Biomedical subjects
J Luotonen
Publications and source records attributed to J Luotonen.
Tularemia in otolaryngologic practice. An analysis of 127 cases.
Ulceroglandular, glandular, and oropharyngeal forms of tularemia may occur in otolaryngologic patients, frequently causing diagnostic difficulties. A retrospective analysis of 127 patients with serologically proved tularemia in the head and neck region is presented with special reference to diagnostic difficulties. Short case reports of six patients are included. Difficulties seemed to appear especially in the diagnosis of glandular tularemia. Oropharyngeal tularemia is easily confused with infectious mononucleosis. A high degree of suspicion of tularemia is recommended in endemic areas.
Intracranial penetration of a nail from nailing gun through cheek and infratemporal fossa (a case report).
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Localisation of a CSF fistula by metrizamide CT cisternography.
Localisation of a cerebrospinal fluid fistula in the nasal region is difficult. Lack of a suitable roentgen contrast medium for intrathecal use has earlier restricted the utility of cisternography. Metrizamide cisternography and CT have recently proved to be well tolerated and effective in revealing CSF fistulae. A case report of operatively treated CSF rhinorrhea recurring after three years is presented. With the help of CT metrizamide cisternography, the fistula could finally be localised in the sphenoidal sinus. The re-operation confirmed this finding. The technique of cisternography is described.
Pneumococcal bacteriology after pneumococcal otitis media with special reference to pneumococcal antigens.
Fifty-four ears with evidence of pneumococcus (Pn) in the first acute otitis media (AOM) in 38 infants and with prolongation or recurrence of the MEF during the follow-up were observed for 7-22 months for the presence of Pn by culture or of pneumococcal antigen (Pn-ag) by counterimmunoelectrophoresis or latex agglutination methods in their MEFs. During the first three 1-month observation periods, Pn and/or Pn-ags were detected in 24% to 9% of these ears, always of the initial type/group. Later on new Pn types/groups appeared also. In two of the 9 MEFs persisting for greater than or equal to 3 months, initial Pn-ag, with culturable Pn, was repeatedly found but not for longer than 5 months. Of the 12 ears resulting in secretory otitis media (SOM) only one showed initial Pn-ag (and Pn) in the MEF of SOM. Pneumococcal type/group pattern associated with prolongation or recurrence of infection did not differ from that of initial AOM. In another series of 151 SOM ears in 97 children, Pn-ags were detected in 7 MEFs. Four of them grew Pn, each of the corresponding group. Our studies suggest that the persistence of Pn-ags in the middle ear after AOM is limited and their occurrence in the MEFs of SOM is rare. Thus, the role of the persistence of Pn-ags in prolonged, recurrent or secretory otitis media seems questionable.
Pneumococcal antigens in otitis media.
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Secretory IgA, secretory component and pathogen specific antibodies in the middle ear effusion during an attack of acute and secretory otitis media.
The total concentration of secretory IgA (SIgA) and secretory component (SC) as well as the occurrence of pathogen specific serum type (IgG, IgA and IgM) and secretory type antibodies against Streptococcus pneumoniae and Haemophilus influenzae in the middle ear effusion during an attack of otitis media were studied by using the ELISA method. The middle ear effusion samples were taken at 2 to 4 weeks' intervals from patients with recurrent acute otitis media (RAOM) or secretory otitis media (SOM). In the samples of the RAOM patients the SC/SIgA ratio was 2.2, while in the SOM samples the ratio was 13.6. Both serum and secretory type antibodies to the infecting bacteria could be detected in the middle ear effusions in both of the patient groups. The results of this study show that the middle ear can develop antigenic specific antibodies against the infecting bacteria. The increased production of SC seems to be related to the pathogenesis of SOM.
[Localization of a spontaneous cerebrospinal fluid fistula using metrizamide CT cisternography].
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Streptococcus pneumoniae and Haemophilus influenzae in nasal cultures during acute otitis media.
Middle ear fluid (MEF) aspirates and nasal swabs of children with acute otitis media (N = 255, age 2-6 yrs) were cultured by standard bacteriological methods. In addition, counterimmunoelectrophoresis and latex agglutination were applied to detect pneumococcal polysaccharide antigens (Pn-ag) in MEF. When the nasal culture grew Streptococcus pneumoniae (Pn), Pn was also present in 49% (73/148) and Pn-ag in 64% of the MEF cultures. If Haemophilus influenzae (Hi) appeared in the nasal culture. Hi was present in 41% (25/61) of the MEFs. There was a negative correlation between the growth of Pn or Hi in the nasal culture and the presence of other bacteria in the MEF. However, in spite of these correlations the nasal culture was concluded not to be useful in predicting the MEF bacteria.
Equipment for aspirating middle ear fluid samples.
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Preliminary serologic evidence for a pathogenic role of Branhamella catarrhalis.
Branhamella catarrhalis has been suspected, on the basis of bacteriologic culture results, to have a pathogenic role in 6%-9% of cases of acute otitis media as well as in other upper respiratory tract infections. Serologic evidence of this role was obtained with use of an enzyme immunoassay to detect antibodies to B. catarrhalis. The presence of both IgG and IgA antibodies to Branhamella in the serum and/or middle ear fluid (MEF) of children with acute otitis media correlated with the isolation of B. catarrhalis from cultures of their MEF. An increase in titer of antibodies to Branhamella between acute-phase and convalescent-phase serum samples was found in 10 of the 19 children with otitis media from whom B. catarrhalis but no other pathogen was isolated from the MEF. Such an increase was found in none of the 14 children with otitis media caused by other organisms.
The bacteriology of acute otitis media in children with special reference to Streptococcus pneumoniae as studied by bacteriological and antigen detection methods.
The middle ear fluid (MEF) was studied during an acute attack of otitis media in 519 children, aged 3 months to 6 years. Streptococcus pneumoniae (Pn) was cultured from 39% of the cases; serotypes 19, 6, 3 and 23 were the most common. Haemophilus influenzae (Hi) was cultured in 12%; only 2/64 strains were of type b. Pn were found equally often in all age groups, but Hi were significantly less often isolated in children older than 3 years. The number of negative cultures increased with the age of the child. Pneumococcal capsular polysaccharide was detected with counterimmunoelectrophoresis and/or latex agglutination in 83% of the MEFs from which Pn were cultured, but also in about one third of the MEFs from which no bacteria could be grown. Altogether, with these methods combined Pn were implicated in nearly 60% of the cases of acute otitis media. Gram staining showed polymorphonuclear leucocytes in 85% of pneumococcal otitis cases that were verified by culture but also in 72% of the cases from which no bacteria could be cultured, supporting the contention that also these latter are usually caused by bacteria.
Pneumococcal vaccine and otitis media.
After an acute attack of otitis media 827 children aged 3 months to 6 years were assigned randomly to receive either 14-valent pneumococcal polysaccharide vaccine or a control vaccine (Haemophilus influenzae type b capsular polysaccharide). In children older than 6 months serum antibody responses to most of the vaccine polysaccharides were satisfactory. The response to type 6A was poor. Correspondingly, no clinical protection was seen below 6 months of age or against otitis media caused by group 6 pneumococci. Among the children more than 6 months old, the first 6 months after vaccination saw significantly (p < 0.001) fewer attacks caused by the pneumococal types represented in the vaccine (group 6 excepted) in those who received the pneumococcal vaccine than in those who received the control vaccine. Protection against type 19F was statistically significant (p < 0.01). The overall protective efficacy was 58%--somewhat better in children older than 2 years than in those younger. Previous attacks of otitis caused by pneumococci did not influence the protective efficacy of the vaccine.
The effect of polyvalent pneumococcal polysaccharide vaccine on nasopharyngeal and nasal carriage of Streptococcus pneumoniae.
To investigate the possible effect of a polyvalent pneumococcal vaccine on the nasopharyngeal and nasal carriage of Streptococcus pneumoniae, we studied 313 children under 8 years of age who had received either 14-valent pneumococcal capsular polysaccharide vaccine (Pn) or Haemophilus influenzae type b capsular polysaccharide vaccine (Hib) after having recovered from acute otitis media. Nasopharyngeal and nasal swabs were obtained during a symptomless phase, 6 to 12 months after the vaccination, and cultured by routine bacteriological methods. All S. pneumoniae strains were serotyped and among H. influenzae strains, type b was identified. In the group that had received the Pn vaccine, the carriage rate of S. pneumoniae types present in the vaccine (type 6 excluded) was 20%, somewhat but not significantly lower than the 30% carriage in the group having received the Hib vaccine. Conversely, the carriage rate of H. influenzae was slightly higher in the Pn (26%) than in the Hib (19%) vaccine group. 14% of the H. influenzae strains were of type b, and this proportion was the same in both vaccine groups. There were no differences between the two vaccination groups in the carriage rates of other S. pneumoniae types or of Staphylococcus aureus or of group A hemolytic streptococci. S. pneumoniae was more often cultured from nasopharyngeal than nasal swabs, especially in children over 6 years, whereas the total carriage rates of S. pneumoniae and H. influenzae were largely unaffected by age.
Bacteria in chronic maxillary sinusitis.
Sixty-one chronically inflamed maxillary sinuses produced 131 bacterial strains from mucosal pieces that were taken during a Caldwell-Luc operation and cultured aerobically and anaerobically. Sinus secretions showed only 62 and nasal secretions 106 bacterial strains. Fourteen mucosal strains, including 11 Haemophilus influenzae, grew heavily. None of 24 mucosal anaerobes showed heavy growth. Of 52 antral mucosae with culturable bacteria, 37 disclosed mixed and 15 pure growth. The bacteriological characteristics of the diseased sinus and the nose did not correlate. The duration or extent of the disease, the macroscopic appearance of the diseased sinus, or the presence or absence of allergy were unrelated to bacteriological findings, except that H influenzae was concentrated in purulent sinuses. Intraoperative culture of antral mucosa seems to give the most reliable picture of the bacteriological condition in chronic maxillary sinusitis.
Serum antibody response to pneumococcal otitis media.
Total and immunoglobulin class-specific antibody responses to the infecting pneumococcal serotype/group in sera of 114 children, 3 months to 7 years old, who had acute pneumococcal otitis media, were measured by radioimmunoassay and enzyme-linked immunosorbent assay. Of these children 36% showed a twofold or greater increase of antibodies as a response to their infection, but the responsiveness varied from 17 to 83% among different pneumococcal types. The number and intensity of responses increased with the age of the children. In acute sera only IgG and IgM class antibodies were usually detectable. IgG and IgM class antibodies were regularly formed as a response to the infection. IgA class antibodies were frequently seen in the convalescent sera when the total antibody response was strong, and they were the first to start declining.
Antibody response to 14-valent pneumococcal capsular polysaccharide vaccine in pre-school age children.
Antibody responses to 14-valent pneumococcal capsular polysaccharide vaccine were measured by Farr-type radioimmunoassay in children younger than 7 years of age. On the basis of immunogenicity in young children individual pneumococcal polysaccharides could be identified as uniformly good, strongly age-dependent or uniformly poor immunogens. Pneumococcal types 6A and 23F, which frequently cause pneumococcal infections in small children, were the poorest immunogens in this age group. The children younger than 2 years of age responded very poorly also to types 19F and 18C whereas older children had good antibody responses to these types. The results support the current view that present pneumococcal polysaccharide vaccines are not beneficial in children younger than 2 years of age and stress the importance of attempts to improve their immunogenicity.
Efficacy of pneumococcal vaccination against recurrent otitis media. Preliminary results of a field trial in Finland.
For this study, 781 children, and 3 to 83 months, after presenting with acute otitis media, were immunized with either 14-valent pneumococcal or Haemophilus influenzae type b capsular polysaccharide vaccine. The vaccines were tolerated well. Antibody responses to the 14 pneumococcal polysaccharide types, measured by radioimmunoassay, were fair to good and increased with age, with the exception of types 1, 6 and 12 to which the responses were generally poor. During the follow-up of 1-17 months, average 13 months, 45 vaccine type (except type 6) pneumococcal recurrences were met among 456 pneumococcal-vaccinated and 45 among 288 H. influenzae-vaccinated children, at least six months old (P < .05). The corresponding protective efficacy by the pneumococcal vaccine was 37%, for the first six months, 51% (P < .01). No protection by the pneumococcal vaccine was seen against group 6 pneumococci, nor among 19 infants under six months of age. Nonvaccine type pneumococcal ad H. influenzae recurrences did not significantly concentrate in either of the vaccination groups. Thus, it seems that parenteral immunization of children can reduce the recurrence rate of otitis media caused by pneumococci of types (except type 6) present in the vaccine.