Comprehensive real-time epidemiological data from respiratory infections in Finland between 2010 and 2014 obtained from an automated and multianalyte mariPOC® respiratory pathogen test.

Respiratory viruses cause seasonal epidemics every year. Several respiratory pathogens are circulating simultaneously and typical symptoms of different respiratory infections are alike, meaning it is challenging to identify and diagnose different respiratory pathogens based on symptoms alone. mariPOC® is an automated, multianalyte antigen test which allows the rapid detection of nine respiratory infection pathogens [influenza A and B viruses, respiratory syncytial virus (RSV), human metapneumovirus, adenovirus, parainfluenza 1-3 viruses and pneumococci] from a single nasopharyngeal swab or aspirate samples, and, in addition, can be linked to laboratory information systems. During the study period from November 2010 to June 2014, a total of 22,485 multianalyte respi tests were performed in the 14 participating laboratories in Finland and, in total, 6897 positive analyte results were recorded. Of the tested samples, 25 % were positive for one respiratory pathogen, with RSV (9.8 %) and influenza A virus (7.2 %) being the most common findings, and 0.65 % of the samples were multivirus-positive. Only small geographical variations in seasonal epidemics occurred. Our results show that the mariPOC® multianalyte respi test allows simultaneous detection of several respiratory pathogens in real time. The results are reliable and give the clinician a picture of the current epidemiological situation, thus minimising guesswork.

Effects of a germ-free environment on gut immune regulation and diabetes progression in non-obese diabetic (NOD) mice.

AIMS/HYPOTHESIS: Microbial factors influence the development of diabetes in NOD mice. Studies in germ-free animals have revealed important roles of microbiota in the regulation of Th17 and forkhead box P3 (FOXP3)(+) T regulatory (Treg) activation in the intestine. However, the effects of intestinal microbiota in immune regulation and diabetes development in NOD mice are still poorly understood. METHODS: A colony of germ-free NOD mice was established to evaluate the effects of intestinal microbiota on regulatory immunity in the gut, and on the development of insulitis and diabetes in NOD mice. RESULTS: Diabetes developed in roughly equal numbers in germ-free and specific pathogen-free NOD mice. Insulitis was accentuated in germ-free NOD mice; yet insulin preservation was unaltered. Germ-free NOD mice showed increased levels of Il17 (also known as Il17a) mRNA in the colon, and of Th17 and Th1 cells in the mesenteric and pancreatic lymph nodes, while Foxp3 mRNA and FOXP3(+) Tregs were reduced. In the islet infiltrates, FOXP3(+)CD4(+) T cells were slightly increased in germ-free mice. B cells appeared less activated in the peritoneum and were less abundant in islet infiltrates. CONCLUSIONS/INTERPRETATION: These results indicate that lack of intestinal microbiota promotes an imbalance between Th1, Th17 and Treg differentiation in the intestine. This imbalance is associated with accelerated insulitis, but intact recruitment of FOXP3(+) Tregs into islets, suggesting: (1) a microbial dependence of local induction of Treg in the gut and draining lymph nodes; but (2) a potentially compensatory function of naturally occurring Tregs in the islets, which may help control diabetogenic T cells.

Influence of shear viscosity of quark-gluon plasma on elliptic flow in ultrarelativistic heavy-ion collisions.

We investigate the influence of a temperature-dependent shear viscosity over entropy density ratio η/s on the transverse momentum spectra and elliptic flow of hadrons in ultrarelativistic heavy-ion collisions. We find that the elliptic flow in √S(NN)=200 GeV Au+Au collisions at RHIC is dominated by the viscosity in the hadronic phase and in the phase transition region, but largely insensitive to the viscosity of the quark-gluon plasma (QGP). At the highest LHC energy, the elliptic flow becomes sensitive to the QGP viscosity and insensitive to the hadronic viscosity.

Evaluation of the TPX MRSA assay for the detection of methicillin-resistant Staphylococcus aureus.

The aim of this study was to evaluate a new type of assay for the phenotypic detection of methicillin-resistant Staphylococcus aureus (MRSA). The assay is based on a point-of-care compatible two-photon excitation fluorescence detection technology (TPX). A collection of 243 epidemic MRSA isolates was tested in addition to 138 sporadic MRSA and 101 negative control strains. The assay proved to be both sensitive (97.9%) and specific (94.1%) in the identification of MRSA, with adequate positive (98.4%) and negative (92.2%) predictive values. The time required for obtaining a positive test result was less than 14 h for 99.0% of the MRSA true-positive samples. After a test run, the selectively enriched reaction mixtures may be recovered and further studied by molecular or standard phenotypic methods. The main benefits of the TPX methodology include a simple assay procedure, low reagent consumption, and a high-throughput capacity.

Prescribing antimicrobial agents for dogs and cats via university pharmacies in Finland--patterns and quality of information.

The aim of our study was to evaluate antimicrobial use in dogs and cats in Finland. Information on veterinary prescriptions was gathered from University Pharmacies (n=17) over a one-month period, April 2001. A total of 2719 prescriptions for veterinary use were delivered, of which the majority were for dogs (70%, n=1898) and cats (14%, n=384). The most prescribed therapy group was per-oral antimicrobial agents (53%, n=1449), of which 16% (n=237) were medicines approved for humans. The most commonly used substances for dogs and cats were betalactams, 66% and 78%, respectively. The proportion of fluoroquinolones was 3-5%. The average duration of the treatment periods was 10 days with the exception of treatment of cats with macrolide-lincosamides, where the mean period was 20 days. Indication was mentioned only in 37% of the prescriptions.

Clinical microbiology laboratories do not always detect resistance of Haemophilus influenzae with disk or tablet diffusion methods. Finnish Study Group for Antimicrobial Resistance (FiRe).

The performance of disk diffusion testing of Haemophilus influenzae was evaluated in 20 laboratories. Thirteen disk-medium-breakpoint-inoculum modifications were used in Finnish clinical microbiology laboratories. The performance of various methods was evaluated by testing a susceptible control strain and one with non-beta-lactamase-mediated ampicillin resistance 10 times in 16 laboratories. Gaps in millimeters were measured between these two groups of results. The strains were separated by a gap of at least 5 mm in 8/16 laboratories testing ampicillin, in 7/15 laboratories testing cefaclor, in 5/ 16 laboratories testing cefuroxime, and in 15/16 laboratories testing trimethoprim-sulfa. Detection of ampicillin resistance was better with 2.5 microg tablets than with 10 microg disks or 33 microg tablets. For MIC-determinations, 785 isolates and their disk diffusion results were collected. None of the 12 clinical isolates with non-beta-lactamase-mediated ampicillin resistance was detected as resistant in the participating laboratories. The ampicillin and cefaclor results of the isolates were no better even when a laboratory was able to separate the control strains. Cefaclor results were unreliable because of poor disk diffusion-MIC correspondence and incoherent breakpoint references. Interlaboratory variation of the zone diameters caused false intermediate results of cefuroxime-susceptible strains. When ampicillin, cefaclor and cefuroxime were tested, the discrimination of laboratories using disks and tablets was equal, whereas the laboratories using paper disks were better able to detect trimethoprim-sulfa resistance.

Multiresistance in Staphylococcus spp. blood isolates in Finland with special reference to the distribution of the mecA gene among the Staphylococcus epidermidis isolates. The Finnish Study Group for Antimicrobial Resistance.

A total of 570 Staphylococcus spp. blood isolates collected in Finland in 1991 were tested for susceptiblity to oxacillin and 19 additional antimicrobial agents. The Staphylococcus epidermidis isolates were also analyzed for the presence of the mecA gene by the polymerase chain reaction (PCR). Of the 238 S. epidermidis, 137 (58%) were in vitro identified as methicillin-resistant and 5 (2%) exhibited oxacillin MICs between 1 and 3 micrograms/ml. All these isolates were positive for the mecA gene in PCR as an indication of genetic resistance to methicillin, while none of the remaining 96 S. epidermidis isolates (oxacillin MICs < or = 0.25 microgram/ml) was positive. Multiresistance was observed in 123 (87%) of the 142 mecA-positive S. epidermidis. Of the 332 Staphylococcus aureus isolates, only one (0.3%) was phenotypically resistant to methicillin; the strain was also resistant to three other unrelated classes of antimicrobials. True methicillin resistance of this strain was manifested by the presence of the mecA gene in PCR. Based on these results, multiresistance was still extremely rate among the S. aureus in our country, whereas among the S. epidermidis as many as half of the blood isolates in central hospitals were multiresistant.

Erythromycin resistance of group A streptococci from throat samples is related to age.

BACKGROUND: Factors associated to increased antimicrobial resistance among bacterial pathogens have been widely discussed and need to be evaluated. In Finland resistance to erythromycin in group A streptococci has become an important problem among outpatients. The aim of this study was to investigate whether occurrence of erythromycin resistance among group A streptococci isolated from noninvasive infections correlates with the patients' age and sex. METHODS: Group A streptococci isolated from 10 162 patients were tested for erythromycin resistance in 21 regional microbiologic laboratories located throughout Finland. The age of every patient and the sex of 8121 (80%) patients were known. The statistical significance of the association between the patients' age or sex and the occurrence of erythromycin resistance in group A streptococci, isolated from throat swab samples (8568 isolates) or pus samples (1594 isolates), was measured by logistic regression analysis. RESULTS: When erythromycin resistance of the isolates was regressed with the patients' age and sex, the age of the patient was a clearly significant predictor for the throat isolates (beta coefficient = -0.0114, SD 0.0029, observed value of t test statistic = -3.89, P = 0.0001) but not for the pus isolates. The odds ratio for age was 0.99 with a 95% confidence interval of 0.98 to 0.99. Thus the expected risk of erythromycin resistance on a group A streptococcal throat isolate decreased with increasing age by 1% per year. No significant association between the patients' sex and the occurrence of erythromycin resistance was found. CONCLUSIONS: Significant differences may exist between different age groups in the frequency of antibiotic-resistant isolates among outpatients, perhaps caused by differences in antibiotic prescribing. Thus overall resistance levels do not necessarily represent all age groups, especially children.

Infrequent isolation of multiresistant Acinetobacter baumannii from the staff tending a colonized patient with severe burns.

A patient with severe burns who was colonized by multiresistant Acinetobacter baumannii was cared for in contact isolation by staff intensively trained on hospital hygiene. Of the 1,907 postexposure cultures from the staff and 425 environmental samples, only 0.7% and 4%, respectively, yielded this microorganism. These data show that strict hygienic measures may limit staff colonization and contamination of the environment byA baumannii.

Nosocomial Staphylococcus epidermidis septicaemia among very low birth weight neonates in an intensive care unit.

A cluster of cases of septicaemia caused by coagulase-negative staphylococci was observed among the infants at the Neonatal Intensive Care Unit (NICU) of the Karolinska Hospital in May 1987. The presence of a unique antibiogram among the blood culture isolates prompted an investigation to determine whether an epidemic strain existed or not, using antibiogram, biotyping and plasmid profiles as epidemiological markers. All 14 isolates with a unique antibiogram were investigated, and 22 isolates without the unique antibiogram served as controls. Of the 14 isolates, 11 were Staphylococcus epidermidis and had similar plasmid patterns. Of the 22 control isolates, 15 were S. epidermidis, and none had the special plasmid pattern nor any other recurring plasmid patterns. The use of plasmid profile analysis together with antibiograms thus identified a possible epidemic strain of S. epidermidis which may have been responsible for the upsurge of septicaemia cases at the NICU. The presence of an epidemic strain implies that hospital cross infection control could be important in preventing neonatal septicaemia caused by S. epidermidis.

Impact of UV radiation on the early development of the giant kelp (Macrocystis pyrifera) gametophytes.

The mechanisms and dose-response of UV action on the early development of Macrocystis pyrifera (L.) C. Agardh gametophytes were investigated. Post-release, zoospores undergo germination, germ tube elongation, DNA synthesis, nuclear division and translocation, which were followed for 41 h under laboratory conditions. The spores were exposed to UV radiation before germination (3 h post-release) or before nuclear division (20 h post-release). Biologically effective UV-B doses (BEDDNA300 nm) higher than those used in the experiments are needed for a 50% inhibition in germination (BED50 > 1600 J m-2). Nuclear division/translocation was more sensitive to UV radiation. When the spores were cultured in the dark, UV exposure at both 3 and 20 h post-release resulted in a dose-responsive inhibition of nuclear division/translocation (BED50 64 and 86 J m-2). Culturing in the light indicated recovery in the spores that were irradiated at 3 h post-release (BED50 356 J m-2), whereas no light-dependent recovery occurred within 41 h of culture when irradiated at 20 h post-release (BED50 80 J m-2). The results present a possible mechanism of UV inhibition in early life stages of the giant kelp, suggesting that environmentally relevant UV-B levels can perturb or delay the development and recruitment of the gametophytes by inhibiting nuclear events.

Trimethoprim-resistant Escherichia coli in a geriatric hospital.

A total of 1751 strains of Escherichia coli was collected from the Turku City Hospital in 1981-1982. Of these, 81 per cent were from patients aged 65 years or more. Total trimethoprim resistance was about 22 per cent of strains studied. There was a significant difference between the trimethoprim resistance of strains from those patients with a urinary tract catheter (38 per cent) and those without such a catheter (13.4 per cent) (P less than 0.001).

Positive correlation between the age of patients and the degree of antimicrobial resistance among urinary strains of Escherichia coli.

We have studied the resistance of urinary strains of Escherichia coli in relation to patients' age. A total of 4146 samples of urine was collected during 1984-1990 from patients staying in an acute care university hospital and in a long-term care city hospital in Finland. In the city hospital, the proportion of strains resistant to either ampicillin, trimethoprim, sulphonamides, or to all of these simultaneously (multi-resistant), correlated with increase in age of the patients. In the university hospital, a clear increase was observed in trimethoprim-resistant and multiresistant isolates. Such correlation with age was not observed among catheterised patients in either hospital. Whether this is due to cumulative lifetime use of antimicrobials remains to be studied. We conclude that the incidence of resistant strains of E. coli correlates with patients' age among both chronic and acute care patients who are not catheterised. This is important in the choice of empirical treatment for urinary tract infections of elderly people.

Clinical scoring system in the evaluation of adult pharyngitis.

OBJECTIVE: To compare results of a clinical scoring system for diagnosis of group A streptococcal pharyngitis with microbiologic results, when several different pharyngeal pathogens were tested simultaneously. DESIGN: Evaluation of clinical manifestations of 106 adult patients with pharyngitis of different microbial origin. SETTING: General private practice; Health Center Pulssi, Turku, Finland. PATIENTS: Adult patients whose chief complaints were sore throats. MAIN OUTCOME MEASURE: A symptom score that was assigned to each patient according to the total number of certain signs and symptoms that are postulated to increase the probability of group A streptococcal pharyngitis and blood measurements for infection. RESULTS: The highest symptom scores, 3 and 4, were found in 21 patients. These patients had pharyngitis due to group A streptococcus (four patients), group C streptococcus (four patients), group G streptococcus (two patients), group F streptococcus, Mycoplasma pneumoniae, Chlamydia pneumoniae, influenza A virus, influenza B virus, herpes simplex type 1 virus (two patients), and coxsackie B4 virus. No pathogen could be identified from three of the 21 patients. The C-reactive protein values and the leukocyte counts were raised significantly more often in streptococcal infections than in infections of other origin; the P values were .00016 and .028, respectively. CONCLUSION: Use of a clinical scoring system alone for diagnosis of pharyngitis may lead to improper use of anti-microbial agents. There is a need for accurate microbiologic diagnostic procedures in general practice to determine proper treatment of pharyngitis as well as to test the effect of antibacterial and, in the future, antiviral treatment in respiratory tract infections.

Spectral attenuation of solar ultraviolet radiation in humic lakes in Central Finland.

The attenuation of solar ultraviolet (UV) radiation in five lakes in Central Finland was evaluated through field measurements and/or by determining the optical properties of the lake water during summer 1999. Spectral UV irradiance in the air and at several depths underwater was measured in three lakes (Lake Palosjärvi, Konnevesi, and Jyväsjärvi) with dissolved organic carbon (DOC) ranging from 4.9 to 8.7 mg l(-1) and chlorophyll a ranging from 1.6 to 16 g l(-1). According to the field measurements, 99% of the UV-B radiation was attenuated in approximately a half meter water column in the clearest lake. In the UV-A region at 380 nm, the corresponding attenuation occurred in the upper one meter. In a small humic lake (DOC 13.2-14.9 mg l(-1)) UV-B radiation was attenuated to 1% of the subsurface irradiance within the top 10 cm water column, whereas UV-A radiation (at 380 nm) penetrated more than twice as deeply (maximum 25 cm), as predicted from the absorption coefficients. These results suggest the importance of the dissolved fraction of lake water in governing the UV attenuation in lakes. This was seen from the significant relationship between the vertical attenuation coefficients (Kd) based on field measurements and the absorption coefficients (ad) derived from spectrophotometric laboratory scannings, as well as between Kd and DOC.

Photoinduced toxicity of retene to Daphnia magna under enhanced UV-B radiation.

The effects of UV radiation on the acute toxicity of retene (7-isopropyl-1-methylphenanthrene) to Daphnia magna Straus were studied. Dehydroabietic acid (DHAA) from which retene is formed in the vicinity of pulp and paper industry was also studied. Pyrene, anthracene, and phenanthrene were used as model PAH compounds. The time taken for immobilization (ET50) was monitored under biologically effective UV-B dose rates of 240, 365, 565, and 650 mW m(-2) (UV-A and visible light also present). Median effective concentrations (EC50) were determined after a 15-min UV exposure (565 mW m(-2)) followed by 24 h in the dark. Retene (10-320 microg l(-1)) was not acutely toxic in the dark. The induction of phototoxicity was in agreement with the absorption properties of the compounds (absorption peak of retene at around 300 nm). Photoinduced toxicity followed an order pyrene > anthracene > retene. Phenanthrene and DHAA were not acutely phototoxic. Accumulation of the compound in Daphnia before UV exposure was essential. Some changes in the absorption spectra of the compounds were seen after a 5-h UV irradiation (565 mW m(-2)), but none of the irradiated compounds were acutely toxic without further UV exposure. Therefore, the enhanced acute toxicity was primarily due to internal photosensitization reactions rather than photomodification. The dissolved fraction of 25% pulp and paper mill effluent reduced phototoxicity by attenuating UV radiation. The phototoxicity of retene was a function of both the exposure concentration and the UV-B dose rate, but relatively high UV-B dose rates and concentrations were needed for the acute photoinduced toxicity.

FiRe works - the Finnish Study Group for Antimicrobial Resistance (FiRe).

The Finnish Study Group for Antimicrobial Resistance (FiRe), a network founded in 1991, has established a standard routine susceptibility testing method that yields reliable and comparable results for both diagnostic and epidemiological purposes. Results

Survey of condition-based prescribing of antimicrobial drugs for dogs at a veterinary teaching hospital.

A database of the prescriptions of antimicrobial drugs for the treatment of common infectious diseases in dogs at the Finnish Veterinary Teaching Hospital was searched to determine to what extent national guidelines were being followed. Twenty-two per cent of 5918 dogs were treated orally with antimicrobial drugs. The most commonly used drugs were beta-lactams (49 per cent) of which cephalexin and amoxycillin-clavulanate were most widely prescribed. The usage of fluoroquinolones was only 2.8 per cent. The prescription of antimicrobials for pyoderma was contrary to Finnish guidelines, but the use of cephalexin or amoxycillin-clavulanate as first-line drugs instead of macrolides or lincosamides or trimethoprim-sulphonamides was acceptable because of the presence of resistance by canine staphylococci. The drug most commonly used to treat acute urinary tract infections was trimethoprim-sulphonamide, in agreement with the guidelines. Antimicrobial drugs were used excessively after surgical procedures, and for treating acute gastrointestinal disturbances and small wounds and traumas.

Penetration of UV radiation into Finnish lakes with different characteristics.

Penetration of UV radiation into Finnish lakes was evaluated through field measurements and/or by determining the optical properties of the lake water. The spectral measurements of air and underwater irradiance (280-400 nm) were performed in early September, 1998, in four lakes (Lake Konnevesi, Tuomiojärvi, Jyväsjärvi, and Kopru) representing a variety of humic (DOC 8.1-16.0 mg l-1) and chlorophyll (2.3-14 micrograms l-1) concentrations. A linear relationship was found between vertical attenuation coefficient (Kd) and DOC (r2 > 0.75), whereas no relationship between Kd and chlorophyll a was observed (r2 < 0.20). The depth where the UV-B irradiance is 10% of the value just beneath the surface (z10%) ranged 5-19 cm. Kd based on field measurements, and absorption coefficient (ad) derived from spectrophotometric scanning measurements of filtered lake water showed a linear relationship (r2 = 0.93). Kd values for two lakes where field measurements were not made (DOC 4.2-5.2 mg l-1, chlorophyll a 1.7-1.9 micrograms l-1) were obtained from the relationship between Kd and ad, giving the 10% UV-B penetration depth of 1.3 m to Lake Kuorinka and 0.21-0.24 m to Lake Palosjärvi.

Association af changes in the bacterial ecology of bovine mastitis with changes in the use of milking machines and antibacterial drugs.

The results of mastitis bacteriology made by the National Veterinary and Food Research Institute in Finland during the past 50 years (1.15 million samples) are viewed in relation to simultaneous changes in dairy cow management. Although intensive preventive measures have been applied for decades, the prevalence of bovine mastitis has not decreased. Instead, pathogenic bacteria are becoming progressively less susceptible to the available therapy. In part this must be due to the emergence of antibiotic resistant strains of bacteria, but it seems that the bacterial spectrum has also changed. The incidence of Streptococcus agalactiae (group B streptococci) has decreased, while in contrast, the incidence of staphylococci, initially Staphylococcus aureus and later coagulase-negative staphylococci, has increased. Results suggest that external pressure, like changes in animal husbandry, including antimicrobial treatments and introduction of modern milking machines, act as selective forces on the bacterial species which cause bovine mastitis.