Anja A. I. Kostiala

Invasive Group B Streptococcal Infections in Finland: A Population-based Study

We analyzed surveillance data on group B streptococcus (GBS) infection in Finland from 1995 to 2000 and reviewed neonatal cases of early-onset GBS infection in selected hospitals in 1999 to 2000. From 1995 to 2000, 853 cases were reported (annual incidence 2.2–3.0/100,000 population). We found 32–38 neonatal cases of early-onset GBS disease per year (annual incidence 0.6–0.7/1,000 live births). In five hospitals, 35% of 26 neonatal cases of early-onset GBS infection had at least one risk factor: prolonged rupture of membranes, preterm delivery, or intrapartum fever. Five of eight mothers screened for GBS were colonized. In one case, disease developed despite intrapartum chemoprophylaxis. Although the incidence of early-onset GBS disease in Finland is relatively low, some geographic variation exists, and current prevention practices are suboptimal. Establishing national guidelines to prevent perinatal GBS is likely to reduce the incidence of the disease.

Antibodies against antigens of Candida albicans in patients with fungaemia and bacteraemia, studied by ELISA, precipitation, passive haemagglutination and immunofluorescence techniques.

Antibodies against commercially available antigens of Candida albicans were assayed in 54 sera from 24 patients with fungaemia and in 66 sera from 33 patients with bacteraemia. In patients with persistent fungaemia, antibody was found during the week after the fungus was first cultured from the blood, but peak titres did not usually occur until the end of the second week. A significant rise in titre in C. albicans infection was observed in 50% of paired sera tested by passive haemagglutination (PHA), indirect immunofluorescence (IF) and Ouchterlony immunodiffusion (ID). The same percentage was obtained by counterimmunoelectrophoresis (CIE) against candida metabolic antigens, whereas it was increased to 88% when somatic antigens were used. Enzyme-linked immunosorbent assay (ELISA) demonstrated a rise of titre in 25, 75 and 50% of sera in IgM, IgG and IgA assays, respectively. Sera from patients with transient fungaemia demonstrated persistent antibody titres. In paired sera from patients with bacteraemia, ID and CIE titres were low (greater than or equal to 4). There was an increase of candida antibodies in 0-9% of patients by ELISA, ID or CIE and in 18-21% by PHA or IF. Clinically significant fungaemia was most reliably differentiated serologically from bacteraemia by CIE S-antigen and ELISA IgG assays.

Prospective study on humoral immune response induced by fungal infection in patients with hematologic malignancies

SummaryTo evaluate the immune response in an immunosuppressed population, antibodies against commercially availableCandida albicans antigens were prospectively studied during 37 episodes of acute stomatitis caused byC. albicans and 36 episodes complicated by deep-seated mycoses in 62 adult patients with hematologic malignancies. During uncomplicated stomatitis in patients with acute leukemia, the mean peak IgM, IgG and IgA class enzyme-linked immunosorbent assay (ELISA) units differed significantly from the basic level preceding fungal infection. Mean time until peak values was 2.7–3.8 weeks after diagnosis of stomatitis. During systemic mycoses the antibody response was similar. Among patients with other hematologic malignancies, predominantly lymphomas, several were terminally ill and responded infrequently by antibody production. Similar results were given by Ouchterlony immunodiffusion and counterimmuno-electrophoresis. Thus, patients with acute leukemia showed an antibody response to fungal infection; the peak values, however, were somewhat delayed.ZusammenfassungZur Beurteilung der Immunantwort bei immunsupprimierten Patienten wurden bei 62 erwachsenen Patienten mit malignen hämatologischen Erkrankungen während 37 Episoden akuter Candida-Stomatitis und 36 Episoden mit invasiver Pilzinfektion prospektiv Antikörper gegenCandida albicans bestimmt. Die Testung erfolgte mittels kommerziell erhältlicher Antigene. Bei Patienten mit akuter Leukämie waren die im Enzym-gebundenen Immunsorbenttest ermittelten Einheiten für die mittleren maximalen IgM-, IgG- und IgA-Antikörperkonzentrationen während der Phase akuter, unkomplizierter Stomatitis von den Basiskonzentrationen vor Auftreten der Pilzinfektion signifikant verschieden. Die maximalen Antikörperkonzentrationen waren 2,7 bis 3,8 Wochen nach der Diagnose der Stomatitis festzustellen. Während der systemischen Mykosen war ein ähnliches Verhalten der Antikörperantwort zu beobachten. Die Patienten mit anderen malignen hämatologischen Erkrankungen, vorwiegend Lymphomen, waren zum Teil in einem terminalen Krankheitsstadium und wiesen selten eine Antikörperantwort auf. Die Testung mittels Ouchterlony-Immundiffusion und Gegenstromelektrophorese erbrachte ähnliche Ergebnisse. Bei Patienten mit akuter Leukämie war somit eine Antikörperantwort mit Pilzinfektionen festzustellen, doch traten die Maximalwerte mit gewisser Verspätung auf.

Levels of C-reactive protein in patients with hematologic malignancies.

The levels of C-reactive protein (CRP) were assayed in 282 serial sera of 70 patients with hematologic malignancies who were under antineoplastic medication, and surveyed with frequent blood cultures. The mean peak value of CRP in febrile patients with bacteriologically verified sepsis was 162 mg/l and differed significantly (p less than 0.001) from that (23 mg/l) of afebrile patients with negative blood cultures, but not from that (115 mg/l) of febrile patients without confirmed bacteremia. All the values in afebrile patients with negative blood cultures were less than 100 mg/l; 71% of their peak values were less than 40 mg/l. Thus the malignancy itself or its treatment did not considerably mount CRP response.

Oral mycoses and their treatment

Mycoses of the mouth and nearby areas can be caused by both yeasts and filamentous fungi. They may appear either independently or as part of a systemic infection. It is typical of many mycoses that they occur as a consequence of local factors operating in the mouth, or in patients debilitated by severe diseases. Yeasts that are part of the normal microbial flora of man, among them especially Candida species, are the most frequent causative agents. Some tropical or semitropical infections may occur in Scandinavia and Finland, but they are rare. Local therapy with antimycotics is often effective in acute infections, whereas some chronic ones may make systemic administration necessary. Some of these infections are treated surgically.

Serum levels of C-reactive protein in patients with pulmonary tuberculosis and malignant tumors of the chest.

SummarySerum C-reactive protein (CRP) concentration was studied in patients with newly diagnosed postprimary pulmonary tuberculosis and in those with malignant intrathoracic tumors. In tuberculosis, there was a wide scatter in CRP values and the mean did not differ from that of the tumor patients. Tuberculous patients with cavitation in chest X-ray had significantly higher levels of CRP than those without as well as healthy controls. Normal CRP did not exclude tuberculosis and all the values were below 100 mg/l.ZusammenfassungSerumspiegel von C-reaktivem Protein (CRP) wurden bei Patienten mit neu diagnostizierter, post-primärer Lungentuberkulose und bei Patienten mit malignen Lungentumoren gemessen. Bei Tuberkulose variierten die CRP-Werte stark, die Mittelwerte unterschieden sich nicht von denen der Tumorpatienten. Bei Patienten mit röntgenologisch gesicherter kavernöser Tuberkulose lagen die CRP-Spiegel signifkant höher als bei Tuberkulösen ohne Kavernebildung und gesunden Kontrollpersonen. Ein normaler CRP-Spiegel schloß eine Tuberkulose nicht aus, alle Werte lagen unter 100 mg/l.

Effect of nitrofurantoin and methenamine hippurate prophylaxis on bacteria and yeasts in the urine of patients with an indwelling catheter

Abstract Nitrofurantoin or methenamine hippurate was given prophylactically to elderly patients without urinary tract infection at the beginning of long-term catheterization (mean 81 days), but it only delayed the appearance of bacteriuria. Escherichia coli was most frequently the first species to appear (≥10 4 /ml) in the urine of 40 patients given methenamine hippurate as well as in the control group (41 patients), whereas in 42 patients treated with nitrofurantoin more resistant species, such as Proteus mirabilis , Providencia spp. and Pseudomonas aeruginosa most often appeared first. Weekly tests made during the course of catheterization showed that E. coli disappeared from the nitrofurantoin-treated patients, while pseudomonas increased in this group and providencia in the control group. Pseudomonas was isolated more frequently in the nitrofurantoin than other groups. With the exception of klebsiellae, the bacterial strains isolated from the nitrofurantoin group were as sensitive to various antibiotics as were those from other groups. Significantly more samples with growth of yeasts (≥10 4 /ml) were obtained from nitrofurantoin treated than from methenamine hippurate treated patients. Candida albicans was the species of yeasts most often isolated.

Delayed hypersensitivity, macrophage migration, and antibodies in guinea-pigs immunized with diphtheria toxoid. II. Macrophage cytophilic antibody to diphtheria toxoid in desensitized animals.

Guinea‐pigs were immunized with diphtheria toxoid (DT) in Freunds complete adjuvant (FCA) and boosted three times with DT in saline. Boosting increased anti‐DT passive haemagglutinins, haemolysins, and cytophilic antibody on the surface of peritoneal exudate cells, but skin reactions to DT became negative and peritoneal cell migration was no longer inhibited by DT. When normal peritoneal cells were incubated in the sera of boosted animals, their migration was not inhibited by antigen, although they had cytophilic antibody on their surface as shown by rosette formation.

Delayed-type hypersensitivity measured as an increase of ear thickness in guinea pigs.

Determination of swelling at an intracutaneous test site in the pinna of the ear of guinea pigs immunized with protein antigens in complete Freunds adjuvant was found to be a more sensitive assay of delayed-type hypersensitivity than the measurement of flank skin erythema and induration. In fact, 100 times less specific antigen was needed to detect 24-hour reactivity in the pinna of the ear. Reactivity early after sensitization (cutaneous basophil hypersensitivity), however, was best revealed as an erythematous lesion of the flank skin 24 h after testing.

Delayed hypersensitivity, macrophage migration, and antibodies in guinea-pigs immunized with diphtheria toxoid. I. Immunization with antigen-antibody precipitation.

Guinea‐pigs were immunized with diphtheria toxoid (DT) or with DT‐anti‐toxin precipitate, both in Freunds complete adjuvant (FCA). DT‐induced inhibition of peritoneal cell migration was equally strong in both groups and increased with time after immunization. Some guinea‐pigs immunized with DT‐antitoxin precipitate were boosted with DT or DT‐antitoxin precipitate, both in FCA. This increased the antibody titre but did not affect 24‐hour skin reactivity or migration inhibition. Migration inhibition did not correlate with anti‐DT passive haemagglutinins, haemolysins, or cytophilic antibody on peritoneal cells, but did correlate with 24‐hour skin reactivity.