[Shortages in Swedish tuberculosis care. Good results only in 71 percent of cases after 12-month treatment as shown in a current study]. / Det finns brister inom den svenska tuberkulosvården. Fullgott resultat efter tolv månader hos endast 71 procent visar aktuell studie.

During the period August 1994-December 1995 783 cases of active tuberculos (TB) were notified to the health authorities in Sweden. By means of questionnaires sent to the consulting physicians (92 per cent response rate) the treatment outcome was studied twelve months after the diagnosis. Out of 676 patients only 71 per cent were reported to have completed the treatment and be cured of TB. This indicates that there is room for improvement as regards monitoring patients, if necessary by Directly Observed Therapy (DOT), in order to make sure that prescribed treatment is adhered to.

Intradermal hepatitis B vaccination in health care workers. Response rate and experiences from vaccination in clinical practise.

Health care workers at risk for hepatitis B virus infection are recommended for vaccination. Low-dose intradermal (i.d.) administration of vaccine has been suggested as a less expensive alternative to intramuscular (i.m.) inoculation. To evaluate the i.d. vaccination route, health care workers were included in a prospective study. The subjects were vaccinated with 0.1 ml (= 2 microg) recombinant vaccine (Engerix B, SmithKline Beecham) i.d. at 0, 1 and 6 months. Two months after the third vaccination, measurement of the anti-HBs level was conducted. An anti-HBs level > or =10 IU/l was considered protective. Those with an anti-HBs level <10 IU/l were given a fourth dose with new serological control after another 2 months. The results are based on the 1406 subjects that it was possible to evaluate. The seroconversion rate to protective anti-HBs level after 3 doses was 68% and after 3 or 4 doses 89%. Factors associated with a lower response rate were increasing age (p<0.05) and smoking (p<0.001). Sex or body mass index had no influence on the results. Vaccination technique seems to be of utmost importance when the i.d. route is used. Well instructed and experienced nurses are required and quality control with follow-up of overall seroconversion rate within each centre is needed.

[Policy program to minimize spread of infection. Prolonged cough may be a sign of tuberculosis]. / Policyprogram för minskad smittspridning. Långdragen hosta kan vara tuberkulos.

In a worldwide epidemiological perspective, Sweden is well favoured with an annual tuberculosis incidence of approximately six cases per 100,000 of the population. Neither the impact of the HIV pandemic nor the occurrence of multiresistant strains of Mycobacterium tuberculosis has yet become a major problem in the care of tuberculosis patients in Sweden. Only a few per cent of HIV patients have developed tuberculosis, and during the period, 1991-94, only one per cent of M. tuberculosis isolates in Sweden were resistant to such antimycobacterials as isoniazid and rifampicin. However, the epidemiological situation in the neighbouring Baltic states is a matter for concern. Bovine tuberculosis has been eradicated in Sweden, the last case having been diagnosed in 1978. Although the reported efficacy of BCG (bacillus Calmette-Guérin) tuberculosis vaccine varies according to the population studied, protective rates of 70-85 per cent have been reported for Sweden and other west European countries. Re-vaccination of tuberculin-negative individuals has not been shown to yield added protection. The aim of a national programme for protection against tuberculosis is to preserve our favourable epidemiological situation by early detection of new cases, effective contact tracing, and BCG vaccination of children in population groups at risk. The primary means of achieving this is the education of health care personnel to retain tuberculosis as a differential diagnosis. Moreover, national guidelines for contact tracing must be duly observed, and immigrants from high prevalence areas need to be screened for tuberculosis. Registration of all cases of tuberculosis should be maintained at regional and national levels, and follow-up must be meticulous until a successful outcome of treatment is accomplished. Recommendations for dealing with tuberculosis should be made available and duly implemented at all hospitals caring for tuberculosis patients, in order to avoid nosocomial transmission. Although BCG vaccination at birth was formerly general in Sweden, since 1975 only children considered to be at risk have been vaccinated. Thus, non-vaccinated young adults are now entering the health care sector as students or employees, and should be offered BCG vaccination. Moreover, the epidemiological situation both in Sweden and in neighbouring countries needs to be monitored carefully in order that recommendations concerning BCG vaccination and other preventive measures can be modified if necessary.

Occurrence of pneumococci with resistance or decreased susceptibility to penicillin in southeast Sweden.

The minimal inhibitory concentrations (MICs) of 14 beta-lactam and non-beta-lactam antibiotics were determined for all pneumococci with intermediate susceptibility (I), (n = 26) or resistance (R), (n = 15) to penicillin G isolated at the Clinical Microbiology Laboratory, University Hospital, Linköping, Sweden during 1994. These isolates accounted for 3% of all pneumococcal isolates. The results were compared with those of 26 penicillin-susceptible isolates. The MICs of all tested beta-lactam antibiotics increased with MICs of penicillin G. The least increase and the lowest MICs of these agents were recorded for cefotaxime and imipenem. 27% of I- and R-strains were multiple-resistant, most often to tetracycline, trimethoprim-sulfametoxazole, erythromycin, chloramphenicol and clindamycin. All strains were susceptible to vancomycin and rifampicin. I-strains belonged to at least 5 different serotypes. However, 12 of the 15 R-strains were serotype 9 and 6 of these were recovered during contact tracing, indicating spread of a single clone within day-care centres.

Viral haemorrhagic fever in Sweden: experiences from management of a case.

The first recognized case in Scandinavia with potential man to man transmission of viral haemorrhagic fever occurred in Linköping, Sweden, in January 1990. Following a visit to Kenya a 21-year-old male student suffered a very severe illness including extremely prolonged high grade fever, rash, disseminated intravascular coagulation with thrombocytopenia and severe bleedings. This necessitated one month of intensive care support including respirator treatment. The patient was discharged after 2 1/2 months in good condition, with a partial femoral nerve paresis. About 100 medical personnel were exposed to aerosol or blood before a strict containment regimen was established. No secondary cases occurred.

Erysipelothrix rhusiopathiae septicaemia.

A 53-yr-old man developed pyrexia after a butcher's saw wound. One month later Erysipelothrix rhusiopathiae was isolated from the blood despite uncomplicated wound healing.

Reactive arthritis after campylobacter jejuni enteritis. A case report.

A 36-year-old HLA B 27 positive woman developed reactive type arthritis a week after enterocolitis. Stool culture and serological tests indicated Campylobacter jejuni infection. Serological evidence of previous Chlamydial infection was also obtained. The arthritis ran a benign course of 6 months, leaving no residual symptoms.

Physicochemical surface properties of Escherichia coli strains isolated from different types of urinary tract infections.

Escherichia coli strains isolated from three groups of patients with urinary tract infections, such as acute pyelonephritis, acute cystitis, and asymptomatic bacteriuria, were analyzed with respect to their physicochemical surface properties by means of polymer two-phase partitioning in dextran-polyethylene glycol systems and hydrophobic interaction chromatography on Octyl-Sepharose. Strains causing acute pyelonephritis constituted a homogenous group which, depending on the growth conditions, demonstrated smooth-type lipopolysaccharide, elevated negative charge, and liability to hydrophobic interaction, whereas strains isolated from acute cystitis and asymptomatic bacteriuria showed a more heterogenous pattern.

Influence of O and K antigens on the surface properties of Escherichia coli in relation to phagocytosis.

Strains of Escherichia coli with different O and K antigens were investigated with respect to physicochemical surface characteristics and liability to phagocytosis. Using two-phase partitioning analysis for the surface characterization, three main groups of strains emerged: Group I (O1:K1, O2:K1, O3:K2ab) showing both smooth hydrophilic O antigens and negatively-charged K antigen which rendered the strains maximally resistant to phagocytosis. Group II (O55:K59, O111:K58) showed no acidic K antigen but only smooth hydrophilic O antigen properties. However, these strains were as resistant to phagocytosis as the strains in group I. A third group (O14:K7, O24:K +) contained strains with rough, hydrophobic O antigen and negatively-charged K antigen. When the K antigen was removed by heat treatment these strains became more sensitive to phagocytosis. Certain other strains (O28:K-, O56:K + and O118:K-) did not fit into the three groups. These experiments show that the physicochemical surface effects and biological significance of the K antigen must be evaluated in relation to the properties conveyed by the corresponding O antigens.

Surface characteristics of Escherichia coli strains in relation to development of bacteraemia.

Three groups of E. coli bacteria isolated from blood, urine and faeces were analysed with respect to physicochemical surface properties in aqueous polymer two-phase systems. Eighty-eight per cent of the bacteria isolated from blood cultures showed affinity for the dextran-rich bottom phase, whereas 60% and 30% of the bacteria isolated from urine and faeces, respectively, collected to the same phase. Further two-phase analysis indicated that the bacteraemia strains exposed more negative surface than the other groups of bacteria, and that this charge was reduced after heat treatment (70 degrees C, 40 min). These results thus indicate that the strains causing bacteraemia possess similar surface properties, and may have been selected from the more heterogeneous group of bacteria found in urine and faeces. It is further conceivable to propose that bacteria found in the blood expose more heatsensitive, negatively-charged K antigen than the other groups of bacteria.