Gastric mucosal interleukin-8 and IL-8 antibody concentrations related to prevailing Helicobacter pylori infections. A Danish-Albanian study.

OBJECTIVES: Helicobacter pylori (H. pylori) appears to initiate an inflammatory cascade. Thus, phagocytes are accumulated in the gastric mucosa, in inflammatory conditions. Further, a potent chemotactic mediator, interleukin 8 (IL-8) is synthesized at such sites. The recently described IL-8 autoantibodies may, however, counteract the pro-inflammatory actions of IL-8. The aim was to study the correlation between H. pylori infection and IL-8, together with IL-8 autoantibodies in two different populations from a developed and a developing country. METHODS: Two different endoscopically characterized populations (65 Danes and 89 Albanians) were examined. IL-8 and IL-8 autoantibodies were detected by ELISA techniques, and H. pylori was identified by histological examinations. RESULTS: Significantly more Albanian controls and dyspeptic patients (80 out of 89 persons) were H. pylori positive as compared to 24 of 65 Danes (p < 0.001). The median IL-8 level among Albanian controls 349 pg/mg protein was significantly higher than among Danes < 61 pg/mg protein (p < 0.001), and was at the same level as found in Danish peptic ulcer patients (p > 0.05). Further, H. pylori positive patients from both countries had significantly higher levels of IL-8 as compared to H. pylori negative patients (p < 0.001). However, significantly higher levels of IL-8 autoantibodies were found in the Albanian sub-population (median 138 O.D. units versus 52 O.D. units among Danes) (p < 0.001). CONCLUSIONS: In H. pylori related disorders, a high mucosal IL-8 production has been found. However, this investigation further demonstrates higher levels of IL-8 autoantibodies among dyspeptic patients from a developing country, which might possibly counteract the pro-inflammatory actions of IL-8 by binding the molecule. The physiological significance of an altered immune response as described here needs to be elucidated in future studies.

[Penicillin resistant pneumococci--not a threat in Denmark yet?]. / Penicillinresistente pneumokokker--endnu ikke en trussel i Danmark?

The occurrence of penicillin resistance in clinical isolates of pneumococci was investigated in two clinical microbiological laboratories in Copenhagen, Denmark. One of the laboratories predominantly received samples from patients with frequent use of antibiotics mainly because of chronic lung diseases. In this laboratory, 6.3% of 245 isolates of pneumococci had intermediate resistance to penicillin. In the other laboratory, which received samples from a number of hospitals and general practice, only 1.3% of isolates of pneumococci had reduced sensitivity to penicillin. Penicillin-resistant pneumococci are rare in Denmark, but are more prevalent in patients who frequently use antibiotics.

[Penicillin treatment of non-nosocomial pneumonia in Danish medical departments. A questionnaire]. / Penicillinbehandling af ekstranosokomielt erhvervet pneumoni på medicinske afdelinger i Danmark. En spørgeskemaundersøgelse.

This study describes the most common penicillin-regime for hospitalized patients with community-acquired pneumonia in Denmark. One hundred and seventy-one consultant physicians received an anonymous questionnaire, 85% were returned and 75% were evaluated. The most common regime is a treatment duration of six to ten days with 3-6 million IU of penicillin daily given in three doses. The most common route of administration is intravenously until the patient's body temperature drops. Then the same dose is given orally. Variations in strategy were revealed and call for further investigations to establish and maintain restrictive antibiotic regimes.

[Extraintestinal Salmonella infections in four Danish counties. Inverse relationship between invasiveness and zoonotic serotypes]. / Ekstraintestinale Salmonella-infektioner i fire danske amter. Invers relation mellem invasivitet og incidens af zoonotiske serotyper.

The relationship between invasiveness and incidence of non-typhoid salmonellosis was ascertained retrospectively in a population of 1.9 million in four Danish counties during the three-year period 1992-1994. The study comprised 4175 cases diagnosed by culture either locally or at Statens Serum Institut, Copenhagen. Two hundred and forty-four patients had extraintestinal infections caused by 24 out of the total number of 101 different serotypes. Invasiveness ranged widely from 4% to > 90% for individual serotypes. Salmonella typhimurium and Salmonella enteritidis formed a high-incidence group (incidence rates > or = 25/100,000/year) compared to the remaining 22 serotypes (< 5/100,000/year). The low-incidence group was more invasive than the high-incidence group even when excluding Salmonella dublin, which is highly invasive, and including 212 cases of salmonelloses caused by serotypes isolated entirely from faeces (relative risk 1.54, 95% confidence limits 1.19 < RR < 2.00). The data corroborate a previous more limited study and indicate that previous exposure to salmonella and acquired immunity may play a role in the occurrence of extraintestinal non-typhoid salmonellosis.

[Spondylitis and medullary transverse syndrome caused by Staphylococcus aureus]. / Spondylit og medullaert tvaersnitssyndrom forårsaget af Staphylococcus aureus.

Three cases of haematogenous osteomyelitis in the vertebral column caused by Staphylococcus aureus are reported. The cases, which were associated with severe neurological symptoms and/or death, were initially characterized by a long period with no or discrete local signs of infection and by values of temperature and leucocyte counts within or close to normal values. In this period measurements of the sedimentation reaction and C-reactive protein were elevated, and were markers of persistent infection. At the Department of Clinical Microbiology in the county of Copenhagen blood cultures from a total of 49 patients were found to be positive for S. aureus during the period January to March 1996. Six patients were found to have osteomyelitis (12%, including four cases of spondylitis) and nine patients were suspected of having osteomyelitis. This frequency of patients with S. aureus bacteraemia having osteomyelitis was significantly higher than reported in another Danish study (10), which together with the severe outcome of the infection emphasizes the need for attentiveness to these serious complications of S. aureus bacteraemia.

[Salmonella dublin]. / Salmonella dublin.

Salmonella dublin's natural host is cattle; it may cause acute disease in calves, while adult animals may be asymptomatic carriers. In humans S. dublin is the most invasive of the zoonotic Salmonella-bacteria found in Denmark. It is much more frequently isolated from the blood than from the faeces and may give rise to serous metastatic infections in practically all organs. The number of registered human infections rose from zero to 46 per year during the period 1980-1988, but has now stabilized at a level of about 20 per year. Outbreaks have been described abroad as being caused by unpasteurised milk and cheese; in Denmark beef and cow's liver must be viewed as the dominant source of infection. The direct routes of infection are, however, unknown. Tightening of regulations for the slaughtering of animals from S. dublin infected herds, optimal hygiene in the slaughterhouses and increased cooperation between the veterinary and medical professions concerning investigation of routes of infection are necessary measures to be taken in order to reduce the number of human S. dublin infections.

[Prevention of duodenal ulcer recurrence with penicillin]. / Forebyggelse af recidiv af ulcus duodeni med penicillin.

The aim of this study was to test the hypothesis that infection with Helicobacter pylori is essential for recurrence of duodenal ulcer. We performed a randomized controlled trial of the relapse rate of duodenal ulcer during 12 weeks treatment with penicillin V or placebo in 170 out-patients from five centres. The relapse rate was 9% during treatment with penicillin and 50% with placebo, P < 0.0001. It is concluded that infection with penicillin-sensitive bacteria, i.e. H. pylori, plays an important role for recurrence of duodenal ulcer disease. Penicillin V suppresses this infection but does not eradicate it.

Bacterial contamination of air and surgical wounds during joint replacement operations. Comparison of two different types of staff clothing.

Compared with conventional surgical clothing, polypropylene coveralls reduced the bacterial contamination of the air of a conventionally ventilated operating room by 62%. The contamination of surgical wounds during joint replacement was also reduced, but not to a significant degree. Sixteen percent of the bacteria sampled from the wounds were resistant to the prophylactic antibiotic and the importance of a clean air system for performing joint replacement operations is stressed. The use of commercially available non-woven swabs for sampling bacteria from the surgical wound compared favourably with the use of specially prepared velvet pads.

[Diphtheria in Denmark 1956-1989. Occurrence of Corynebacterium diphtheriae and other diphtheria toxigenic bacteria]. / Difteri i Danmark 1956-1989. Forekomsten af Corynebacterium diphtheriae og andre difteritoksigene bakterier.

The public immunization program against diphtheria, established in 1941, has almost eradicated the disease in Denmark, and 1956 became the first year without any notified cases. Since then, toxigenic strains have only been isolated five times--three cases of clinical diphtheria due to Corynebacterium diphtheriae biovar. mitis and two cases of tonsillitis/pharyngitis due to Corynebacterium ulcerans. The source of the infection was not identified in any of the cases. The first case of diphtheria in 1968 was imported from abroad. The following two cases in 1983 and 1985 were due to strains of the same phage type and peptide profile as the strains isolated during the epidemic in Sweden in 1984-1986. This indicates that the Danish cases and the Swedish epidemic derived from the same source. The diphtheria immunity of the Danish population is decreasing, and the level of protection is approaching the Swedish level. The impact is that a situation like that in Sweden may be anticipated with diphtheria epidemic in the lowest socio-economical groups--the skid row dwellers, alcoholics and drug abusers--if the immunization program against diphtheria is not intensified.

[Bacteremia caused by zoonotic Salmonella types in greater Copenhagen in 1984-1988]. / Bakteriaemi forårsaget af zoonotiske Salmonella-typer i Storkøbenhavn 1984-1988.

The five departments of clinical microbiology in Greater Copenhagen have together carried out a retrospective review of bacteraemia caused by the zoonotic Salmonella serotypes in the period 1984-1988 in the municipalities of Copenhagen and Frederiksberg and in the County of Copenhagen. A gradual increase in frequency was observed from 11 cases in 1984 to 58 cases in 1988. The serotype most commonly isolated was Salmonella dublin followed by Salmonella enteritidis and Salmonella typhimurium. S. dublin was found to be more invasive and more virulent than the other serotypes. Predisposing factors were present in 56% of the patients; the commonest of these was malignant disease. Fatal or complicated course of the disease were observed more frequently in predisposed patients than in persons who had previously been healthy. A total of 17% of the patients died and one fourth of these had ruptured aortic aneurysm probably on account of Salmonella arteritis. 20% developed recurrence of bacteraemia while in the remaining patients the disease ran an uncomplicated course. It is concluded that the marked increase in the number of cases and the serious course taken by the infection demonstrate a definite need for increased prophylactic efforts in the food industry.

Fatal septicaemia caused by DF-2 in a previously healthy man.

A case of fatal septicaemia caused by DF-2, a fastidious gram-negative rod is presented. Attention is drawn to the connection between DF-2 septicaemia and dog bites or contacts, not only in patients with impaired host defence but also in previously healthy individuals. As the organism is difficult to subculture, infections with DF-2 may easily be overlooked.

Chlamydial antibodies in Danish children.

Chlamydial antibodies in titers of greater than or equal to 1:16 were found in 24 percent of 803 randomly selected healthy Danish school children. A higher prevalence of antibodies was found among the girls in all the age groups. The prevalence of antibodies increased significantly with increasing age up to puberty. The findings indicate a wide distribution of infections with Chlamydia trachomatis in childhood. The possible clinical expression of these infections is generally unknown.

Wound infection rates following preoperative versus intraoperative commencement of antibiotic prophylaxis.

The effect of antibiotic prophylaxis initiated one hour prior to contamination or at the time of contamination was evaluated in a randomized blind study using a guinea pig model of surgical wound infection. Would infection, defined as accumulation of pus draining spontaneously or after opening of the wound, developed in 135 guinea pigs after intraincisional contamination before wound closure with 10(7) Escherichia coli plus 10(8) Bacteroides fragilis. Antibiotic prophylaxis with gentamicin plus clindamycin significantly reduced the wound sepsis rate from 82% in the control group of 61 animals to 19% in the two treated groups of 68 and 67 animals (p less than 0.001). However, the timing of antibiotic prophylaxis did not influence wound sepsis rates, rectal temperature during the postoperative period, or bacterial recovery from wound infections.

Etiology of acute epididymitis presenting in a venereal disease clinic.

Sixteen patients aged 19-42 years and suffering from acute epididymitis were investigated. In twelve patients evidence of acute epididymitis developed without premonitory urethral symptoms. The only microbiologic finding for ten patients was Chlamydia trachomatis; both C. trachomatis and Neisseria gonorrhoeae were isolated from four patients. Two patients, who had recently had antibiotic treatment, harbored neither of these microorganisms. These observations indicate that C. trachomatis must be considered a dominant cause of acute epididymitis in the younger age groups. This fact has implications for the choice of treatment (erythromycin or tetracycline) and the investigations and treatment of sexual contacts.