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1.
Med Mycol ; 48(3): 458-65, 2010 May.
Artículo en Inglés | MEDLINE | ID: mdl-19672782

RESUMEN

Deep, respiratory tract and ear infections due to Microascaceae (Pseudallescheria, Scedosporium, Microascus or Scopulariopsis) were studied nationwide in Finland during 1993-2002. The data were based on 52,000 fungal cultures that represented about 50% of all such specimens in Finland and included all Finnish cases of profound immunosuppression. There were 39 cases that were re-evaluated as clinically significant, i.e., three pneumonias, two deep pedal infections and five wound infections, 11 sinusitis and 18 ear infections. The pedal infections and most pneumonias occurred in immunocompromised patients. Most cases, except the ear infections, were due to Pseudallescheria boydii. Two patients had lethal P. boydii pneumonia and a deep P. boydii infection of the foot contributed to a third lethal case. Two of the patients with lethal outcomes had received an allogeneic haematopoietic stem cell transplantation (AHSCT). Two patients with haematological malignancies were cured of deep site infections by a prolonged course of itraconazole. Wound, sinus and ear infections were cured or improved by local surgery or topical therapy. There were 0.8-1.7 cases of any type of infection per million inhabitants per year (MY) and 3.4 cases/1000 AHSCT. Mortality associated with Microascaceae in any type of patient was 0.06-0.12 MY.


Asunto(s)
Ascomicetos/aislamiento & purificación , Micosis/epidemiología , Micosis/microbiología , Otitis/epidemiología , Otitis/microbiología , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/microbiología , Administración Tópica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antifúngicos/administración & dosificación , Niño , Desbridamiento , Femenino , Finlandia/epidemiología , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Micosis/mortalidad , Micosis/terapia , Factores de Riesgo , Resultado del Tratamiento , Adulto Joven
2.
Clin Microbiol Infect ; 15(11): 1026-32, 2009 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-19548923

RESUMEN

Previous studies on the usefulness of C-reactive protein (CRP) in patients with community-acquired pneumonia (CAP) have yielded somewhat inconsistent results. Our aim was to assess the value of CRP in estimating the severity and complications of CAP. CRP levels during the first 5 days of hospitalization were measured in 384 adult patients with CAP, and the data were evaluated using comprehensive statistical analyses. Significantly higher CRP levels on admission were detected in Pneumonia Severity Index (PSI) classes III-V than in classes I and II (p <0.001). An increment of 50 mg/L CRP on admission was associated with a 1.22-fold odds for a patient to be in PSI classes III-V as compared with classes I and II (OR 1.22, 95% CI 1.11-1.34; p <0.001). CRP levels were significantly higher in bacteraemic pneumonia than in non-bacteraemic pneumonia (p <0.001). An increment of 50 mg/L CRP was associated with a 1.67-fold odds for a patient to be bacteraemic (OR 1.67, 95% CI 1.46-1.92; p <0.001). CRP levels >100 mg/L on day 4 after the admission were significantly associated with complications (p <0.01). There was a trend for an association between the level of CRP on admission and the time to reach clinical stability (p <0.01). In conclusion, CRP may be valuable for revealing the development of complications in CAP. It may also be useful to assess the disease severity, thus being complementary to the assessment of the PSI. In our patients, high CRP levels were associated with a failure to reach clinical stability.


Asunto(s)
Proteína C-Reactiva/análisis , Infecciones Comunitarias Adquiridas/diagnóstico , Neumonía Bacteriana/diagnóstico , Neumonía Viral/diagnóstico , Índice de Severidad de la Enfermedad , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/complicaciones , Neumonía Viral/complicaciones , Valor Predictivo de las Pruebas
3.
Clin Microbiol Infect ; 12(6): 591-3, 2006 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-16700713

RESUMEN

The Vitek 2 system was compared with conventional assimilation, fermentation and morphological methods for its ability to identify yeast isolates from among 151 clinical specimens and 16 known type culture or quality control strains. An unequivocal identification was obtained for 155 (92.8%) isolates, with low discrimination for nine (5.4%) and false identification for three (1.8%) isolates. All isolates of Candida albicans, Candida glabrata and Candida krusei were identified correctly. It was concluded that the Vitek 2 system offers an excellent alternative for the identification of yeasts in a clinical laboratory.


Asunto(s)
Candida/aislamiento & purificación , Técnicas de Tipificación Micológica/métodos , Técnicas de Tipificación Micológica/normas , Candida/clasificación , Humanos , Técnicas de Tipificación Micológica/instrumentación , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
5.
Eur J Haematol ; 74(3): 203-11, 2005 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-15693789

RESUMEN

PURPOSE: To assess the usefulness of new culture-independent microbiological methods to analyse bronchoalveolar lavage (BAL) fluid from haematological patients with clinical pneumonia. PATIENTS AND METHODS: Results of 135 BALs from 122 disease episodes in 99 patients treated between 1996 and 2002 were retrospectively analysed. Forty-three patients had undergone haematopoietic stem cell transplantation and 56 patients had been treated with conventional chemotherapy for haematological malignancy. In addition to conventional microbiological methods, polymerase chain reaction (PCR) tests for Pneumocystis carinii, cytomegalovirus (CMV), Legionella sp., mycobacterium, Mycoplasma pneumoniae, and Chlamydia pneumoniae and the Aspergillus antigen test were performed. RESULTS: Three (2.2%) quantitative and four (3.0%) special bacterial cultures gave an aetiological diagnosis. A respiratory virus was isolated in 10 episodes (8.2%). The diagnostic yield increased to 35.6% (48 of 135) by other methods. The P. carinii PCR test was positive in 21 of 24 patients with P. carinii pneumonia, being the only microbiological indication of P. carinii in four cases. The CMV PCR test was positive in 18 patients, but in 14 patients the clinical significance of the finding remained unproven. The Aspergillus antigen test was positive in seven of nine patients with aspergillosis, being the only microbiological indication of Aspergillus in three cases. The result of BAL indicated commencement of specific antimicrobial treatment in 27 episodes (22.1%). CONCLUSION: The contribution of new culture-independent methods to the total diagnostic yield was of note. Among these methods, the P. carinii PCR and Aspergillus antigen tests proved the most valuable, while the CMV PCR test was not clinically useful.


Asunto(s)
Líquido del Lavado Bronquioalveolar/microbiología , Neoplasias Hematológicas/complicaciones , Huésped Inmunocomprometido , Infecciones/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Aspergilosis/diagnóstico , Aspergilosis/etiología , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/etiología , Femenino , Neoplasias Hematológicas/terapia , Humanos , Infecciones/etiología , Masculino , Técnicas Microbiológicas/métodos , Persona de Mediana Edad , Infecciones por Pneumocystis/diagnóstico , Infecciones por Pneumocystis/etiología , Reacción en Cadena de la Polimerasa , Estudios Retrospectivos , Pruebas Serológicas
6.
J Neurol Neurosurg Psychiatry ; 74(6): 728-33, 2003 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-12754340

RESUMEN

OBJECTIVE: To evaluate the usefulness of the broad range bacterial rDNA polymerase chain reaction (PCR) method combined with DNA sequencing in the aetiological diagnosis of intracranial or spinal infections in neurosurgical patients. METHODS: In addition to conventional methods, the broad range bacterial PCR approach was applied to examine pus or tissue specimens from cerebral or spinal lesions in patients treated in a neurosurgical unit for a clinical or neuroradiological suspicion of bacterial brain abscess or spondylitis. RESULTS: Among the 44 patients with intracranial or spinal lesions, the final diagnosis suggested bacterial disease in 25 patients, among whom the aetiological agent was identified in 17. A causative bacterial species was identified only by the rDNA PCR method in six cases, by both the PCR methodology and bacterial culture in six cases, and by bacterial culture alone in five. All samples in which a bacterial aetiology was identified only by the PCR approach were taken during antimicrobial treatment, and in three patients the method yielded the diagnosis even after >/= 12 days of parenteral treatment. One case also identified by the PCR approach alone involved a brain abscess caused by Mycoplasma hominis, which is not readily cultured by routine methods. CONCLUSIONS: In patients with brain abscesses and spinal infections, the broad range bacterial rDNA PCR approach may be the only method to provide an aetiological diagnosis when the patient is receiving antimicrobial treatment, or when the causative agent is fastidious.


Asunto(s)
Infecciones Bacterianas/genética , Infecciones Bacterianas/microbiología , Absceso Encefálico/microbiología , ADN Ribosómico/análisis , Mielitis/microbiología , Reacción en Cadena de la Polimerasa/métodos , Antiinfecciosos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Biopsia , Absceso Encefálico/tratamiento farmacológico , Absceso Encefálico/patología , Neoplasias Encefálicas/microbiología , Neoplasias Encefálicas/patología , Técnicas de Cultivo , ADN Bacteriano/genética , Humanos , Mielitis/tratamiento farmacológico , Mielitis/patología , Técnicas Estereotáxicas
7.
Scand J Surg ; 91(2): 178-81, 2002.
Artículo en Inglés | MEDLINE | ID: mdl-12164519

RESUMEN

BACKGROUND: Follow up studies have shown that 0.5 to 4% of the total joint arthroplasties will be complicated by infection. Distinction between aseptic loosening and infection is important for prediction of the final outcome after revision arhtroplasty but also for the choice of operative treatment. However, diagnosis of low grade chronic infection is extremely demanding. MATERIALS AND METHODS: 68 hip and knee revision arthroplasties were reviewed retrospectively in order to evaluate the reliability of pre- and perioperative analysis of infection during total joint revision arthroplasties. The sensitivity and specificity for clinical signs, blood white-cell count, C-reactive protein level, radiographic analysis, bone and leukocyte scans, joint aspirations, and gram staining were determined. Tissue sample were harvested and cultured in all cases. Positive cultures were regarded as a true infection. RESULTS: We were not able to characterize the infection by clinical signs. Also no single test was able to show the presence of infection in all cases. The best results were obtained from pre- and perioperative joint aspirations. Joint aspiration showed 1.0 specificity and 0.75 sensitivity. CONCLUSION: It is clear from this study that no single test is able to show the presence of infection in every case. Classical clinical signs, laboratory tests, special imaging studies and joint aspirations have all yielded a notable rate of false negative results. Therefore, we recommend that, if arthroplasty patients have pain in prosthetic joint without clear radiological evidence of loosening, bone scans and preoperative joint aspirations should be undertaken. Also, if radiological evidence of loosening is accompanied with one or more of following criteria; C-reactive protein level elevated, radiologic evidence of infection, loosening within the first five years after implantation. In case of infection a delayed two-stage reconstruction should be managed.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Infecciones Relacionadas con Prótesis/diagnóstico , Anciano , Femenino , Humanos , Masculino , Falla de Prótesis , Infecciones Relacionadas con Prótesis/microbiología , Reoperación , Estudios Retrospectivos , Sensibilidad y Especificidad
9.
Antimicrob Agents Chemother ; 44(6): 1479-84, 2000 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-10817696

RESUMEN

Enterobacteria in fecal flora are often reported to be highly resistant. Escherichia coli is the main species; resistance data on other species are rare. To assess the effect of the host's environment, antimicrobial resistance was determined in fecal species of the family Enterobacteriaceae from three populations: healthy people (HP)(n = 125) with no exposure to antimicrobials for 3 months preceding sampling, university hospital patients (UP) (n = 159) from wards where the antibiotic use was 112 defined daily doses (DDD)/bed/month, and geriatric long-term patients (LTP) (n = 74) who used 1.8 DDD/bed/month. The mean length of hospital stay was 5 days for the UP and 22 months for the LTP. The isolates were identified to at least genus level, and MICs of 16 antimicrobials were determined. From the university hospital, resistance data on clinical Enterobacteriaceae isolates were also collected. Resistance data for on average two different isolates per sample (range, 1 to 5) were analyzed: 471 E. coli isolates and 261 other Enterobacteriaceae spp. Resistance was mainly found among E. coli; even in HP, 18% of E. coli isolates were resistant to two or more antimicrobial groups, with MIC patterns indicative of transferable resistance. Other fecal enterobacteria were generally susceptible, with little typically transferable multiresistance. Clinical Klebsiella and Enterobacter isolates were significantly more resistant than fecal isolates. The resistance patterns at both hospitals mirrored the patterns of antibiotic use, but LTP E. coli isolates were significantly more resistant than those from UP. Conditions permitting an efficient spread may have been more important in sustaining high resistance levels in the LTP. E. coli was the main carrier of antimicrobial resistance in fecal flora; resistance in other species was rare in the absence of antimicrobial selection.


Asunto(s)
Farmacorresistencia Microbiana , Enterobacteriaceae/efectos de los fármacos , Heces/microbiología , Enterobacteriaceae/genética , Especificidad de la Especie
10.
Pediatr Infect Dis J ; 19(4): 293-8, 2000 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-10783017

RESUMEN

BACKGROUND: Childhood community-acquired pneumonia is a common illness, but there have been relatively few comprehensive studies of the viral and bacterial etiology in developed countries. The aim of the present investigation was to determine the etiology of community-acquired pneumonia in hospitalized children by several laboratory methods. METHODS: In a 3-year prospective study a nasopharyngeal aspirate for viral studies and acute and convalescent serum samples for viral and bacterial serology were taken from 254 children with symptoms of acute infection and infiltrates compatible with pneumonia in the chest radiograph. The role of 17 microbes was investigated. RESULTS: A potential causative agent was detected in 215 (85%) of the 254 patients. Sixty-two percent of the patients had viral infection, 53% had bacterial infection and 30% had evidence of concomitant viral-bacterial infection. Streptococcus pneumoniae (37%), respiratory syncytial virus (29%) and rhinovirus (24%) were the most common agents associated with community-acquired pneumonia. Only one patient had a positive blood culture (S. pneumoniae) of 125 cultured. A dual viral infection was detected in 35 patients, and a dual bacterial infection was detected in 19 patients. CONCLUSIONS: The possible causative agent of childhood community-acquired pneumonia can be detected in most cases. Further studies are warranted to determine what etiologic investigations would aid in the management of pneumonia. With effective immunization for S. pneumoniae and respiratory syncytial virus infections, more than one-half of the pneumonia cases in this study could have been prevented.


Asunto(s)
Infecciones Comunitarias Adquiridas/microbiología , Neumonía Bacteriana/microbiología , Neumonía Viral/microbiología , Distribución por Edad , Distribución de Chi-Cuadrado , Niño , Preescolar , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/epidemiología , Femenino , Finlandia/epidemiología , Hospitalización , Humanos , Incidencia , Lactante , Masculino , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/epidemiología , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Estudios Prospectivos , Factores de Riesgo , Muestreo , Distribución por Sexo
11.
J Clin Microbiol ; 38(1): 32-9, 2000 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-10618059

RESUMEN

A broad-range bacterial PCR targeting rRNA genes (rDNAs) was used to directly analyze 536 clinical samples obtained from 459 hospitalized patients during a 4-year study period. The molecular diagnosis based on DNA sequencing of the PCR product was compared to that obtained by bacterial culture. The bacteriological diagnosis was concordant for 447 (83%) specimens. Broad-range rDNA PCR was the only method that yielded an etiologic diagnosis for 11 (2.4%) of 459 patients. Compared to culture and clinical assessment, the sensitivity of the PCR method combined with sequencing was 74.2%, and the specificity was between 98.7 and 99.6%. At present, the described molecular approach proved superior to bacterial culture in two clinical situations: infections caused by bacteria with unusual growth requirements and specimens taken during antimicrobial treatment of the patient.


Asunto(s)
Infecciones Bacterianas/diagnóstico , Reacción en Cadena de la Polimerasa/métodos , ARN Ribosómico/aislamiento & purificación , Antibacterianos/uso terapéutico , Bacterias/aislamiento & purificación , Infecciones Bacterianas/tratamiento farmacológico , Técnicas Bacteriológicas , Bases de Datos Factuales , Finlandia , Humanos , ARN Ribosómico/genética , ARN Ribosómico 16S/genética , ARN Ribosómico 16S/aislamiento & purificación , ARN Ribosómico 23S/genética , ARN Ribosómico 23S/aislamiento & purificación , Reproducibilidad de los Resultados , Análisis de Secuencia de ADN
13.
J Clin Microbiol ; 36(11): 3155-9, 1998 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-9774556

RESUMEN

We evaluated a commercial immunoglobulin M (IgM)-capture immunoassay for the detection of Mycoplasma pneumoniae infections in 278 pediatric patients with community-acquired, radiographically defined pneumonia. Acute- and convalescent-phase serum samples were collected from all patients and were tested for M. pneumoniae-specific IgM and IgG antibodies by Platelia enzyme immunoassays (Sanofi Diagnostica Pasteur, Marnes la Coquette, France). Nasopharyngeal aspirates (NPAs) were collected at the time of admission to the hospital. A total of 227 NPAs were subjected to the detection of M. pneumoniae DNA by PCR, and 191 NPAs were cultured by using the Pneumofast kit (International Mycoplasma, Signeswere, France). Southern hybridization of PCR products and the IgM test with solid-phase antigen (Serion Immunodiagnostica, Würzburg, Germany) were used for additional confirmation of a positive result, which required agreement of at least two different methods. A total of 24 (9%) confirmed diagnoses of mycoplasma infection were made, 5 (21%) of which were in children <5 years of age. Of the positive children, 24 of 24 (sensitivity, 100%) were positive by the IgM-capture test with convalescent-phase serum, 19 of 24 (79%) were positive by the IgM-capture test with acute-phase serum, 19 of 24 (79%) were positive by IgG serology, 10 of 20 (50%) were positive by PCR, and 8 of 17 (47%) were positive by culture. An additional 5 (of 254) children were positive by the Platelia IgM test alone (specificity, 98%). When the PCR with Southern hybridization result was combined with the IgM-capture test result with the acute-phase sera, the sensitivity of rapid laboratory diagnosis increased to 95%. In conclusion, the IgM serology test was the single most valuable tool for the diagnosis of M. pneumoniae pneumonia in children of any age.


Asunto(s)
Anticuerpos Antibacterianos/sangre , Técnicas para Inmunoenzimas/métodos , Inmunoglobulina M/sangre , Mycoplasma pneumoniae/inmunología , Neumonía por Mycoplasma/diagnóstico , Neumonía por Mycoplasma/inmunología , Enfermedad Aguda , Adolescente , Niño , Preescolar , Estudios de Evaluación como Asunto , Humanos , Técnicas para Inmunoenzimas/estadística & datos numéricos , Inmunoglobulina G/sangre , Lactante , Mycoplasma pneumoniae/genética , Mycoplasma pneumoniae/aislamiento & purificación , Neumonía por Mycoplasma/microbiología , Reacción en Cadena de la Polimerasa/estadística & datos numéricos , Sensibilidad y Especificidad , Pruebas Serológicas
14.
J Clin Microbiol ; 36(8): 2205-9, 1998 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-9665992

RESUMEN

We used broad-range bacterial PCR combined with DNA sequencing to examine prospectively cerebrospinal fluid (CSF) samples from patients with suspected meningitis. Fifty-six CSF samples from 46 patients were studied during the year 1995. Genes coding for bacterial 16S and/or 23S rRNA genes could be amplified from the CSF samples from five patients with a clinical picture consistent with acute bacterial meningitis. For these patients, the sequenced PCR product shared 98.3 to 100% homology with the Neisseria meningitidis sequence. For one patient, the diagnosis was initially made by PCR alone. Of the remaining 51 CSF samples, for 50 (98.0%) samples the negative PCR findings were in accordance with the negative findings by bacterial culture and Gram staining, as well as with the eventual clinical diagnosis for the patient. However, the PCR test failed to detect the bacterial rRNA gene in one CSF sample, the culture of which yielded Listeria monocytogenes. These results invite new research efforts to be focused on the application of PCR with broad-range bacterial primers to improve the etiologic diagnosis of bacterial meningitis. In a clinical setting, Gram staining and bacterial culture still remain the cornerstones of diagnosis.


Asunto(s)
Líquido Cefalorraquídeo/microbiología , Meningitis Meningocócica/diagnóstico , Neisseria meningitidis/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Medios de Cultivo , ADN Bacteriano/análisis , ADN Bacteriano/aislamiento & purificación , Femenino , Humanos , Listeria monocytogenes/aislamiento & purificación , Masculino , Persona de Mediana Edad , Neisseria meningitidis/genética , Estudios Prospectivos , ARN Ribosómico 16S/genética , ARN Ribosómico 23S/genética , Sensibilidad y Especificidad , Análisis de Secuencia de ADN
15.
Clin Infect Dis ; 26(6): 1413-7, 1998 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-9636872

RESUMEN

We retrospectively studied the incidence of anaerobic bacteremia during 6 years (1991-1996) at Turku University Central Hospital (Turku, Finland). The clinical significance of a positive anaerobic blood culture, the effect of a positive culture on the choice of antimicrobial therapy, and the outcome for patients were evaluated. Cultures of blood from 81 patients yielded anaerobic bacteria (4% of all bacteremias). Anaerobic bacteremia was clinically significant in 57 patients (0.18 cases per 1,000 admissions). Only half (28) of these patients received appropriate and effective antimicrobial treatment before the results of blood cultures were reported; for 18 patients (32%), initially ineffective treatment was changed on the basis of the bacteriologic results, and for 11 patients (19%), the treatment was not changed. The mortality in these patient groups was 18%, 17%, and 55%, respectively. Empirical therapy may provide coverage for anaerobes in only half of the patients with anaerobic bacteremia, and failure to pay attention to the results of anaerobic blood cultures may have serious consequences for patients.


Asunto(s)
Bacteriemia/microbiología , Bacterias Anaerobias , Bacteriemia/mortalidad , Femenino , Finlandia , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos
16.
Pediatr Infect Dis J ; 17(2): 89-93, 1998 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-9493801

RESUMEN

BACKGROUND: Measles continues to be a significant health problem in developing countries. OBJECTIVES: To describe the clinical features of measles-associated pneumonia (MAP) and to identify other pathogens involved. METHODS: Measles diagnosis was ascertained either by the typical symptom complex or by a sensitive enzyme immunoassay for antibody among children < 5 years of age admitted to the hospital with pneumonia. Other pathogens were identified by blood culture, virus isolation or antigen detection from nasopharyngeal aspirate and antibody determination from serum. RESULTS: Of 182 MAP cases 162 (89%) had clinically typical measles. Twenty patients had a diagnostic antibody finding with an atypical clinical presentation. Thirteen percent were younger than 9 months of age. The case fatality rate was 17%, with a significantly increased odds ratio (OR) for those with cyanosis [OR 4.6, 95% confidence interval (CI) 1.7 to 13], respiratory rate > or = 60/min (OR 3, 95% CI 1.3 to 7) or fulfilling criteria for very severe pneumonia (OR 5.3, 95% CI 2.3 to 12). Mixed infection was found in 53% of patients. Blood culture was positive in 10 patients, Streptococcus pneumoniae (N = 5) being the most common finding. Adenovirus (19%) and parainfluenza (25%) viruses were the most frequent other viruses. A dense infiltrate was seen significantly more often among measles patients with bacterial coinfection (87.5%) than those with other viruses (36%, P = 0.007) or no evidence of other infection (33%, P = 0.004). CONCLUSION: In MAP, coinfection with other microbes is common. Cyanosis and a respiratory rate of > or = 60/min predict a greater risk of dying.


Asunto(s)
Sarampión/complicaciones , Neumonía/complicaciones , Preescolar , Comorbilidad , Países en Desarrollo , Humanos , Lactante , Sarampión/diagnóstico , Sarampión/epidemiología , Neumonía/epidemiología , Pruebas Serológicas
17.
Acta Orthop Scand ; 69(6): 559-65, 1998 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-9930097

RESUMEN

560 bones were harvested by The Turku Bone Bank between 1972-1995. It was started with massive allografts for bone tumor surgery, but today most are femoral heads for hip revision surgery. The increase in harvested bones nearly trebled from 1984-1989 to 1990-1995. Only 1 positive hepatitis C test was found. There were no hepatitis B or HIV positive donors. The incidence of discarding after screening was 24%, with positive bacterial growth (8%, usually Staphylococcus epidermidis) as the commonest reason. 2 massive grafts with negative cultures when harvesting were positive after thawing and resulted in deep infection. 369 allografts were transplanted. The infection rate of massive allografts for bone tumor surgery was 5/63 in 1973-1995, and 2/52 in 1985-1995. The infection rate for hip revision surgery was 3.4%. The clinical functional results correspond to those reported in larger international series.


Asunto(s)
Infecciones Bacterianas/transmisión , Bancos de Huesos/estadística & datos numéricos , Trasplante Óseo/estadística & datos numéricos , Infecciones por VIH/transmisión , Adolescente , Adulto , Anciano , Infecciones Bacterianas/prevención & control , Femenino , Finlandia , Infecciones por VIH/prevención & control , Hepatitis B/prevención & control , Hepatitis B/transmisión , Hepatitis C/prevención & control , Hepatitis C/transmisión , Humanos , Masculino , Persona de Mediana Edad , Riesgo , Infecciones Estafilocócicas/prevención & control , Infecciones Estafilocócicas/transmisión , Staphylococcus epidermidis , Donantes de Tejidos , Trasplante Homólogo
18.
Clin Immunol Immunopathol ; 80(2): 110-5, 1996 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-8764554

RESUMEN

In order to study the role of tonsils in the host defense in the oral region one pre- and two postoperative (1 and 6 months) whole saliva samples were collected from 25 young adults referred for tonsillectomy. Saliva samples were analyzed for selected host defense factors, representing both immune (total IgA, IgG, IgM, anti-Streptococcus mutans, anti-EBV, anti-CMV, and anti-adenovirus IgA and IgG) and nonimmunoglobulin (lysozyme, lactoferrin, salivary peroxidases, thiocyanate, hypothiocyanite, and agglutinins) mediators. Following tonsillectomy, a significant (P < 0.04) reduction was observed in specific IgG antibodies, suggesting that tonsils participate in local IgG response to oral antigens. Total IgM levels also decreased (P< 0.006), which may to some extent reflect reduced antigenic stimuli compared to preoperative status with frequent tonsillitis. Saliva-derived nonimmunoglobulin host defense factors, except lactoferrin, which declined significantly, remained normal throughout the study period. Our study indicates that tonsils play a role in local oral IgG-mediated immune response but tonsillectomy does not seem to lead to any significant long-term impairment of salivary defense capacity.


Asunto(s)
Antibacterianos/análisis , Inmunoglobulinas/análisis , Saliva/inmunología , Saliva/microbiología , Tonsilectomía , Adolescente , Adulto , Aglutininas/análisis , Anticuerpos Antibacterianos/análisis , Femenino , Humanos , Estudios Longitudinales , Masculino , Muramidasa/análisis , Peroxidasa/análisis , Periodo Posoperatorio , Saliva/enzimología , Streptococcus mutans/inmunología , Tiocianatos/análisis
19.
Scand J Infect Dis ; 28(1): 41-6, 1996.
Artículo en Inglés | MEDLINE | ID: mdl-9122632

RESUMEN

A total of 94 adult patients with bacteraemic pneumococcal disease were retrospectively analyzed for the factors associated with a fatal outcome. Included there were 61 males and 33 females with a mean age of 54.1 =/- 17.7 years. Of all patients, 28 (29.8%) were previously healthy, 66 (70.2%) had at least one chronic underlying disease and 29 (30.9%) were classified as alcohol abusers. The total case-fatality rate was 34%, which is higher than in the other recent Scandinavian studies. The disease was fulminant in 13 patients who died within 24 hours of admission. The mortality was significantly higher among those patients who had underlying diseases than among those who were previously healthy (p = 0.03). In addition, unfavourable prognosis was associated with septic shock on arrival (p = 0.03) respiratory insufficiency requiring mechanical ventilation (p < 0.05) and nosocomial infection (p = 0.03). The patients who succumbed were significantly older that those who survived (p < 0.01). Moreover, the absence of leucocytosis, thrombocytopenia and elevated serum creatinine levels predicted an unfavourable outcome. Contradictory to some previous reports, increased mortality was associated neither with the male sex, alcohol abuse nor the focus of infection. The continuously high mortality and rapid lethality of bacteraemic pneumococcal disease underscore the importance of following the present recommendations on the use of pneumococcal vaccine in high-risk patients.


Asunto(s)
Bacteriemia/mortalidad , Infecciones Neumocócicas/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bacteriemia/tratamiento farmacológico , Femenino , Hospitales de Enseñanza , Humanos , Masculino , Persona de Mediana Edad , Infecciones Neumocócicas/tratamiento farmacológico , Pronóstico
20.
J Med Virol ; 47(4): 416-20, 1995 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-8636712

RESUMEN

The humoral immune response of 18 army recruits with febrile upper respiratory infection (URI) was studied by enumerating virus-specific, antibody-secreting cells in the peripheral blood. Diagnosis was based on viral antigen detection in nasopharyngeal specimens, virus isolation from throat swabs, or on antibody measurement from paired serum samples. At the time of the sample collection, three viruses, including adenovirus, influenza A, and influenza B, were found mainly to cause URIs among the recruits, and ELISPOT assay for enumeration of the specific antibody-secreting cells was selected for these viruses. Of the 36 patients with febrile URI studied, viral diagnosis was made in 18 cases, which included 11 patients with adenovirus infection, three with influenza A, and four with influenza B. The first blood sample was collected at the first signs of URI and the second and third samples at 2-week intervals. The adenovirus-positive patients developed a strong IgG class antibody-secreting cell response against the homologous virus, which peaked at the first sample and decreased steeply by the second and third samples. In the influenza A and B patients, the response was similar kinetically to that seen in adenovirus-positive patients. In those cases where also IgA and IgM class antibody-secreting cells were determined, the IgG response dominated. The ELISPOT method has potential also as a diagnostic tool for respiratory infections.


Asunto(s)
Infecciones por Adenovirus Humanos/inmunología , Adenovirus Humanos/inmunología , Anticuerpos Antivirales/inmunología , Virus de la Influenza A/inmunología , Virus de la Influenza B/inmunología , Gripe Humana/inmunología , Infecciones del Sistema Respiratorio/inmunología , Infecciones por Adenovirus Humanos/sangre , Infecciones por Adenovirus Humanos/virología , Anticuerpos Antivirales/sangre , Humanos , Inmunoglobulina A/sangre , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Gripe Humana/sangre , Gripe Humana/virología , Nasofaringe/patología , Nasofaringe/virología , Infecciones del Sistema Respiratorio/sangre , Infecciones del Sistema Respiratorio/virología
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