whole-body protein turnover in adult rats. The rats were either starved, given a protein-free but energy-sufficient diet (1 MJ/kg body weight (BW) per d) or a diet containing intact casein, hydrolysed casein, or hydrolysed soya-bean protein at a level of 9.1 g/kg BW per d. The diets, which were isoenergetic with the same carbohydrate: fat ratio, were given as a continuous intragastric infusion for at least 4 d. During the last 19 h 15N-glycine (a primed continuous infusion) was given intragastrically and 15N was recovered from urinary ammonia and urea during isotope steady state for measurement of protein synthesis and protein degradation. Compared with starvation the protein-free diet decreased N excretion by 75%, probably by increasing the rate of reutilization of amino acids from endogenous proteins for protein synthesis. The protein diets produced a positive N balance which was independent of the protein source. Intact and hydrolysed casein increased protein synthesis 2.6- and 2.0-fold respectively, compared with the protein-free diet. Protein degradation increased 1.4- and 1.2-fold respectively. Hydrolysed soya-bean protein did not increase protein synthesis but decreased protein degradation by 35% compared with the protein-free diet. Compared with the hydrolysed soya-bean protein, intact casein resulted in 2.2- and 2.8-fold higher rates of protein synthesis and degradation respectively. These results are not easily explained by known sources of misinterpretation associated with the 15N-glycine method. Hydrolysed casein and hydrolysed soya-bean protein produced similar concentrations of insulin-like growth factor-1, insulin, glucagon, and corticosterone. The difference in amino acid composition between the dietary proteins was reflected in plasma amino acid composition and this is suggested to be responsible for the different effect on protein turnover. Preliminary results from this study have previously been published in abstract form (Nielsen et al. 1991).

A general approach for PCR-amplification and sequencing of chloroplast DNA from crude vascular plant and algal tissue.

A universal and reliable sequencing approach suitable for evolutionary and phylogenetic studies of most plant species has been developed. The initial step in the approach is PCR with primers from conserved regions in the chloroplast genome. Prior to PCR a simple DNA extraction is carried out where lysed tissue is embedded in agarose and dialyzed. Due to the use of one biotinylated primer in the PCR, the PCR products can be bound to magnetic streptavidin-coated beads and then sequenced directly by the solid-phase approach. The regions used for sequencing and subsequent analyses are the intron of the trnL gene and the intergenic spacer between the trnL and the trnF genes in the chloroplast DNA. Comparisons of the sequences obtained from closely and distantly related species show that the different chloroplast DNA regions harbor variations suitable for phylogenetic inference from the subspecific to the interfamiliar level. The strategy can be used both for manual and automated sequencing.

Hyphal transport of 15 N-labelled nitrogen by a vesicular-arbuscular mycorrhizal fungus and its effect on depletion of inorganic soil N.

Hyphal transport of nitrogen from a 15 N-labelled ammonium source by a VA-mycorrhizal fungus was studied under controlled experimental conditions. Cucumis sativus L. cv. Aminex (F1 hybrid) was grown alone or together with Glomus intraradices Schenck and Smith in containers with a hyphal compartment separated from the rooting medium by a fine nylon mesh. Lateral movement of the applied 15 N towards the roots was minimized by using a nitrification inhibitor (N-serve) and a hyphal buffer compartment. Recovery of 15 N by mycorrhizal and non-mycorrhizal plants was 6 and 0%, respectively, after a labelling period of 23 days. The corresponding figures, without N-serve added, were 4 and 7%. A prolongation of the labelling period by 8 days (N-serve applied) resulted in an increase in the 15 N recovery by mycorrhizal plants to 30% of the applied 15 N. Non-mycorrhizal plants contained only traces of 15 N. The external hyphae depleted the soil in the hyphal compartment efficiently for inorganic N. In contrast, hyphal compartments of control containers still contained considerable amounts of inorganic N. The 15 N assimilated by the external hyphae in one hyphal compartment was not translocated in significant amounts to the external hyphae in another hyphal compartment. The possible implication of this for inter-plant N transfer by VA hyphal connections is discussed.