Per Søgaard

Detection and identification of Anaplasma phagocytophilum, Borrelia burgdorferi, and Rickettsia helvetica in Danish Ixodes ricinus ticks

Borreliosis is an endemic infection in Denmark. Recent serosurveys have indicated that human anaplasmosis may be equally common. The aim of this study was to look for Anaplasma phagocytophilum and related pathogens in Ixodes ricinus ticks and estimate their prevalence, compared to Borrelia, using PCR. Ticks were collected from three locations in Denmark: Jutland, Funen, and Bornholm. Ticks from Jutland and Funen were analysed individually, ticks from Bornholm were analysed in pools of 20. A. phagocytophilum was found in ticks from all areas. A. phagocytophilum was found in 23.6% of ticks from Jutland and Funen, while 11% were positive for Borrelia burgdorferi. The Borrelia genotype B. afzelii was most prevalent, followed by B. valaisiana, B. burgdorferi s.s. and B. garinii.A. phagocytophilum was found in 14.5% of nymphs and 40.5% of adult ticks, while Borrelia was found in 13% of nymphs and 8% of adult ticks. The difference in prevalence between Anaplasma and Borrelia in adult ticks supports the idea that their maintenance cycles in nature may be different. Ticks were also infected with Rickettsia helvetica. Our study indicates that A. phagocytophilum prevalence in ticks in Denmark is as high as Borrelia prevalence and that human anaplasmosis may be unrecognized.

16S rRNA Gene Sequencing in Routine Identification of Anaerobic Bacteria Isolated from Blood Cultures

ABSTRACT A comparison between conventional identification and 16S rRNA gene sequencing of anaerobic bacteria isolated from blood cultures in a routine setting was performed (n = 127). With sequencing, 89% were identified to the species level, versus 52% with conventional identification. The times for identification were 1.5 days and 2.8 days, respectively.

Selection of multiple resistance in Salmonella enteritidis during treatment with ciprofloxacin

We report on a strain of Salmonella enteritidis which was found to be resistant to both ciprofloxacin and beta-lactams and chloramphenicol in a patient treated with ciprofloxacin for a splenic abscess. We conclude that in invasive infections such as a splenic abscess caused by Salmonella, early surgical intervention is important. Multiple-drug-resistant strains of Salmonella may be selected by treatment with ciprofloxacin alone.

A Survey of Campylobacter Bacteremia in Three Danish Counties, 1989 to 1994

Over a 5-year period (April 1989 to March 1994) bacteremia caused by Campylobacter species was diagnosed in 15 patients in a population of 1.3 million in three counties in Jutland province, Denmark. The incidence was 0.2/100,000/year and the ratio of blood to fecal isolates, was 0.008. Campylobacter coli and Campylobacter jejuni accounted for 6 cases each, Campylobacter fetus for 2, and in 1 case the species diagnosis was uncertain. Seven patients were males and 8 females; median age was 42 (range 15-90) years. 11 patients had underlying disorders, including immunological, neoplastic and vascular disease. In a 67-year-old man a Starr-Edwards prosthesis of the aortic valve was probably infected by C. fetus, as recurrent bacteremia resolved following valve replacement. Eight patients had pyrexia and diarrhea, whereas 7 had pyrexia with only slight intestinal discomfort or none at all. In 4 patients the bacteremia was associated with cutaneous cellulitis or vasculitis. 14 of 15 patients survived. Campylobacter bacteremia seems to be more common in Denmark than hitherto thought.

Seroprevalence of Human Granulocytic Ehrlichiosis in High-risk Groups in Denmark

The aim of this study was to evaluate the seroprevalence of human granulocytic ehrlichiosis (HGE) among 300 residents in the county of Funen, Denmark. All of these people had either suspected or confirmed borreliosis. Two hundred control sera were included in the study. Samples were submitted by general practitioners and by hospital departments. An indirect immunofluorescence assay was used to identify sera reactive to HGE and an enzyme-linked immunosorbent assay was used to analyse Borrelia burgdorferi antibodies. There were 63 (21%) HGE-positive sera, 53 of which came from Borrelia-seropositive patients. Among patients with negative Borrelia serology, but with clinical suspicion of borreliosis, 14.3% were HGE-positive (n = 70). Of the 200 control sera, 3.5% were HGE-positive and 10.5% were Borrelia-positive. No HGE-positive samples were found among subjects < 20 y of age, wheras 20.4% of Borrelia seropositive samples where from subjects < 20 y of age. No mortality was observed in the HGE-positive group and the percentage of serum samples positive for both Borrelia and HGE did not differ significantly between hospitalized and non-hospitalized patients. Our study indicates that HGE infection with or without concomitant or previous Borrelia burgdorferi infection is common in tick-exposed individuals > 20 y old in the county of Funen, Denmark.The aim of this study was to evaluate the seroprevalence of human granulocytic ehrlichiosis (HGE) among 300 residents in the county of Funen, Denmark. All of these people had either suspected or confirmed borreliosis. Two hundred control sera were included in the study. Samples were submitted by general practitioners and by hospital departments. An indirect immunofluorescence assay was used to identify sera reactive to HGE and an enzyme-linked immunosorbent assay was used to analyse Borrelia burgdorferi antibodies. There were 63 (21%) HGE-positive sera, 53 of which came from Borrelia-seropositive patients. Among patients with negative Borrelia serology, but with clinical suspicion of borreliosis, 14.3% were HGE-positive (n = 70). Of the 200 control sera, 3.5% were HGE-positive and 10.5% were Borrelia-positive. No HGE-positive samples were found among subjects < 20 y of age, wheras 20.4% of Borrelia seropositive samples where from subjects < 20 y of age. No mortality was observed in the HGE-positive group and the percentage of serum samples positive for both Borrelia and HGE did not differ significantly between hospitalized and non-hospitalized patients. Our study indicates that HGE infection with or without concomitant or previous Borrelia burgdorferi infection is common in tick-exposed individuals > 20 y old in the county of Funen, Denmark.

Homogeneity of Danish Environmental and Clinical Isolates of Shewanella algae

ABSTRACT Danish isolates of Shewanella algae constituted by whole-cell protein profiling a very homogeneous group, and no clear distinction was seen between strains from the marine environment and strains of clinical origin. Although variation between all strains was observed by ribotyping and random amplified polymorphic DNA analysis, no clonal relationship between infective strains was found. From several patients, clonally identical strains of S. algaewere reisolated up to 8 months after the primary isolation, indicating that the same strain may be able to maintain the infection.

Pasteurella aerogenes Isolated from Ulcers or Wounds in Humans with Occupational Exposure to Pigs: A Report of 7 Danish Cases

Pasteurella aerogenes is rarely isolated from human specimens. The species is found in the digestive tract of pigs. From 1976 to 1994 7 strains were cultured in Denmark from wounds or ulcers. Five patients were bitten by pigs and 2 patients with ulcers were employed in pig farming. A mixture of bacterial species was often found. All 7 strains of P. aerogenes were susceptible to ampicillin, cephalosporins and ciprofloxacin. Ability to hydrolyse urea, to produce oxidase and catalase, to decarboxylate ornithine and to produce gas from glucose and inability to produce indole was characteristic for P. aerogenes. Most bite wounds were located on the lower lateral part of the thigh. Foul smelling pus and abscess formation was the rule. Incision, drainage and antibiotic treatment were usually necessary.

Bacteriological autopsy I. A methodological study

The two aims of this investigation were:

Standardised procedures can improve the validity of susceptibility testing of uropathogenic bacteria in general practice

Objective - To investigate whether the validity of susceptibility testing in general practice would improve when preceded by an intervention. Intervention - Instruction in standardised susceptibility testing procedures given by laboratory instructors. Method - Urine specimens containing monocultures of typical uropathogenic bacteria were sent to 23 general practices before and after the intervention. Practices performed susceptibility testing by the Sensicult and the Iso-Res agar methods and the validity of the results before and after the intervention was compared. Results from susceptibility testing at the bacteriological laboratory, Odense University Hospital, were used as gold standard. Results ? The median frequency of correct results increased from 82% to 98% for susceptibility testing based on Sensicult (p = 0.001) and from 90% to 96% based on Iso-Res agar (p = 0.05). Conclusion ? The validity of susceptibility testing in general practice improves when preceded by instruction in standardised procedures.

Bacteria in lung tissue from an autopsy population of alcoholics

The retrieval of bacteria from the lungs postmortem was examined in a population of alcoholics who had a medico-legal autopsy performed. The results were compared with non-alcoholic controls. Pneumococci were found more frequently in alcoholics, but in general there were no major differences. Proteus mirabilis was detected in three out of five alcoholics with unascertainable cause of death. It is speculated whether this species may cause septicaemia in some alcoholics due to abnormal splanchnicus circulation.