Torvald Ripa

Chlamydia trachomatis infection in patients with acute salpingitis.

Abstract We examined the prevalence of Chlamydia trachomatis in the cervix and the fallopian tubes of patients with acute salpingitis. Cycloheximide-treated McCoy cells were used as the growth medium. For purposes of comparison, women with infections confined to the lower genital tract and women without signs of genital infections were also studied. C. trachomatis was isolated from the cervix in 19 of 53 patients with acute salpingitis, in one of 18 lower-genital-tract infections and in none of 12 without signs of genital infection. C. trachomatis was recovered from six of the 20 valid specimens from the fallopian tubes of the patients with acute salpingitis. Our results indicate that chlamydia is a common etiologic agent in acute salpingitis. (N Engl J Med 296:1377–1379, 1977)

Is the Increase in Notifications of Chlamydia trachomatis Infections in Sweden the Result of Changes in Prevalence, Sampling Frequency or Diagnostic Methods?

Based on clinical and laboratory surveillance data, trends in the incidence rates of genital Chlamydia trachomatis infections in Sweden between 1991 and 1999 were analysed according to age group and sex. The influence of changes in laboratory methods on the reported infections was assessed. After a decrease in the incidence rate of infection of 36% between 1991 and 1994, followed by a period of stability, a 20% increase was observed between 1997 and 1999 (from 157 to 189/100,000). Between 1991 and 1999 the female:male ratio decreased from 1.7 to 1.4. Incidence rates started to increase in 1994 in the 15-19 y age group for both sexes. Crude Chlamydia positivity increased from 4.1% (352,050 people tested) in 1994 to 5.4% (305,946 people tested) in 1999. This increase in Chlamydia positivity was seen both in laboratories that had changed to more sensitive methods and in those that had not. Changes in laboratory methods can therefore only partially explain the increase in notified cases. Increased screening of men may have contributed to the increase, but rising incidence rates in all young age groups of both sexes suggest a true increase in prevalence.

Bacillus Cereus: A significant pathogen in postoperative and post-traumatic wounds on orthopaedic wards

Over a period of 19 months, Bacillus species, most frequently B. cereus, were isolated from postoperative and post-traumatic wounds in 24 patients on orthopaedic wards in a Swedish hospital. Clinical signs of infection were found in all but 3 patients: in 9 patients, mild signs with increased secretion from the wounds; in 10 patients, moderate signs with fever and/or significant local reaction around the wounds; and in 2 patients, severe signs with necrotic infections. Bacillus spp. were isolated from one-fourth of all patients with wound complications following total hip arthroplasty. Their hospitalization was significantly prolonged, compared with a control group (p = 0.0042). Isolates of B. cereus from wounds should not be dismissed as contaminants or as non-pathogenic, but must be assessed in the light of the clinical situation.

Outbreaks of Infections with Erythromycin-resistant Group A Streptococci in Child Day Care Centres

Erythromycin-resistant group A streptococci (ERGAS) are considered rare in Sweden. In the county of Halland (240,000 inhabitants) in southern Sweden, we had 294 isolates of ERGAS between January 1984 and June 1985. Almost all strains were of T-type 12 and only resistant to erythromycin (MIC values approximately 8 g/l). Seven child day care centres (DCC) were involved in the outbreaks and on average 49% of all children were infected in each outbreak. Employees were seldom infected (8%), but parents and siblings more often (23% and 36%). One course of phenoxymethylpenicillin succeeded in eradicating ERGAS from 75% of those infected. The ERGAS strains are now established in southern Sweden and account for about 2% of all group A streptococcal infections in the county of Halland.

Serotypes of Streptococcus pneumoniae isolated from blood and cerebrospinal fluid related to vaccine serotypes and to clinical characteristics

Pneumococci isolated from blood and cerebrospinal fluid from 1998 to 2001 in 2 counties in south-west Sweden were serotyped with the capsular reaction test. Of the 836 strains, 353 (42%), 598 (72%) and 789 (94%) belonged to serotypes included in the 7- and 11-valent pneumococcal conjugate vaccines and in the 23-valent polysaccharide vaccine, respectively. The most common serotype was type 1 (119 isolates) followed in descending frequency by serotypes 7F, 9V, 14, 4 and 12F (90–49 isolates per serotype). The coverage rates of the 7- and 11-valent conjugate vaccines among 58 strains isolated from children and adolescents 0–19 y of age were 46% and 93%, respectively. A comparison of clinical characteristics of infections caused by different serotypes showed that types 1 and 7F were less commonly associated with severe underlying diseases, that patients infected with these serotypes were younger than the average and, thus, had a lower case-fatality rate.

Kinetics of the Actions of Tetracyclines on Escherichia coli as Studied by Microcalorimetry

Microcalorimetry was used to study the kinetics of the actions of various tetracyclines on a strain of Escherichia coli. Differences in the capacity to suppress the metabolism of this bacterium were observed. When the antibiotic was present from the start of the experiment, a heat production of 2.0 μW/ml was registered after 12.5 h using minocycline; the corresponding figures for doxycycline, oxytetracycline, and tetracycline were 7.3, 6.6, and 4.5 h, respectively. In these experiments, equal concentrations, i.e., half the minimum inhibitory concentration (MIC), of each drug were used. The MIC for all the tetracyclines tested, determined by the broth dilution technique, was 0.8 μg/ml. In other experiments, the antibiotic (concentration, 1.6 μg/ml = 2× MIC) was introduced into the growth vessel during the logarithmic growth phase of the organism. The extent and duration of the inhibitory effect on the metabolism, as judged from the decrease in heat production, varied with the different tetracyclines. Immediately after introduction, minocycline, doxycycline, oxytetracycline, and tetracycline decreased the heat production in decreasing order of potency. With tetracycline, the heat production rose after about 1 h, and with minocycline it rose after about 9 h. The heat production remained at a low level for at least 19 h when using doxycycline and oxytetracycline. The results indicate that microcalorimetry offers a means for studies of the kinetics of the antibacterial actions of antibiotics and provides information that cannot be obtained by conventional bacteriological techniques. This information may be of use, in conjunction with pharmacokinetic data, in establishing optimum doses and dose intervals in antibiotic therapy.

Concentrations of Tinidazole in Body Fluids and Tissues in Gynaecological Patients

The concentrations of tinidazole in various tissues and body fluids were studied in gynaecological patients after a single 2g oral dose. Tinidazole was determined by the agar-diffusion technique using a strain of Clostridium bifermentans. Reliable estimates of concentrations down to 0.5 microng/ml could be obtained. Dichloromethane extraction of tinidazole added to various tissues in known amounts gave a recovery of 100 +/- 10%. Peak serum values of 32-52 microng/ml were reached 3-6h after the administration. The concentrations in peritoneal fluid, obtained at operation 8.5-15h after the intake, varied between 16 and 40 microng/ml. Specimens from the Fallopian tubes yielded 15-26 microng tinidazole/g tissue; similar levels were obtained specimens from myometrium, endometrium, portio, vaginal secretions, omental fat, and cutis. It is concluded that, with the given dose, tinidazole concentrations are achieved in fluids and tissues of the female genital tract that are far in excess of those that should be therapeutical in infections caused by microorganisms know to respond to nitroimidazole treatment.

Pneumonia associated with Chlamydia trachomatis infection in an infant.

ABSTRACT. Hallberg, A., Mårdh, P.‐A., Persson, K., and Ripa, T. (Departments of Paediatrics and Virology, Malmö General Hospital, and Department of Medical Microbiology, University Hospital, Lund, Sweden). Pneumonia associated with Chlamydia trachomatis infection in an infant. Acta Paediatr Scand, 68: 765, 1979—Chlamydia trachomatis was isolated from the epipharynx of a 10‐week‐old baby girl taken ill with pneumonia but without signs of conjunctivitis. The infant developed specific antibodies to the organism. The course of the pneumonia was protracted, with cough and tachypnea. The baby, who was afebrile, improved on antibiotic therapy but pulmonary infiltrates persisted for several months. To our knowledge, this is the first case of pneumonia in an infant associated with C. trachomatis infection reported elsewhere than North America.

Antimicrobial susceptibility of invasive pneumococcal isolates from a region in south-west Sweden 1998-2001

Invasive disease caused by antibiotic resistant pneumococci is a worldwide problem. All invasive pneumococcal strains in an area of south-west Sweden with 1.7 million inhabitants were collected prospectively during 1998–2001. Minimum inhibitory concentrations (MICs) were determined by E-test and correlated to serotypes and clinical characteristics. Of 827 strains, 744 (90%) were susceptible (S) to all agents tested and 83 (10%) were indeterminate (I) or resistant (R) to at least 1 agent. 22 isolates (2.7%) were I to penicillin (MIC >0.06 to ≤1.0 mg/l), but none were R (MIC >1.0 mg/l). Numbers and proportions of decreased susceptibility against other agents tested were as follows: erythromycin R: 30 (3.6%), clindamycin R: 6 (0.7%), tetracycline R: 16 (1.9%), moxifloxacin R: 1 (0.1%), cotrimoxazole I: 17 (2%) and R: 31(4%). Non-susceptibility to at least 1 agent was not correlated with age, clinical manifestation, underlying diseases and outcome. The serotype distribution differed between non-susceptible and susceptible strains. The serotypes in the 7-valent pneumococcal conjugate vaccine covered 42% of all infections and 73% of those caused by non-susceptible strains. In conclusion, the impact of antibiotic resistance in invasive pneumococcal disease remains limited in south-west Sweden.

Effective Sampling Device And Mucopurulent Cervlcltls In Women With Chlamydial Cervical Infection

Brushes (Cytobrushtm, Medscand) are superior to swabs for the collection of endocervical cells for cytologic examination. In the present randomized study, Cytobrush was compared with ENT‐swabs and with white, cotton‐tipped swabs to obtain samples for the diagnosis of chlamydial cervicitis. The women were examined for the presence of mucopurulent cervicitis (MPC). The subjects comprised 126 women, most of whom had been referred because of asymptomatic chlamydial infection. Specimens obtained with brushes were culture‐positive in 83 women and positive in a direct fluorescent antibody test (FA‐test) in 78 women. The corresponding figures for samples obtained with swabs were 80 and 74, respectively. The mean number of inclusions was significantly higher in samples obtained with brushes (4 999), compared with swabs (3 155), as was the mean number of elementary bodies (3 000 vs 2 481). MPC was detected in 65 % of the women with asymptomatic chlamydial cervicitis, and in 93% of those with symptomatic infection. The corresponding figures for a pathologic wet smear were 62% and 80%. respectively. The specificity and predictive values of a positive and negative MPC‐test was 21 %, 39%, and 86%, respectively, and for a pathologic wet smear 53%, 44%, and 85%, respectively. We conclude that brushes are superior to swabs for sampling material, both for culture and for direct FA‐tests. The MPC and the wet smear tests could be of value in the diagnosis of chlamydial cervicitis, providing confirmatory laboratory tests are used.