The results of cultures from bronchial lavage (BL) were compared with those obtained with a telescoping protected brush catheter (PBC) in 56 nonselected patients presenting with a pulmonary infiltrate of unknown etiology. At the time of bronchoscopy, 34 patients were under antibiotics. In 20 cases, the cultures from PBC and/or BL were positive. On the basis of quantitative bacteriological analysis and medical chart review, we conclude that PBC is more sensitive and more specific than BL for the diagnosis of clinically significant infections of the lower respiratory tract.

Adult↗

PubMed1985

[Prevalence of infectious diseases at the Vaud University Hospital Center].

The prevalence of infectious diseases at our hospital (Centre hospitalier universitaire vaudois, Lausanne [CHUV], 900 beds) was studied retrospectively over a two years period (1980-1981). The medical diagnosis of 30203 patients recorded in the computerized medical archives, representing 93% of the patients admitted during the period of observation, was reviewed. To assess the reliability of the computerized data, quality control was carried out through detailed analysis of all the histologically proven appendicitis recorded during 1981. 88% of the histologically proven appendicitis were registered in the computer and the diagnosis was specific in 87% of cases. An infectious disease was the primary reason for admission in 12.8% of the patients (3873) during the study period. Altogether, 20.2% of patients presented with an infection during their hospital stay. Because of the retrospective nature of the study it was not possible to determine whether these additional infections were nosocomially acquired. The organ systems most frequently infected were the respiratory tract (28.5% of all infections), the digestive tract (20.5%), the skin and osteoarticular system (16%) and the urogenital tract (11.6%). An infection was the primary reason for admission of 40.2% of the patients hospitalized in the dermatology service, of 19.7% of patients admitted in internal medicine, of 15-17% of the patients admitted in pediatrics, ENT and general surgery, and of 1-2% of the patients admitted in neurosurgery and radiotherapy. These observations highlight the continuing importance of infectious diseases in a modern hospital, in spite of high socio-economic levels, stringent hygiene and epidemiologic measures, and modern antibiotic availability.

Appendicitis↗

PubMed1985

[Community-acquired pneumonias: importance of pneumococcal pathology].

The frequency and the various etiologies of community acquired pneumonia are not well established. In adults, it is believed that half of the cases are caused by viruses and Mycoplasma pneumoniae. The pneumonia in these patients is limited and treated on an ambulatory basis. In patients who need to be hospitalized, the main etiology of pneumonia is S. pneumoniae. Despite effective antibiotic treatment, pneumococcal pneumonia still remains a life-threatening infection, especially in bacteremic patients presenting with underlying predisposing factors such as renal insufficiency, liver cirrhosis, and age over 70. In order to prevent the morbidity and mortality due to pneumococcal pneumonia, vaccination of the high-risk population on a larger scale than at present should be considered.

Adult↗

PubMed1985

[Epidemic listeriosis. Report of 25 cases in 15 months at the Vaud University Hospital Center].

25 cases (14 adults, 11 neonates) of Listeria monocytogenes infection were observed during a 15-month period (1983/1984) at the University Medical Center (CHUV) in Lausanne (Switzerland), in contrast to a mean of only 3 cases per year during the period 1974-1982. Eleven of 14 adults had neuromeningeal disease (3 meningitis, 7 meningoencephalitis, 1 encephalitis), and 3 patients had septicemia, two of whom were pregnant women. Among 8 adults with CNS parenchymal infection, 6 had involvement of the brainstem (rhombencephalitis), none of whom had an underlying disease characteristically predisposing to L. monocytogenes infection. Prominent clinical features in all patients with neuromeningeal disease included altered consciousness, headache and fever, and in 7 out of 8 patients with parenchymal CNS involvement an influenza-like illness was present prior to the development of neurological symptoms. Among the neuromeningeal cases the mortality rate was 45% (5 of 11), and 4 out of 6 survivors had severe neurological sequelae. During this 15-month period L. monocytogenes had become the leading cause of adult bacterial meningitis in this hospital. This is the first report on epidemic listeriosis in Switzerland, although sporadic cases have been described for 20 years. In contrast to previous years, analysis of the seasonal variation of the cases shows a peak of L. monocytogenes infections during the winter months of 1983/84. The high incidence of human listeriosis was not associated with an increase in animal cases. The human cases were uniformly distributed over the area, apparently in relation to population density.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1985

Evaluation of the Cobasbact system for rapid antimicrobial susceptibility testing of positive blood culture broths.

The automated Cobasbact system was adapted for direct antimicrobial susceptibility testing of positive blood culture broths and its performance compared with that of the conventional Kirby-Bauer agar disc diffusion method using 278 positive blood samples. Overall, 1746 antibiotic-organism combinations were tested. Full agreement was 86.9% and essential agreement (i.e. including minor discrepancies) was 91.8%. The system would seem to produce acceptable susceptibility results within five hours after detection of a positive blood culture broth.

Anti-Bacterial Agents↗

PubMed1985

Assessment of burn wound sepsis.

Biopsies are useful for monitoring wound infection. Not only does this method have a diagnostic value, but it also helps to evaluate the effectiveness of local and systemic wound treatment, to determine the appropriate time of skin autografting and finally to assess the chance of survival.

Bacteria↗

PubMed1985

Three-year caries increments after fluoride rinses or topical applications with a fluoride varnish.

251 9-12-yr-old children completed a 3-yr, double-blind, clinical trial of two caries preventive fluoride programs. Caries increments and progression patterns were compared in two groups of children who rinsed every fortnight with a 0.2% NaF solution or received biannual topical applications with a fluoride varnish (Fluor-Protector). Clinically recorded mean DFS increments were 3.3 +/- 0.2 (SE) in the rinse group and 3.5 +/- 0.2 in the varnish group. In both groups nearly half of these increments were recorded in the occlusal surfaces of second molars. The mean incremental DFS recorded radiographically on approximal surfaces of posterior teeth were 1.1 +/- 0.2 and 1.5 +/- 0.2 in the rinse and varnish group, respectively. None of the inter-group differences were statistically significant (P greater than 0.05). Detailed analyses of the radiographic scores revealed a similar and extremely slow caries progression in the two study groups and they strengthened the conclusion of equal clinical efficacy of the two treatments. None of the fluoride programs had been able to change preestablished patterns of caries development among the children.

Child↗

PubMed1984

[Brucellosis: a varied clinical presentation in 9 patients].

From 1973 to 1983 nine cases of Brucella melitensis infection were hospitalised at the Centre hospitalier universitaire vaudois (CHUV), Lausanne. In each case, the infection was acquired in a Mediterranean country (4 cases in Italy, 2 in Spain, 2 in Portugal and 1 in Greece). In 6 of the cases the disease was acquired by ingestion of dairy products and in 2 cases by direct animal contact. Despite classical initial symptomatology (fever, rigors, weakness), the time from first symptoms to diagnosis varied between 10 days and 5 months. This delay probably explains why 6 of 9 patients were admitted because of septic complications: orchi-epididymitis, arthritis, meningitis and endocarditis. With prolonged antibiotherapy, the evolution was favourable in all cases. The patient who presented with endocarditis required emergency aortic valve replacement. Culture of the valve showed the presence of 10(9) B. melitensis/g of tissue. Cure was achieved by the administration of streptomycin and tetracycline for 6 weeks, followed by cotrimoxazole for one year. These cases show that the diagnosis of Brucella infection is becoming rare in Switzerland. It is often not suspected, and prompt diagnosis is delayed until further complications occur. Serology and blood cultures should be done in every patient presenting with fever after a stay in endemic countries.

Adult↗

PubMed1984

Effect of bacterial immunization on experimental reflux nephropathy.

This study was designed to test the hypothesis that young animals with vesicoureteral reflux might be more vulnerable to renal parenchymal infection by bacteria to which they had not been previously exposed. Forty-four crossbred male piglets had surgical induction of vesicoureteral reflux at 2 weeks of age and introduction of urinary tract infection at 6 weeks. They were sacrificed at 12 weeks of age. Between the ages of 2 and 6 weeks, 22 piglets received subcutaneous injections of formalin-killed Escherichia coli in incomplete Freund's adjuvant as described. The remaining 22 piglets received incomplete Freund's adjuvant and vehicle alone. The antibody responses to antigenic challenge were weak to moderate. Immunized animals tended to have less renal scarring and better renal tubular uptake of dimercaptosuccinic acid, in addition to significantly lower serum creatinine values (p less than 0.001) and less mesangial cell proliferation in glomeruli (p = 0.05). We conclude that previous exposure to a specific bacterial strain and bacterial immunization have at least a mild protective effect on the development of reflux nephropathy.

Animals↗

PubMed1984

Clinical evaluation of the lysis-centrifugation blood culture system for the detection of fungemia and comparison with a conventional biphasic broth blood culture system.

In a comparative fungal blood culture study, a lysis-centrifugation system (Isolator; Du Pont Co., Wilmington, Del.) detected 89% of all episodes of fungemia; the lysis-centrifugation system detected fungemia exclusively or significantly earlier than did a biphasic brain heart infusion bottle system 83% of the time. The lysis-centrifugation system was particularly useful in the early detection of fungemia caused by Candida tropicalis and Candida glabrata. In 53% of the clinically significant episodes, the earlier detection was directly helpful in the management of patients with fungemia. High-magnitude candidemia (greater than 5 CFU/ml of blood) was significantly associated with the presence of an infected intravascular catheter and with Candida species other than Candida albicans. The lysis-centrifugation system was sensitive in the detection of fungemia during the monitoring of patients receiving antifungal agents or after removal of an infected intravascular catheter.

Candidiasis↗

PubMed1983

Retrospective comparison of three blood culture media for the recovery of yeasts from clinical specimens.

In a retrospective fashion, two different blood culture bottles with biphasic brain heat infusion media, one permanently and the other transiently vented, were compared to a transiently vented tryptic soy broth blood culture bottle for the recovery of yeasts from blood. A total of 95 isolates of Candida species and 19 isolates of Cryptococcus neoformans were recovered, of which 95% were from the permanently vented biphasic medium bottle incubated at 30 degrees C, 57% were from the transiently vented biphasic medium bottle incubated at 35 degrees C, and 45% were from the transiently vented tryptic soy broth bottle incubated at 35 degrees C. In 81% of the patients with candidemia, yeasts were detected either only (50%) or earlier (31%) in the permanently vented biphasic blood culture bottle. The mean recovery time was shorter in both biphasic media compared to the tryptic soy broth bottle. Cryptococcus neoformans was not recovered from the transiently vented broth, and less than 50% of the isolates of Candida glabrata and Cryptococcus neoformans grew in the transiently vented biphasic bottle. The results suggest that when fungemia is suspected, the use of a permanently vented biphasic bottle incubated at 30 degrees C will increase the recovery rate of yeasts from blood and that the transiently vented biphasic bottle and tryptic soy broth bottle are less satisfactory for this purpose.

Candida↗

PubMed1983

Identification of human oculomotor system for quantitative diagnostics of eye muscle diseases.

Various discrete parameter estimation methods are explained and applied to the eye muscle model of Collins. Their effectiveness and accuracy are studied. Comparing saccadic eye movements to the motions of a fixation target data for parameter estimation are provided. As a first application, saccades of a subject with a Duane-Syndrome are evaluated.

Adult↗

PubMed1983

Biological dosimetry by chromosome aberration scoring with parallel image processing with the Heidelberg POLYP Polyprocessor system.

Chromosome aberrations in human peripheral blood are recognized parameters of cellular damage and are used as indicators of exposure to ionizing radiation. In order to reach the low dose range, up to 10,000 metaphase cells each consisting of 46 chromosomes have to be analysed for each radiation exposed person. In order to perform this task within reasonable time limits the application of the Heidelberg POLYP Polyprocessor is considered. The POLYP consists of a number of processor modules and several global memory modules which are interconnected by a multi-common-bus for parallel data transfers and a multiple synchronization bus for processor/task-scheduling. The system is designed for handling large amounts of data in real time as is typical for image processing applications.

Chromosome Aberrations↗

PubMed1983

Effect of indomethacin on the incidence of experimental Escherichia coli pyelonephritis.

In the presence of temporary obstruction (20 h), ascending Escherichia coli urinary infection leads to irreversible acute exudative pyelonephritis (AEP) in rats. The purpose of the present study was to investigate the early inflammatory events which take place in response to the presence of bacteria in the kidney parenchyma and lead to the development of AEP. Rats were given indomethacin before and during the obstructive phase of kidney infection and were sacrificed at different times thereafter. Although renal infection (as defined by bacterial counts) was equally frequent (76%) and severe in indomethacin-treated and control rats sacrificed at the end of the obstructive period, it was found that the incidence of AEP (as defined by the inflammatory response of the kidney elicited by bacteria) 2 days after removal of the obstruction was significantly reduced from 74% in controls given water to 48% in indomethacin-treated animals (P = 0.02). Rat kidneys without AEP had bacterial counts of 10(2)/g. Since indomethacin apparently had no direct antibacterial activity against E. coli and no effect on urine osmolalities, it is likely that the reduction in the incidence of AEP and the concomitant eradication of bacteria after removal of the obstruction was due to an effect of indomethacin that is related to the renal response to infection. This was possibly due to decreased inflammation, as indicated by the fact that when pyelonephritis developed in indomethacin-treated rats it was less severe than in controls. These results suggest that if inflammation can be mitigated when bacteria are present in the kidney during obstruction, the bacteria may be cleared spontaneously once the normal urinary flow is restored.

Animals↗