Risk factors associated with onychomycosis.

OBJECTIVE: To examine possible risk factors related to onychomycosis. BACKGROUND: Onychomycosis is a common disease with multifactorial aetiology, but little is known about the risk factors for this disease. PATIENTS AND METHODS: Questions related to signs, symptoms and possible risk factors associated with onychomycosis were sent to 3992 persons aged 16 years and older selected randomly from the Icelandic National Registry. Patients with suspected onychomycosis, based on photographs, were offered mycological examination. Data from the questionnaire and the results of mycological examination were used to calculate the odds ratio (OR) for several factors that might be associated with onychomycosis. RESULTS: Two thousand four hundred and eighty-six subjects responded to the questionnaire. Prevalence for mycologically determined onychomycosis was 11.1% in the Icelandic population. A history of the following factors more than doubled the risk of onychomycosis: cancer (OR 3.44; 95% CI 1.15-10.35), psoriasis (OR 2.44; 95% CI 1.61-3.72), tinea pedis interdigitalis (OR 3.93; 95% CI 3.11-4.95), the moccasin form of tinea pedis (OR 4.26; 94% CI 3.34-5.45), parents with onychomycosis (OR 2.59; 95% CI 1.89-3.53), children with onychomycosis (OR 3.48; 95% CI 2.05-5.88), spouse with onychomycosis (OR 2.53; 95% CI 1.72-3.72), regular swimming activity (OR 2.57; 95% CI 2.00-3.30) and age 50 years or older (OR 2.74; 95% CI 2.19-3.42). CONCLUSIONS: Several risk factors are associated with onychomycosis. Knowledge of these risk factors is important when treating and educating patients with onychomycosis.

Killing of Gram-positive cocci by fatty acids and monoglycerides.

The susceptibilities of three Gram-positive cocci to medium-chain saturated and long-chain unsaturated fatty acids and their one-monoglycerides were studied. The bacteria were incubated with equal volumes of lipid solutions for 10 min. Lauric acid, palmitoleic acid and monocaprin reduced the number of CFU by 6.0 log10 or greater at 5 mM concentration for streptococci of group A (GAS) and group B (GBS). When further compared at lower concentrations and after longer incubation time monocaprin proved to be the most active. Capric acid showed the highest activity against Staphylococcus aureus at 10 mM. However, at lower concentrations monocaprin was the only lipid that showed significant activity against S. aureus. The mode of action of monocaprin against GBS was studied by a novel two-color fluorescent assay of bacterial viability and by electron microscopy. The results indicate that the bacteria are killed by disintegration of the cell membrane by the lipid, leaving the bacterial cell wall intact. The highly lethal effect of monocaprin indicates that this lipid might be useful as a microbicidal agent for prevention and treatment of infections caused by these bacteria.

[Kingella kingae ostemyelitis and septic arthritis in paediatric patients. Six cases from the Department of Pediatrics, National University Hospital of Iceland.].

Kingella kingae (K. kingae) is a gram negative rod most often associated with septic arthritis and osteomyelitis in children. Infections caused by K. kingae had not been reported in Iceland when six cases were diagnosed at the Pediatric Department at the National University Hospital of Iceland. In this report we describe those cases and review the literature.

In vitro susceptibilities of Neisseria gonorrhoeae to fatty acids and monoglycerides.

The susceptibility of Neisseria gonorrhoeae to several medium-chain fatty acids and their 1-monoglycerides was tested at a short inactivation time of 1 min. The results indicate that monocaprin, a monoglyceride of capric acid (10 carbon atoms, no double bonds), causes the fastest and most effective killing of all strains of N. gonorrhoeae tested.

Hydrogels containing monocaprin have potent microbicidal activities against sexually transmitted viruses and bacteria in vitro.

OBJECTIVE: To investigate the in vitro microbicidal and cytocidal potency of monocaprin dissolved in pharmaceutical hydrogel formulations and to evaluate their potential use as vaginal microbicides against sexually transmitted pathogens such as herpes simplex virus type 2 (HSV-2), human immunodeficiency virus type 1 (HIV-1), Chlamydia trachomatis, and Neisseria gonorrhoeae. METHODS: Gel formulations were mixed with equal volumes of virus/bacteria suspensions in culture medium and incubated for 1 and 5 minutes. The reduction in virus/bacteria titre was used as a measure of microbicidal activity. Similarly, gels were mixed with human semen to study their effect on leucocytes. The toxicity of the gels was tested in rabbits by the standard vaginal irritation test. RESULTS: Gels containing 20 mM of monocaprin caused a greater than 100,000-fold inactivation of HSV-2 and Neisseria in 1 minute and of Chlamydia in 5 minutes. Similarly, the gels caused a greater than 10,000-fold inactivation of HIV-1 in semen in 1 minute. They caused more than a 10,000-fold reduction in the number of viable leucocytes in semen in 1 minute. No toxic effect on the vaginal mucosa of rabbits was observed after daily exposure for 10 days. CONCLUSIONS: Hydrogels containing monocaprin are potent inactivators of sexually transmitted viruses and bacteria in vitro. This simple lipid seems to be a feasible choice as a mucosal microbicide for prevention of sexually transmitted infections. It is a natural compound found in certain foodstuffs such as milk and is therefore unlikely to cause harmful side effects in the concentrations used.

In vitro inactivation of Chlamydia trachomatis by fatty acids and monoglycerides.

The antichlamydial effects of several fatty acids and monoglycerides were studied by incubating Chlamydia trachomatis bacteria with equal volumes of lipid solutions for 10 min and measuring the reduction in infectivity titer compared with that in a control solution without lipid. Caprylic acid (8:0), monocaprylin (8:0), monolaurin (12:0), myristic acid (14:0), palmitoleic acid (16:1), monopalmitolein (16:1), oleic acid (18:1), and monoolein (18:1) at concentrations of 20 mM (final concentration, 10 mM) had negligible effects on C. trachomatis. In contrast, lauric acid (12:0), capric acid (10:0), and monocaprin (10:0) caused a greater than 10,000-fold (>4-log10) reduction in the infectivity titer. When the fatty acids and monoglycerides were further compared at lower concentrations and with shorter exposure times, lauric acid was more active than capric acid and monocaprin was the most active, causing a greater than 100, 000-fold (>5-log10) inactivation of C. trachomatis at a concentration of 5 mM for 5 min. The high levels of activity of capric and lauric acids and particularly that of monocaprin are notable and suggest that these lipids have specific antichlamydial effects. The mode of action of monocaprin was further studied by removal of the lipid by centrifugation before inoculation of Chlamydia onto host cells and by electron microscopy. The results indicate that the bacteria are killed by the lipid, possibly by disrupting the membrane(s) of the elementary bodies. A 50% effective concentration of 30 microgram/ml was found by incubation of Chlamydia with monocaprin for 2 h. The rapid inactivation of large numbers of C. trachomatis organisms by monocaprin suggests that it may be useful as a microbicidal agent for the prevention of the sexual transmission of C. trachomatis.

Comparison of Roche Cobas Amplicor and Abbott LCx for the rapid detection of Chlamydia trachomatis in specimens from high-risk patients.

OBJECTIVE: To evaluate two automated amplification systems for the detection of Chlamydia trachomatis in urogenital specimens, the Cobas Amplicor (Roche Diagnostic Systems, Branchburg, NJ) and the LCx (Abbott Laboratories, Abbott Park, IL). STUDY DESIGN: The two systems were compared testing specimens from 302 high-risk patients, including 98 female cervical swab specimens and 204 male urine specimens. The patients attended the state STD clinic in Reykjavik, Iceland, either because of symptoms or as a result of contract tracing. RESULTS: The prevalence of C. trachomatis infection was 15.3% in women and 13.2% in men. For the male urine specimens, the sensitivity and specificity were 100% and 99.4% for the Cobas Amplicor and 74.1% and 100% for the LCx. In the cervical swabs, both systems detected all 15 true-positive specimens. The internal control used with the Cobas Amplicor detected inhibition in 2% of the male urine and 20% female cervical swabs, respectively. CONCLUSION: The Cobas Amplicor demonstrated slightly better sensitivity than LCx in male urine specimens. Both systems offer the benefits of automation for routine diagnostic testing.

Reduced prevalence of cervical Chlamydia infection among women requesting termination.

BACKGROUND: The prevalence and pattern of Chlamydia trachomatis infection among women requesting induced abortion in the three year period 1992-95 was evaluated and compared to the results of a previous study in 1982-84, where the prevalence of chlamydial infection had been 13.5%. METHODS: A total of 1995 women requested termination, 1855 (93%) of whom were tested for Chlamydia and were included in the study. Two types of tests for chlamydial infection, ELISA and PCR, were used in two consecutive periods. In addition cultures for gonorrhea were done in each case. Information on age, marital status, parity, gestational age and the results of chlamydia and gonorrhea tests of the women and sexual partners were recorded. RESULTS: Chlamydia trachomatis positive women were 149 (8.0%), a significant reduction from the previous 1982-84 study (p<0.001). Women with positive tests were significantly younger (80% < or = 25 years of age; p<0.001) and more frequently single (86.6%; p<0.001), than those with negative tests, as in the previous period. Of the partners, 80.4% were contacted, and 52.1% presented for investigation. Of those tested 42.1% were Chlamydia positive. Four women (0.2%) had Neisseria gonorrhea but none of the partners. CONCLUSIONS: The prevalence of Chlamydia trachomatis is receding among women coming for termination of pregnancy. As treatment before or at operation has repeatedly been shown to be of benefit and since the prevalence is still considerable, continued screening of these women is justified.

In vitro susceptibility of Helicobacter pylori to protolichesterinic acid from the lichen Cetraria islandica.

With reference to the traditional use of Cetraria islandica (Iceland moss) for relief of gastric and duodenal ulcer, plant extracts were screened for in vitro activity against Helicobacter pylori. (+)-Protolichesterinic acid, an aliphatic alpha-methylene-gamma-lactone, was identified as an active component. The MIC range of protolichesterinic acid, in free as well as salt form, was 16 to 64 micrograms/ml.

Kingella kingae infections in paediatric patients: 5 cases of septic arthritis, osteomyelitis and bacteraemia.

Kingella kingae is a Gram-negative rod most often recognized as 1 of the organisms causing septic arthritis and osteomyelitis in children. Infection caused by K. kingae had not been diagnosed in Iceland until 5 cases were diagnosed at the Paediatric Department at the University Hospital of Iceland over a 1 year period. In this report we describe these 5 children with invasive infection caused by K. kingae (2 with septic arthritis, 1 with osteomyelitis, 1 with septic arthritis and osteomyelitis, and 1 with bacteraemia) and review the literature. All bacterial isolates were identified by the Bactec culture system.

Diagnosis of Chlamydia trachomatis infection in high-risk females with PCR on first void urine.

Recently the polymerase chain reaction (PCR) has been shown to be more sensitive than older methods in detecting Chlamydia trachomatis, when performed on endocervical swabs. A total of 203 high-risk females were enrolled in a comparative study of 3 methods for diagnosing C. trachomatis infections: McCoy cell culture and Amplicor PCR on endocervical swabs, and urine. Thirty-four had positive cultures, 38 positive PCR from cervix and 37 had positive PCR on urine specimens. When discrepancy occurred, the leftover Amplicor specimen was retested by Roche with Amplicor and a primer for the major outer membrane protein (MOMP) gene. In all three tests, 32 were positive. The sensitivity of culture was 87%, 92% in cervical PCR and 95% in urinary PCR. The specificity was 100% in both culture and urinary PCR but 98% in cervical PCR. Amplicor PCR performed on female urine is at least as sensitive and specific as cell culture.

[Human listeriosis diagnosed in Iceland 1978-1994.].

Listeriosis has been recognised in Iceland, as a distinct disease entity in sheep called silage disease (votheysveiki), since 1910. The use of silage was introduced in Iceland in the latter part of the 19th century. Because of the climatic conditions it came into widespread use and the connection between silage and listeriosis was first demonstrated in Iceland by Pálsson et al. The first case of human listeriosis was diagnosed in 1961. The diease was not diagnosed again untill 1978 when four cases were identified. In the period between 1978 and 1994 L. monocytogenes was isolated from 36 patients, 11 males and 25 females. During this period the population of Iceland grew from 224.384 to 264.919. If mother and child are counted as one the incidence is approximately 8.3 per million per year. There were nine cases of neonatal infections, nine cases involving pregnant women, 13 cases of immunosuppressed patients and five patients were previously healthy. There were four miscarriages. The patients received conventional treatment of ampicillin and aminoglycoside or in one case chloramphenicol. All neonates but two survived. One older patient with meningitis died and 3 severely immunocompromised patients died. All of the strains were of the most common serotypes, 4b, l/2a and l/2b. The different serotypes were not evenly distributed during the study period. During the years 1978-1984 only one of 13 isolates was serotype l/2a and the rest was 4b. On the other hand all but three strains isolated since 1985 were either 172a or l/2b. During the first part of the study period the majority of cases involved neonates or pregnant women but during the second part most of the patients were old or immunocompromised. Nothing is known about the source of the infection in any of the patients except in one neonate which was considered to be nosocomially infected.

[Results of cultures and serotyping of S. pyogenes 1986-1993.].

Streptococcus pyogenes is a major human pathogen. It is a common cause of pharyngitis, cellulitis and wound infections. Late complications like rheumatoid arthritis and glomerulonephritis are associated with certain M proteins on the surface of the bacteria. In 1987 an increase was noted in the incidence of serious infections caused by this bacterium. The increase has been associated with protein type M 1. Typing with antibodies against T proteins is simpler to perform than M typing and can give as good epidemiological information. Culture results from January 11986 to December 31 1993, from the Department of Microbiology at the National University Hospital in Reykjavik, were reviewed. T protein type of some of the strains, that had been preserved by freezing, was determined by agglutination after culture in Todd Hewitt broth as described by Efstratiou. T-protein type of 384 strains from 1991-1993 was determined and the results compared to unpublished results from 1988 and 1989. T-protein type was also determined on all S. pyogenes strains that were isolated from blood in 1989 to 1993. The following T-types were most common: 1988-1989 Tl vas 30%; 1991, T4 and T28 70% and 62% in 1992; in 1993 Tl and T3 were 59%. Thirty one strains were sent to the Streptococcal Reference Laboratory, Central Public Health Laboratory, London, for determination of M-proteins. All strains but one, that were sent to Britain for M-protein typing, had corresponding T-proteins (Mx=Tx; My=Ty and so on). Big fluctuations in the number of isolations of S. pyogenes strains was observed during the study period: Fewest in 1989 or 629, but the number was highest in 1993 or 2057. The changes in incidence seemed to correlate with certain serotypes.

[Clinical chemistry and bacteriological testing in Iceland 1990.].

In this article we present the number and composition of clinical laboratory testing, both haematological, biochemical and bacteriological, performed at hospitals, primary care centers and private clinics in Iceland, in the year 1990. Inquiries were sent to 85 institutions, 52 (61%) responded. The number of assays performed at the laboratories/institutions not responding was estimated. The total number of assays performed in 1990 at these Icelandic institutions was 1.7 million which equals to 6.7 tests per person. Comparison to a similar investigation of assays done in 1982 showed that for those institutions which participated both years the number of tests other than bacteriological tests had increased by 23.2%. Tests done at larger hospitals had increased by 30%, at intermediate sized hospitals they had increased by 14.5%, and testing at primary care centers had decreased by 10% between 1982 and 1990. Bacteriological and clinical chemistry tests increased significantly or by 53% and 49% respectively. On the other hand hematological tests increased only by 1% and tests on urine decreased by 25%. By far the most common assay performed was blood count, ESR came second both years.

[Diagnosis of chlamydia trachomatis infections in women: urinary PCR compared to cervical culture and PCR on cervical swabs in high risk females.].

Diagnosis of Chlamydia trachomatis infections in women has traditionally depended on cell culture or enzyme linked immunoassay. Recently Polymerase Chain Reaction (PCR) has been shown to be more sensitive than these methods when performed on endocervical swabs. A total of 203 high risk females were enrolled in a comparative study of three methods for diagnosing C. trachomatis infections: McCoy cell culture and Amplicor(R) PCR on endocervical swabs and urine. Thirty four had positive cultures, 38 positive PCR from cervix and 37 had positive PCR on urine specimens. When discrepancy occurred, the leftover Amplicor(R) specimen was retested by Roche with Amplicor(R) and a primer for the Major Outer Membrane Protein (MOMP) gene. None was false positive in cell culture or in urinary PCR but two were false positive in cervical PCR. In all three tests, 32 were positive. The sensitivity of culture was 87%, 92% in cervical PCR and 95% in urinary PCR. The specificity was 100% in both culture and urinary PCR but 98% in cervical PCR. The results show that Amplicor(R) PCR performed on female urine is more sensitive and as specific as cell culture.

[Clinical evaluation of a rapid polymerase chain reaction (PCR) assay: for the detection of chlamydia trachomatis in specimens from high risk patients.].

A Rapid Polymerase Chain Reaction Assay (Ampli-cor(R)-PCR) was evaluated for the detection of Chlamydia trachomatis in specimens from 179 high risk patients. The results were compared to McCoy cell culture and specimens were retested with Amplicor(R) and primers for the Major Outer Membrane Protein (MOMP) gene when discrepancy occurred. Of 88 females enrolled in the study, 30 were infected (34%). Sensitivity, selectivity, predictive value of a positive (PVP) and a negative (PVN) on endocervical specimens were 97%, 96.5%, 96.5% and 98% respectively. Of 91 male urine specimens, 33 (36%) came from infected patients. The sensitivity and specificity of the Amplicor(R) assay was 94% and 74% respectively for male urine specimens and the PVP and PVN were 72% and 96% respectively. The sensitivity was low on the original run on urethral specimens but the majority of false negative specimens became positive when retested. Amplicor(R) performed on urine samples was the most sensitive test for detecting Chlamydial infections in males.

[Clinical evaluation of two immunoassay methods for the rapid detection of chlamydia trachomatis: antigen in endocervical specimens from high risk female patients.].

Two rapid immunoassay methods, QuickVue-Chlamydia (Quidel Corp., San Diego California) and Kodak Surecell (Kodak Corp. Rochester, N.Y.) were evaluated for the detection of Chlamydia trachomatis antigen in endocervical swabs from high risk females attending a sexually transmitted disease clinic. The results were compared to McCoy cell culture and a polymerase chain reaction assay (Amplicor(R)-PCR, Roche Molecular Systems). Of the 240 females enrolled in the study 45 were considered infected (18.8%). Sensitivity, specificity, predictive value of a positive (PVP) and predictive value of a negative (PVN) of the QuickVue-Chlamydia assay were 96%, 99%, 96% and 99% respectively. Sensitivity, specificity, PVP and PVN of the Surecell assay were 96%, 100%, 100% and 99% respectively. The performance of the two immunoassay methods was similar, the sensitivity was the same and the specificity of the Kodak Surecell was slightly better than that of the QuickVue. On the other hand, the QuickWVL-Chlamydia assay was considerably simpler to perform (fewer steps) than the Kodak Surecell assay and took significantly less of technologists time.

[Diagnostic efforts for the detection of chlamydia trachomatis infections in Iceland 1982-1994.].

The results of diagnostic testing for the detection of Chlamydial infections in Iceland during the years 1982 to 1994 were reviewed. During those 13 years 123,461 laboratory tests were performed in 101,574 examinations. These examinations were positive in 14,462 instances. The first diagnostic test to be introduced was cell culture in 1982. From then on the number of examinations and the number of positive examinations increased steadily until 1988, when positive examinations reached a peak at approximately 570 cases per 100,000 inhabitants. In 1990 a sharp decline in both the total number of examinations and positive results was observed. The percentage of positive examinations declined during the study period. In 1991 and 1992 the number of examinations, the number of positive examinations and the percentage of positive examinations increased but the number of positive tests declined again in 1993. In 1994 the polymerase chain reaction assay (PCR) replaced the much less sensitive Chlamydiazyme(R) assay and the number of positive examinations rose again although the number of tests declined. The dramatic reduction in prevalence experienced in Sweden does not seem to have taken place in Iceland. In Sweden a substantial effort was made to screen asymptomatic populations. In Iceland the screening of asymptomatic patients increased from the beginning of the study period until 1988 but declined thereafter. Screening of asymptomatic populations as well as contact tracing may be important for bringing about a significant reduction of the prevalence of sexually transmitted infections caused by Chlamydia trachomatis.

[Lower genital tract infection with chlamydia trachomatis in women requesting induced abortion.].

Postoperative pelvic infection is a serious complication of induced abortion, and may occur in 2-6% of cases. A study of the prevalence and distribution by age and marital status of cervical Chlamydia infection in 1991-93 in women seeking termination of pregnancy is in progress. The data for 1993 are presented and compared to results from a previous study. There were 686 women requesting termination of pregnancy in 1993. Of those 636 had induced abortion by suction evacuation, 11 aborted spontaneously, three were not pregnant, two were refused termination of pregnancy and 34 women withdrew their request. Of those who had the operation, 633 (92.3%) had samples taken and 48 were Chlamydia trachomatis positive (7.6%). The reduction from the previous study was significant where 13.5% of the women were Chlamydia positive. The Chlamydia positive women were also younger and more often single than those who were negative. It has been shown that if Chlamydia positive women are treated the incidence of later endometritis and salpingitis is not higher than among those that are negative. This emphasizes the importance of screening and treating Chlamydia positive women requesting termination of pregnancy.

[Prevalence of genital chlamydia trachomatis infections in college students.].

UNLABELLED: Sexually transmitted Chlamydia infection is the most common venereal disease in Iceland. Although considerable information is available on the epidemiology of these infections, the true prevalence of C. trachomatis infections in Iceland is unknown because all the studies have been conducted on selected populations. The purpose of the present study was twofold: To investigate the prevalence of Chlamydia infection in an unselected group of people in the age group at high risk, and to investigate the usefulness of collecting urine samples from college students as a screening method for Chlamydia. All students, aged 18-21, in the senior classes in a college in Reykjavik were requested to submit a first void urine (FVU) specimen taken in the morning and asked to fill out a short questionnaire. The urine samples were tested with a polymerase chain reaction assay, the Amplicor(R) PCR. One hundred eighty three students received urine collection kits. One hundred sixty (87.4%) delivered specimens. Seventy three males and 110 females received the containers. Sixty males (82%) and 100 (91%) females returned the samples. Three samples turned out to be positive (2%), all of them from females. For those who were sexually active (one or more partners for the last six months) the prevalence was 2.6% (117/160). IN CONCLUSION: The prevalence of asymptomatic Chlamydia infection in college students in this school was low, probably too low for screening to be cost effective. The procedure was not satisfactory because of the low percentage that enquired about their tests. It is therefore unsuitable in a screening program.