Results of faecal donor instillation therapy for recurrent Clostridium difficile-associated diarrhoea.

We report a success rate of 83% with faecal donor instillation therapy (FDIT) in this retrospective study of 40 patients with recurrent Clostridium difficile-associated diarrhoea (CDAD), treated at a medium sized Norwegian hospital from 1994 through 2008. The stool transplant was instilled either in the duodenum through a gastroscope or in the colon through a colonoscope with next of kin or other household member as donor. In 29 cases (73%) the first treatment was successful, with no documented recurrence of diarrhoeal disease within 80 days. Of the 11 patients failing to respond to the first instillation treatment, 6 patients received a second instillation, 4 of which were successful. A total of 33 patients (83%) were successfully treated with FDIT. Of the 7 non-responders, 5 were seriously ill due to long lasting diarrhoeal disease and co-morbidity and died within 80 days after the procedure, and 2 were believed to have inflammatory bowel disease with response to corticosteroid treatment. No adverse effects of FDIT were observed. In our experience the procedure is easy to perform, well tolerated, effective, and may be a valuable treatment option in selected cases.

[Short-term treatment of Hepatitis C in heroin-dependent patients]. / Korttids hepatitt C-behandling av heroinavhengige pasienter.

BACKGROUND: Standardized treatment (24-week) with pegylated interferon and ribavirin induces sustained virological response in 80 % of patients with Hepatitis C (HCV) genotype 2 or 3. Most patients who are dependent on heroin and receiving methadone maintenance therapy (MMT) have been excluded from this treatment due to concerns about compliance. Short-term therapy (14 weeks) of other patient groups have shown promising results. The purpose of this study was to investigate the feasibility, efficacy and adverse effects of short-term treatment in a group of MMT patients with chronic hepatitis C infection genotype 3. MATERIAL AND METHODS: Eight such patients were treated with weekly pegylated interferon injections (180 microg) and daily ribavirin tablets (800 mg) for 14 weeks. A nurse gave the injections and the patients were followed-up closely with weekly meetings, telephone and SMS. RESULTS: Virus was eradicated in all patients after four weeks (RVR = 100 %). Seven patients completed treatment and all had undetectable virus at 14 weeks (88 %). At follow-up six months post treatment, six patients had sustained virus response (SVR = 75 %), the last patient refused to be tested. The adverse effects were of moderate intensity and could be treated with dose adjustments and supportive therapy, without additional medication. Drug abuse was a minor problem during treatment and no one relapsed to drug injections. INTERPRETATION: Short-term (14 weeks) therapy with pegylated interferon and ribavirin can then be feasible, efficient and safe for Hepatitis C genotype 3. We stress the importance of close monitoring and support from a multidisciplinary team. MMT is a good opportunity to introduce HCV treatment.

Treatment results with debridement and retention of infected hip prostheses.

A retrospective systematic review of the management of a periprosthetic joint infection (PJI) cohort of 78 cases was conducted at a single-centre, middle-sized Norwegian hospital from 1997 to 2007. We analysed 40 cases that were managed by surgical debridement with hip prosthesis retention followed by long-lasting pathogen-directed antibiotic therapy. A follow-up time of 58 to 510 weeks free from PJI relapse occurred in 27 of 40 PJI cases (67.5%). The need for a more advanced secondary orthopaedic procedure was recognized in 13 cases. The pathogen responsible for PJI was recovered in only 80% of cases, hence 20% were managed as culture-negative PJI. In cases without prior hip infection or hip surgery, success rate reached 96.3%. Multiple risk factors were found in most cases undergoing PJI relapse. Debridement with hip prosthesis retention should be restricted to only current management guidelines.

Reduction of unnecessary i.v. antibiotic days using general criteria for antibiotic switch.

This study was designed to help physicians consider change from intravenous to oral antibiotic therapy for any infection from d 3 of hospital stay, by implementing guidelines for antibiotic switch. A 2-centre intervention study was conducted at Sorlandet Hospital HF Kristiansand and Arendal. All patients admitted to the Medical Clinic at these hospitals prescribed with intravenous antibiotics at hospitalization, were included. After collecting data in an observation period, antibiotic switch guidelines were launched in the respective departments of both hospitals. The length of unnecessary intravenous d, duration of hospital stay and outcome of treatment were compared before (observation group) and after (intervention group) the guidelines were implemented. Antibiotic switch was considered from d 3 and onward. The effect of switch guidelines implementation was measured as a reduction of unnecessary intravenous d. Duration of unnecessary intravenous antibiotic therapy was significantly reduced from 3.4 d in the observation group to 1.4 d in the intervention group. Unnecessary intravenous d were found to constitute 83% of total intravenous therapy duration in the observation group and 48% in the intervention group. Duration of hospital stay was significantly reduced from 7.0 to 6.3 d. There was no statistically significant difference in mortality rate, re-prescription of intravenous antibiotic therapy or re-admittance to the hospital. In conclusion, implementing antibiotic switch guidelines significantly reduces the duration of unnecessary intravenous antibiotic therapy. The switch guidelines were based on general criteria for antibiotic switch for any infection.

Severe dengue virus infection in travelers: risk factors and laboratory indicators.

BACKGROUND: Dengue fever is the most common arboviral disease in travelers. In countries where dengue virus is endemic, sequential (secondary) infections with different dengue virus serotypes are associated with disease severity. Data on severity and secondary infection rates in a population of travelers are lacking. METHODS: Intensified surveillance of dengue fever in travelers was performed within the European Network on Surveillance of Imported Infectious Diseases. Data were collected at 14 European clinical referral centers between 2003 and 2005. RESULTS: A total of 219 dengue virus infections imported from various regions of endemicity were reported. Serological analysis revealed a secondary immune response in 17%. Spontaneous bleeding was observed in 17 (8%) patients and was associated with increased serum alanine and aspartate aminotransferase levels and lower median platelet counts. Two (0.9%) patients fulfilled the World Health Organization (WHO) case definition for dengue hemorrhagic fever. However, 23 (11%) travelers had severe clinical manifestations (internal hemorrhage, plasma leakage, shock, or marked thrombocytopenia). A secondary immune response was significantly associated with both spontaneous bleeding and other severe clinical manifestations. CONCLUSIONS: In travelers, severe dengue virus infections are not uncommon but may be missed if the WHO classification is strictly applied. High liver enzyme levels and low platelet counts could serve as indicators of disease severity.

First human cases of tickborne encephalitis, Norway.

The first reported case of tickborne encephalitis (TBE) in Norway occurred in 1997. From 1997 to 2003, from zero to two cases of human TBE have been diagnosed per year in Norway, for a total of eight cases. Clinical TBE cases in dogs are not reported in Norway.

[Tick-borne encephalitis in Norway]. / Skogflåttencefalitt i Norge.

BACKGROUND: The first person reported with tick-borne encephalitis (TBE) in Norway fell ill in 1998; the second patient caught the disease in autumn 1999. Both had been to the island of Tromøy in Aust-Agder county. Searches for TBE antibodies were intensified in persons with encephalitis and a seroprevalence study was carried out. MATERIAL AND METHODS: Sera from persons with encephalitis were tested for IgM and IgG antibodies to TBE virus with enzyme immunoassay and a neutralization test. Stored sera from persons living on Tromøy in 1997-2000 were studied for IgG antibodies. RESULTS: We report three cases of TBE, two had encephalitis in September-October 2000. The third patient, with antibodies to TBE virus found by retrospective testing, had the disease in August 1997. IgG antibodies to TBE virus were found in 3 out of 126 (2.4%) samples from Tromøy. INTERPRETATION: We report the first case of TBE in Norway. Of the first five Norwegian cases, four had been on Tromøy before they fell ill, three of them as tourists. In previous studies, IgG antibodies to TBE virus were found in 0.3-0.4% of persons from different parts of Agder counties. The seroprevalence studies indicate that Tromøy may have a higher incidence of TBE than the rest of the two southern counties. Our results confirm that TBE occurs in the coastal area of southern Norway.