Borrelia burgdorferi antibodies in outdoor and indoor workers in south-west Sweden.

Two hundred and fifty-three farmers and forest workers and 249 clerks from south-west Sweden were recruited to a cross-sectional seroprevalence study to find out if individuals working outdoors are more prone to acquire Borrelia burgdorferi infection than indoor workers and to find undiagnosed cases of Lyme borreliosis. The participants answered a questionnaire and blood specimens were collected to estimate the prevalence of antibodies to B. burgdorferi in each group. Sera were analysed with an enzyme-linked immunoassay technique to determine IgG antibodies to B. burgdorferi flagellum. The prevalence of B. burgdorferi antibodies was 7.6% in the farmers and forest workers vs. 5.3% in the clerks (adjusted odds ratio [age, sex] = 1.2 [95% confidence interval = 0.5-2.8]). One case of Lyme borreliosis was diagnosed. The positive predictive value of the antibody test was estimated to be 3% in the studied populations. B. burgdorferi infection is of low endemicity in south-west Sweden and is probably not an occupational risk among outdoor workers. Undiagnosed cases of Lyme borreliosis are uncommon. The test used is not acceptable for screening purposes.

Cerebellar aspergilloma.

A cerebellar aspergilloma simulating brain tumour in a 48-year-old woman with alveolar proteinosis is described. The course of the disease was recurrent. Despite neurosurgery, ventricular drainage, amphotericin B, flucytosine and other antifungal agents, the disease was ultimately fatal. The diagnostic and therapeutic problems of aspergillosis in the central nervous system are discussed. Suspicion and serology might lead to early diagnosis and a better prognosis.

Clinical evaluation of lysis-centrifugation technique and a biphasic bottle system for blood culture.

The lysis centrifugation technique (Isolator, DuPont) for blood culture was compared with a system with biphasic medium in bottles. The Isolator was filled with 10 ml of blood once. One aerobic and one anaerobic bottle were injected 3 times with 2.5 ml of blood each. Organisms were detected in 90/748 blood cultures; 26 of which were contaminants. 34 pathogens were detected by both methods, 12 with the Isolator only and 18 with the 3 bottle pairs only. The first pair of bottles revealed 45/52 isolates, the second and third pairs gave an additional 6 and 1 isolate respectively. The contamination rate was 2.3% for the Isolator, which is lower than earlier reported, and 1.3% for the bottles. The most common pathogens were Escherichia coli, Pseudomonas aeruginosa and Streptococcus pneumoniae. The Isolator gave a faster diagnosis in 23 of the 34 cases. No decrease in the recovery rate was seen after 8 h, the longest recommended transport time for the Isolator tubes. One Isolator gave the same yield as the first pair of bottles and combining the methods increased the yield 25% compared to either method alone.

Random locomotion in dark-field microscopy of single granulocytes from venous blood, tissue and exudate. Methodological considerations and clinical applications.

The random locomotion of granulocytes was studied in dark-field microscopy, and a standardized procedure for the classification of granulocytes into rapid-moving, (RM), slow-moving (SM) and non-moving (NM) cells was developed. When granulocytes from blood donors were tested, 54% were RM, 21% SM and 25% NM with variation between repeated tests, acceptable for a semiquantitative method. When the test was applied in 124 patients with infectious and inflammatory diseases and hematological malignancies, a significantly higher number of NM blood cells was found in patients with septicemia and pneumonia. The method was found especially suitable for samples containing few granulocytes, such as samples from soft-tissue infections, pulmonary infiltrates and neutropenic blood.

Disseminated aspergillosis treated with amphotericin B and surgery in a boy with chronic granulomatous disease.

A case of systemic infection caused by Aspergillus fumigatus in a seven-year-old boy suffering from chronic granulomatous disease is described. The fungus had infiltrated his lungs, his left foot and the popliteal and inguinal lymph nodes. Amphotericin B, 1 mg/kg daily, was given for three months via a central venous catheter, Progressive anaemia made amputation of his left leg necessary. The bone tissue was heavily infiltrated with fungal elements. The regional lymph nodes were also resected because of fungal growth. After six months no fungi were found in liver aspirates taken on account of liver abscesses due to Staphylococcus aureus. The combined medical and surgical approach resulted in complete eradication of the Aspergillus infection, as verified by the disappearance of Aspergillus precipitins.

Intrauterine infection by non-capsulated Haemophilus influenzae in a case of maternal immunodeficiency.

A 29-year-old woman with an upper respiratory tract infection due to Haemophilus influenzae, gave birth to a premature infant who died after 3 h. The mother's strain was non-capsulated, as were the strains cultured from the infant's blood, lungs, nose, and throat. Antigen analyses revealed, however, that the strains were not identical. The infant probably acquired the infection via the transplacental route. The uncommon infection was in this case attributed to a transient dysgammaglobulinemia in the mother.

Counterimmunoelectrophoresis of sputum and blood for the diagnosis of chest infections caused by pneumococci or Haemophilus influenzae.

In 107 patients with lower respiratory tract infections, counterimmunoelectrophoresis (CIE) of blood and sputum, bacterial cultures of blood, sputum and nasopharyngeal secretion, and enzyme-linked immunosorbent assay (ELISA) for antibody determination were performed, with special reference to pneumococci and Haemophilus influenzae. For pneumococci CIE of sputum was superior to culture especially in antibiotic-treated patients. The clinical significance of a positive CIE of sputum was supported by close correlation to significant antibody increase. The usefulness of CIE regarding H. influenzae was more difficult to evaluate.

Chronic granulomatous disease in three siblings.

A family of 7 persons is described in which one male and two female siblings have chronic granulomatous disease (CGD). The CGD diagnosis was established by histories of recurring infections, typical histopathology, deficient nitroblue tetrazolium (NBT) reduction and deficient neutrophil killing of Staphylococcus aureus. Noteworthy infections were liver abscesses, pneumonia, pleurisy, lymphadenitis, skin pustules, urinary tract infection and dental abscesses. The affected boy was the most severely ill with liver abscesses. One sister also had liver abscesses with Staph. aureus and both were treated with cloxacillin in combination with fucidin and surgical intervention. A survey of the closest relatives with the NBT test disclosed no further cases. In this family in the heredity seems to be of the recessive type.

The significance of serum-sensitive bacilli in gram-negative bacteremia.

Clinical findings from 76 patients (median age 67 years) with gram-negative bacteremia were analysed and related to the sensitivity of the blood isolates to the bactericidal activity of normal human serum. 28 strains (37%) were resistant, an equal number intermediately sensitive and 20 markedly sensitive (26%). No correlation was found between serum sensitivity and origin of the bacteremia, presence of fever or blood granulocyte count. The frequency of shock in immunocompromised patients with serum-resistant strains was 60% (6/10); in those with intermediately or markedly sensitive strains it was 44% (8/18). In the non-immunocompromised patients with resistant strains the frequency of shock was 33 (6/18) versus 10% (3/30) in those without such strains. Thus the risk of developing shock with gram-negative bacteremia seems to depend on both parasite and host factors, although in this study only the latter were statistically significant. We conclude that serum-sensitive strains can invade the blood stream in spite of the serum bactericidal activity and cause severe disease in some patients.

Serum myeloperoxidase and lactoferrin in neutropenia.

Radioimmunosorbent assays for determination of serum content of the neutrophil proteins myeloperoxidase and lactoferrin are described. Serial studies were performed in patients with neutropenia. In 2 cases of cyclic neutropenia the myeloperoxidase level showed slight variations within the normal range during the cycle while lactoferrin displayed a clear correlation with neutrophil counts. In 1 case with persistent agranulocytosis myeloperoxidase was normal but lactoferrin was extremely low. During the regeneration phase of drug-induced neutropenia neutrophil counts and serum lactoferrin increased in a parallel fashion. Since serum myeloperoxidase was normal during profounded neutropenia it is suggested to derive primarily from myeloperoxidase-rich granulopoietic precursor cells of the marrow. Serum lactoferrin on the other hand seems to derive from leakage of more granulopoietic cells of blood and marrow. Studies of neutrophil proteins of serum may aid in evaluation of neutropenic patients.

Antibacterial effect of biological dressings in the treatment of infected wounds.

Human cadaver split skin preserved in a special transport medium (Histocon; Histo-Lab. Ltd., Göteborg, Sweden) and porcine split skin (Skintec; Genetic Lab. Inc., Minneapolis, USA), were used in thirteen patients with infected wounds. Cadaver skin made it possible to reduce applications of wound dressing to two or three times a week without aggravation of infection and made the wound bed suitable for autografting. Skintec was less reliable in these respects. The two biological dressings had equal pain reducing properties. Leukocyte agglutinins, attributable to the treatment with cadaver skin did not appear. Because of retained histological and histochemical characteristics in the preserved cadaver skin it was preferred to Skintec. A regimen consisting of initial wound toilet, antibiotic treatment, skin changing every second or third day finally made permanent skin grafting possible. Secondary gains were a reduce in nursing and dressing routine as compared to saline dressings.