Aulikki Sivonen

Clinical Efficacy of Meningococcus Group A Capsular Polysaccharide Vaccine in Children Three Months to Five Years of Age

We performed field trials in the course of an epidemic in Finland to learn whether Group A memingococcal capsular polysaccharide vaccine protects infants and young children from meningitis. The first trial involved 130,178 children between the ages of three months and five years; 49,295 children received the vaccine, 48,977 received a control Haemophilus influenzae Type b polysaccharide vaccine, and 31.906 remained unvaccinated. No cases of meningitis or sepsis caused by Group A meningococci were seen in the first year of observation among the children vaccinated with meningococcal vaccine whereas six occurred among those vaccinated with the H. influenzae vaccine and 13 among those not vaccinated. In the second trial 21,007 children of the same ages received the meningococcal vaccine. No cases caused by Group A occurred among those vaccinated, although five to seven would have been expected within the year. Meningococcal Group A vaccine appears efficacious in young infants and children.

Long-term treatment of ulcerative colitis with ciprofloxacin: A prospective, double-blind, placebo-controlled study

BACKGROUND & AIMS Although bacterial bowel flora may be one of the contributing factors in the pathogenesis of chronic mucosal inflammation, antibiotic treatment has no established role in ulcerative colitis. The aim of the study was to evaluate the role of ciprofloxacin in the induction and maintenance of remission in ulcerative colitis in patients responding poorly to conventional therapy with steroids and mesalamine. METHODS Ciprofloxacin (n = 38; 500-750 mg twice a day) or placebo (n = 45) was administered for 6 months in a double-blind, randomized study with a high but decreasing dose of prednisone and maintenance treatment with mesalamine including follow-up for the next 6 months. Clinical assessment and colonoscopic evaluation were performed at 0, 3, 6, and 12 months. Treatment failure, the primary end point, was defined as both symptomatic and endoscopic failure to respond. RESULTS During the first 6 months, the treatment-failure rate was 21% in the ciprofloxacin-treated group and 44% in the placebo group (P = 0.02). Endoscopic and histological findings were used as secondary end points and showed better results in the ciprofloxacin group at 3 months but not at 6 months. CONCLUSIONS Addition of a 6-month ciprofloxacin treatment for ulcerative colitis improved the results of conventional therapy with mesalamine and prednisone.

Magnetic resonance imaging is superior to computed tomography and ultrasonography in imaging infectious liver foci in acute leukaemia.

Abstract: We conducted a prospective study in order to compare ultrasonography, computed tomography and magnetic resonance imaging in the detection of liver foci in patients with acute leukaemia and clinical suspicion of hepatic candidiasis. 28 adult patients fulfilling set entry criteria after recovery from neutropenia were studied. Lesions in the liver were detected by at least one imaging modality in 21 patients: by ultrasonography in 7 (33% of detected cases), computed tomography in 12 (57%) and by magnetic resonance imaging in 20 patients (95%). Magnetic resonance imaging was significantly more sensitive than ultrasonography (p<0.001) and computed tomography (p<0.02). The difference between computed tomography and ultrasonography was not statistically significant (p = 0.1). Invasive procedures performed in 10 patients provided definite proof of candidiasis in 5 patients, and nodes on the liver surface, compatible with yeast infection, were seen during laparoscopy in 3 other patients without proof of fungal infection. We confirm that magnetic resonance imaging is superior to ultrasonography and computed tomography in imaging liver foci in leukaemic patients recovering from neutropenia with persistent non‐specific signs of infection or hepatic involvement.

Prognostic factors associated with improved outcome of Escherichia coli bacteremia in a Finnish university hospital.

All cases of bacteremia caused solely byEscherichia coli in 1977–1979, 1987–1989, and 1993–1994 in a Finnish university hospital were reviewed retrospectively to determine the clinical manifestations, the outcome, and the prognostic factors. In 332 episodes, mortality during the month after the first positive blood culture was 17%. This figure diminished during the study period from 23% in the 1970s to 9% in the 1990s (p=0.028). Mortality was lowest among patients treated with a combination of antibiotics, 7% versus 18% among those treated otherwise (p=0.034). The use of acetaminophen increased during the study period from 18 to 55%. Mortality among patients who received acetaminophen within a period < 24 h to 48 h of the first positive blood culture was 10% versus 22% among others (p=0.002). Logistic regression analysis showed six factors predictive of a fatal outcome: pneumonia, no known focus, shock, CNS disorder, thromboembolism, and rapidly fatal underlying disease. Appropriate antibiotic therapy predicted survival. In the analysis, replacement of appropriate antibiotic therapy by acetaminophen revealed that this drug was significantly associated with survival.

Capnocytophaga canimorsus septicemia: fifth report of a cat-associated infection and five other cases.

Capnocytophaga canimorsus is a fastidious, slow-growing, gram-negative, rod-shaped bacterium that belongs to the normal oral flora of dogs and cats. Human septicemic infections are associated with a high mortality; most cases occur in immunocompromised patients with a history of dog bite. The fifth case of cat-associated septicemia caused byCapnocytophaga canimorsus is described. The six case reports presented here point out the characteristics reported previously: (a) cats are a source of human infection; (b) alcohol abuse is an important risk factor for the development of septicemicCapnocytophaga canimorsus infection; (c) septicemic infection often manifests with disseminated intravascular consumption coagulopathy or purpura; and (d) some cases of septicemia in humans result from pets that lick skin ulcers.

A cluster of seven cases ofClostridium tertium septicemia in neutropenic patients

A cluster of seven febrile and severely neutropenic patients who developedClostridium tertium septicemia during a 13-month period is described. The patients had received third generation cephalosporins for 7 to 13 days (mean 9 days) at the timeClostridium tertium was isolated from blood cultures. Two patients had perirectal and one patient pericaecal cellulitis. The organism was also isolated from bronchial secretions in one patient. No patient had diarrhea. Five of six strains tested were resistant to clindamycin (MIC 2–8 µg/ml), and six of seven strains moderately resistant to penicillin (MIC 1–4 µg/ml). In one patientClostridium tertium grew from blood cultures although metronidazole had been administered for two days. Six patients recovered on antibiotic therapy. In view of the unusual susceptibility pattern ofClostridium tertium, an accurate diagnosis of infection with this organism is important for the choice of an appropriate antimicrobial treatment.

Enteric plesiomonas shigelloides infections in Finnish patients

Plesiomonas shigelloides was isolated from 20/13,027 stool samples submitted for culture to the Department of Bacteriology and Immunology, University of Helsinki, in 1990. All except 2/20 Plesiomonas-positive patients had diarrhea; 13 patients had acute onset of illness after foreign travel and 5 patients had chronic diarrhea with symptoms lasting > or = 2 months. Travel destinations were outside Europe in most cases. In 12 cases Plesiomonas was isolated in pure culture and in 8 cases together with other enteropathogens. All isolates were susceptible to ciprofloxacin, doxycycline, trimethoprim and sulfamethoxazole, gentamicin, cephalexin, cefuroxime, ceftriaxone and cefixime.

Increased yields of pathogenic Yersinia enterocolitica strains by cold enrichment

Yersinia strains recovered from routine stool cultures (n = 13,534) as well as clinical symptoms in the patients were analysed in order to establish whether enteric Yersinia enterocolitica strains recovered only after cold enrichment cultures shared the same pathogenicity markers and caused the same symptoms as strains from primary cultures. 93% of the 201 Yersinia isolates were Y. enterocolitica strains and 71% of these were of serotype O3. Nearly 40% of all Y. enterocolitica strains and 21% of serotype O3 strains were isolated only after 1 weeks cold enrichment of stool specimens. Practically all Y. enterocolitica O3 strains, whether from primary or cold enrichment cultures, were pathogenic not only on the basis of the serotype but also on the basis of Congo-red uptake and calcium-dependent growth at 35 degrees C (CR-MOX test). The symptoms in patients with Y. enterocolitica O3 from primary and cold enrichment cultures were similar except that abdominal pains were more frequent (p < 0.05) in the former. Arthropathia, mesenteric lymphadenitis and erythema nodosum were detected in 15% of the patients with Yersinia isolates and were more frequent in patients with isolates from cold enrichment or without diarrhea.

Chronic diarrhea due to a single strain of Aeromonas caviae.

Over a period of 17 months,Aeromonas caviae was cultured 15 times as the sole enteropathogen from the feces of a man who had developed chronic diarrhea after traveling to Turkey. Determination of rRNA gene restriction patterns confirmed that the seven isolates ofAeromonas caviae studied were identical (hybridization group [HG]4). After therapy with ciprofloxacin for four weeks, the patient was culture negative for the original isolate, and six months later a novel strain ofAeromonas media with a different ribo-pattern (HG 5A) was isolated from the feces of the patient. The patient responded again, both clinically and bacteriologically, to a four-week course of ciprofloxacin and has remained asymptomatic since then.

A Clinical Study of Beta-Haemolytic Groups A, B, C and G Streptococcal Bacteremia in Adults over an 8-Year Period

All of the 88 episodes of beta-haemolytic streptococcal bacteremia (2.9% of all bacteremias) in adult patients during the years 1987-94 in a university hospital were reviewed. 38 bacteremias (43%) were caused by group A, 24 (27%) by group B, 3 (4%) by group C, and 23 (26%) by group G beta-haemolytic streptococcal. There was a statistically significant increase in group A and decrease in group C and G bacteremias (p < 0.02) compared to an earlier 8-year period in the same hospital, although the total number of streptococcal bacteremias remained the same. The most common T types of group A streptococcal strains were T11 (26%), T28 (14%), T6 and T1 (11% each), and T12 (8%). Cardiovascular disease, skin lesions, malignancy, and alcohol abuse were the most common underlying conditions. The most usual types of infection were skin (47%) and respiratory tract infections (23%). The overall mortality was 16%. It was highest in group A (24%) and lowest in group C (0%), 38% of patients with pneumonia died. All streptococcal strains were sensitive to penicillin, vancomycin, and cephalosporins. 11% of group A and 12% of all the strains had decreased sensitivity to erythromycin, 14 and 38% to tetracycline, and 0 and 2% to clindamycin, respectively.