Olaf Scheel

Spread of Subclinical Chlamydia pneumoniae Infection in a Closed Community

Chlamydia pneumoniae infections may spread subclinically. The present investigation took place in a military setting. Sera drawn when the conscripts had entered their military service 2 months previously had been kept frozen and were available. In a camp with 500 people, 35 (7%) developed clinical symptoms of pneumonia. The infection was serologically verified with C. pneumoniae-specific micro-immunofluorescence technique. Of 40 healthy controls, 21 turned out to fulfil the serological criteria of infection, thus, representing subclinical cases. These 21 cases, when extrapolated to the whole camp, equalled a rate of 49% which, added to the 7% of pneumonic cases, gave a total infection rate of 56%. Pre-existing IgG antibodies were demonstrated in 10% of the pneumonic cases, 48% of the subclinical cases, and 89% of the non-infected, healthy controls. Without the access to pre-epidemic sera permitting us to establish 4-fold titre rises, the spread of subclinical C. pneumoniae infection would have been noted at 5%, and not 49% as here demonstrated.

Susceptibility pattern of Scandinavian Francisella tularensis isolates with regard to oral and parenteral antimicrobial agents

Some recently introduced antimicrobial agents have only been incompletely evaluated for use in Francisella tularensis infections. The present study evaluated the susceptibility pattern of Scandinavian human, rodent, and hare F. tularensis isolates with respect to a selection of traditional as well as recently introduced antimicrobial agents. All strains were resistant to the following β‐lactams: penicillin, cephalexin, cefuroxime, ceftazidime, aztreonam, imipenem, and meropenem with minimal inhibitory concentrations > 32 mg/1. Against macrolides, a mixed susceptibility/resistance pattern appeared. All strains were susceptible to gentamicin, chloramphenicol, doxycycline, and four quinolones. Since the quinolones showed the lowest MIC values, and in addition give a good intracellular penetration, we conclude that future drugs to consider against tularemia should definitely include this group of antibiotics. The outpatient mode of antibiotic treatment is especially relevant as the Scandinavian variant of F. tularensis infection is nonlethal, usually pustuloglandular, and not septicemic. Therefore, oral drugs must be sought, and the quinolone group also satisfies this requirement.

Tularemia: A differential diagnosis in oto-rhino-laryngology

Tularemia can present as an oto-rhino-laryngological disease. The clinical and radiological (CT) manifestations, diagnosis and treatment are discussed based on a case report where a patient with tonsillitis and enlarged cervical lymph nodes was admitted to the department of oto-rhino-laryngology of a hospital in Northern Norway. Francisella tularensis was isolated from the blood and there was a high titre of agglutinating serum antibodies to F. tularensis. The patients contaminated drinking water well is the suspect source of infection.

Atherosclerosis and Tuberculosis: Are they both Chronic Infectious Diseases?

pathogens; both pathogens (Mycobacterium tuberculosis and C. pneumoniae) are intracellular bacteria that may escape from the immune system; both pathogens probably have macrophages (Langerhans giant cells in tuberculosis and foam cells in atherosclerosis) as their target cells (3); both diseases are chronic infections with necrosis as a common feature (caseation of tubercles and atheromatosis of plaques);

Outbreak of methicillin-resistant Staphylococcus aureus in a Norwegian hospital.

Methicillin-resistant Staphylococcus aureus (MRSA) occurred sporadically in Norwegian hospitals in the 1960s and 1970s, but disappeared in the late 1970s for unknown reasons. Only 1 outbreak has subsequently been reported. We describe herein a second outbreak in a different hospital, this time featuring a more resistant strain. Staff and patients were screened immediately after detection of the first MRSA isolate. Colonized and infected patients were nursed using contact precautions, and the staff were not allowed to work until 3 nose samples were MRSA-negative. We treated colonized persons with topical administration of mupirocin to the nostrils and a chlorhexidine body wash. The outbreak affected 7 patients and 5 healthcare workers. Pulsed-field gel electrophoresis proved all isolates to be of the same type, and the MRSA phage type was M3. There was no sign of transmission of MRSA after contact precautions were implemented. MRSA was eradicated in 4 of the patients and all 5 healthcare workers. One patient died and 1 was still colonized 3 y after onset of the outbreak. Contact precautions proved to be sufficient to prevent transmission of MRSA.Methicillin-resistant Staphylococcus aureus (MRSA) occurred sporadically in Norwegian hospitals in the 1960s and 1970s, but disappeared in the late 1970s for unknown reasons. Only 1 outbreak has subsequently been reported. We describe herein a second outbreak in a different hospital, this time featuring a more resistant strain. Staff and patients were screened immediately after detection of the first MRSA isolate. Colonized and infected patients were nursed using contact precautions, and the staff were not allowed to work until 3 nose samples were MRSA-negative. We treated colonized persons with topical administration of mupirocin to the nostrils and a chlorhexidine body wash. The outbreak affected 7 patients and 5 healthcare workers. Pulsed-field gel electrophoresis proved all isolates to be of the same type, and the MRSA phage type was M3. There was no sign of transmission of MRSA after contact precautions were implemented. MRSA was eradicated in 4 of the patients and all 5 healthcare workers. One patient died and 1 was still colonized 3 y after onset of the outbreak. Contact precautions proved to be sufficient to prevent transmission of MRSA.

Epidemiological Aspects of Community-acquired and Hospital-acquired Bacteremia in Northern Norway

389 patients with 401 bacteremic episodes, either community-acquired (CAB) or hospital-acquired (HAB), admitted to the University Hospital of Tromsø (UHT), Norway, and 3 small local hospitals in the region (LHs), were reviewed on the basis of data collected in 1985 and 1989. As regards incidence, sex- and age distribution, distribution to either surgical, medical, or pediatric wards, compared with etiological agents and predisposing factors, the statistical significance has been evaluated. The proportion of patients < 50 years was greater at UHT than in the LHs. More patients with HAB associated with predisposing factors were hospitalized at UHT than at the LHs. Coagulase-negative staphylococci occurred less frequently in bacteremic patients at UHT than at the LHs. As opposed to reports from elsewhere, Tromsø University Hospital seems to appear much more similar to the smaller local hospitals in the epidemiological aspects of bacteremia, inasmuch as both HAB and the CAB presented an even distribution pattern between the 2 hospital groups.

Resistant strains isolated from bacteremia patients in northern norway

Bacterial isolates from blood cultures in 1985 and 1989 (227 and 258 isolates, respectively), were compared as regards resistance to a series of antimicrobial agents including the more recent beta-lactams and quinolones. An increase in the number of coagulase-negative staphylococcal strains and a decrease in Staphylococcus aureus strains were detected, otherwise there were no significant differences in the bacterial patterns in 1985 compared to 1989. Except for chloramphenicol, there was no major increase in antimicrobial resistance among Gram-negative species. An increase in the number of multiresistant enterobacteriaceae strains was due to an increased number of klebsiella strains and a decrease in Proteus mirabilis. S. aureus showed an increased resistance to sulfonamides. No methicillin-resistant strain was found. Coagulase-negative staphylococci were significantly more often multiresistant in 1989 than in 1985, and significant increase in resistance to gentamicin, sulfonamides and fusidic acid was found.

Research articleField investigations of tularemia in Norway

In Norway, tularemia is a common disease in small rodent and hare populations, where large outbreaks can be observed. In humans, the yearly number of cases is low, usually less than ten, with peaks up to 44 recorded in recent years. Serological investigations on hunters and healthy school children nevertheless indicate, with up to 4.7% positivity in the latter group, that Francisella tularensis low-grade infection is widespread. F. tularensis in co-culture with amoebae, e.g. Achantamoeba castellanii, may grow after internalization and kill the amoeba. As with Legionella, Francisella virulence may be enhanced after protozoan ingestion. This suggests a mechanism that can explain the pattern of dissemination and infection in our region.