Staphylococcus aureus bacteraemia in children below the age of one year. A review of 407 cases.

The bacteriology, epidemiology, infection types and mortality were reviewed in 407 cases of Staphylococcus aureus bacteraemia in the period 1967-1984 in children less than one year old. The number of bacteraemia cases in this age group increased in the seventies, but only 4% of the bacteraemias seemed to be due to epidemic spreading. Neonates might be at higher risk for S. aureus bacteraemia than older children less than one year old, and nearly all infections in the neonatal period were hospital-acquired. The mortality was 24%, and did not correlate with type of infection, but in neonates it correlated with low birthweight.

Borrelia meningitis in Denmark.

We studied 23 patients with borrelia meningitis, a tick-borne spirochetosis increasingly recognized in Denmark. The disease showed a seasonal incidence from June to December. Twenty one patients experienced a painful sensory radiculitis, in 17 cases followed by a predominantly cranial mononeuritis multiplex mainly affecting the facial nerve (Bannwarth's syndrome). Three patients had focal CNS involvement in the form of a transverse myelitis, a focal encephalitis and a disseminated leucoencephalopathy, respectively. The CSF showed invariably lymphocytic pleocytosis and elevated spinal protein concentration. Measuring borrelia antibodies in the CSF seemed of higher diagnostic sensitivity than in serum. Penicillin therapy was effective even in cases with focal CNS lesions.

Staphylococcus aureus bacteremia in patients with hematological malignancies and/or agranulocytosis.

A total of 6,253 cases of Staphylococcus aureus bacteremia, including 274 (4.4%) endocarditis cases, were registered in Denmark in the period 1975-1984. Patients with hematological malignancies and/or agranulocytosis accounted for 479 of the bacteremia cases. The incidence of endocarditis in this group of patients was only 0.4% as compared to 4.7% in other patients with staphylococcal bacteremia (p less than 0.01). The lower incidence of endocarditis complicating bacteremia in these patients may justify a shorter course of therapy than usually recommended for suspected endocarditis. Patients with hematological malignancies and other patients with agranulocytosis had a higher mortality (49 and 46%, respectively) than other patients with S. aureus bacteremia (33%). The highest mortality was found in patients with multiple myeloma (71%, p less than 0.01), the lowest in patients with acute lymphocytic leukemia (28%, p less than 0.01). The higher mortality in these patients may indicate that empiric antibiotic regimens in granulocytopenic patients should include a specific anti-staphylococcal agent.

875 cases of bacterial meningitis: diagnostic procedures and the impact of preadmission antibiotic therapy. Part III of a three-part series.

Data on the bacteriological findings, diagnostic measures and clinical course of 875 patients with bacterial meningitis are presented. Findings from the medical records and from a follow-up questionnaire survey of 667 of these cases revealed no significant difference between patients treated with antibiotics before admission (pretreated) and those who were not treated before admission (non-pretreated) with respect to clinical condition on admission, mortality and late sequelae. Pretreatment was, however, associated with a longer duration of symptoms. Apart from cases due to Neisseria meningitidis, there were no significant differences in diagnostic findings between pretreated and non-pretreated cases. In the group of pretreated meningococcal patients, however, positive blood cultures, pleiocytosis in the cerebrospinal fluid (CSF) and positive cultures from sites other than blood and CSF were less frequent than in the non-pretreated cases.

Sequelae from bacterial meningitis and their relation to the clinical condition during acute illness, based on 667 questionnaire returns. Part II of a three part series.

During the years 1966-1976, 875 patients with bacterial meningitis were treated at the Department of Infectious Diseases, Rigshospitalet, Denmark. In late 1979 and early 1980 a survey by questionnaire was conducted among survivors concerning the impact of the disease. Replies were received from 667 patients (96.4 per cent). The most common complaints after meningitis were headache (32 per cent) inability to concentrate (31 per cent), altered working capability (33 per cent) and loss of memory (24 per cent). Approximately 20 per cent suffered from impaired hearing, visual disturbances and dizziness. Five per cent had convulsions. Each questionnaire was evaluated for sequelae, and when present these were rated as mild, medium or severe. One-third of the patients had sequelae and in 6 per cent these were severe. Sequelae were most commonly associated with drowsiness, coma, agitation and confusion on admission to hospital.

Eight hundred and seventy-five cases of bacterial meningitis. Part I of a three-part series: clinical data, prognosis, and the role of specialised hospital departments.

Between 1966 and 1976, 875 patients with bacterial meningitis were treated at the Department of Infectious Diseases, Rigshospitalet. Among 495 patients admitted directly to the department, fatality rates were 0.4 per cent for meningococcal infections (including septicaemia), 3.7 per cent for haemophilus meningitis and 8.7 per cent for pneumococcal meningitis. The total fatality rate for directly admitted patients was 3.8 per cent, and 4.0 per cent had sequelae on discharge. Patients transferred from other hospitals often had complications, and their fatality rate (20.1 per cent) was markedly higher than that for directly admitted patients, but not significantly higher than that for patients treated elsewhere in Denmark (17.6 per cent). The low fatality at a specialised unit may reflect an open and swift admission procedure and the preparedness of staff familiar with the management of meningitis. During the first five years after discharge, the relative death risk was increased among meningitis patients but later declined to that found in the general population.

Frequency, phage types and antibiotic resistance of Staphylococcus aureus isolated from blood cultures in Denmark 1975-1981.

In the period 1975-1981, 4060 cases of Staphylococcus aureus bacteremia were recorded in Denmark, and the corresponding strains were examined. The percentage of strains, resistant to penicillin only, rose to 82, and the percentage of multiply-resistant strains fell to five. Newer phage types (94, 96 and 95) increased from 10% to 27% of the material. These strains were usually resistant only to penicillin, but produced large amounts of penicillinase. The ample penicillinase production has also been characteristic for previous epidemic strains, and it is furthermore correlated to mortality. The overall mortality of 34.6% was lower than that of the preceding period. Mortality rates were highest in elderly patients, nosocomial cases, patients with serious primary diseases and endocarditis cases.

Staphylococcus aureus endocarditis in Denmark 1976-1981.

Clinical and bacteriological information on Staphylococcus aureus endocarditis from hospitals all over Denmark in the period 1976-1981 was reviewed in 119 cases, 61 females and 58 males. Patient ages ranged from 16 days to 85 years, with a median age of 63 years. The overall mortality was 71%. The mortality correlated significantly with such factors as age, hospital-acquired infections and resistance to penicillin in infecting strains. Hospital-acquired infections occurred in 38% of the patients. The distribution of phage types among strains isolated from blood cultures from patients with endocarditis corresponded to that of strains from other septicaemia cases. Group I and group III strains and strains of the 94, 96 complex comprised 74% of the phage types of the present material. Infections of the skin were the most common portal of entry for the infecting strains. Apart from drug addicts, of which 11 cases were included, mortality did not correlate with the presence of any underlying diseases.

Lysine prophylaxis in recurrent herpes simplex labialis: a double-blind, controlled crossover study.

L-lysine has an inhibitory effect on the multiplication of herpes simplex virus in cell cultures. We have evaluated the prophylactic effect of L-lysine monohydrochloride 1000 mg daily on recurrent herpes simplex labialis in 65 patients in a double-blind, placebo-controlled, crossover study. After 12 weeks of lysine treatment the patients shifted to placebo treatment for a similar period. On the whole, lysine prophylaxis had no effect on the recurrence rate of herpes simplex. However, significantly more patients were recurrence-free during lysine than during placebo treatment (p = 0.05), suggesting that certain patients may benefit from prophylactic lysine administration. In the herpes lesions described, lysine had no effect on the rate of healing or on the appearance of the lesions at their worst.

Mycoplasma pneumoniae infection associated with affection of the central nervous system.

A total of 371 patients with acute, febrile, non-bacterial affection of the CNS hospitalized between Nov. 1, 1971, and June 1, 1976, were examined for Mycoplasma (M.) pneumoniae infection. Nineteen of the patients showed evidence of a current M. pneumoniae infection, 32 of a previous infection, and 320 no evidence. In patients with a current infection due to M. pneumoniae, suggestive evidence is presented that this agent might be involved in the pathogenesis of the neurological syndromes. Compared to cases without the infection, these cases and, to a lesser degree, those with a previous M. pneumoniae infection showed an increased frequency of pathological values, found by various laboratory and instrumental parameters, and a slightly higher frequency of neurological sequelae. Respiratory illness was present in only 11 of the 19 patients infected with M. pneumoniae, a classical respiratory tract pathogen. The overall incidence of current M. pneumoniae infections among patients with neurological syndromes was 5%, with a maximum of 10% during the 1972 epidemic. This is a much higher figure than expected from a mere coincidence of the two conditions.

Antibiotic policy and spread of Staphylococcus aureus strains in Danish hospitals, 1969-1974.

In the period 1969-1974 a decreasing number of Danish hospital departments recorded epidemic occurrences of Staphylococcus aureus strains, and the local spread of strains was less extensive. Multiple-resistant strains of the 83 A complex were succeeded by type 94 strains, resistant to penicillin only. The level of methicillin resistance fell from 19 to 6%. 12% of methicillin resistant strains are now sensitive to streptomycin and/or tetracyclines; they do not represent a few clones, but belong to a wide spectrum of phage types. The changes follow a reduction in the consumption of streptomycin and tetracyclines not of methicillin or other penicillins. As a contrast to the general reduction of combined resistance to streptomycin and tetracyclines, the strains in dermatological departments, where tetracyclines are commonly used, maintain a high degree of resistance to tetracyclines alone.