[Nursing with the swastika as guiding star. Nothing is black or white. Interview by Bjørn Arild Ostby].
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Germany↗
Biomedical subjects
K Melby
Publications and source records attributed to K Melby.
[Myocarditis and pericarditis in connection with Campylobacter jejuni infection].
We describe a case of myo/pericarditis related to infection with C. jejuni. The microbe was repeatedly isolated from faeces and the patient had specific IgA, IgM and IgG antibodies, detected in serum samples by means of a DIG-ELISA method. The condition is rare and the pathogenesis unclear. The case described may be the result of a primary infection or a reactive immune response.
Adult↗
Ophthalmia neonatorum in northern Norway. I: Epidemiology and risk factors.
During one year, 1928 of all 1958 neonates born in the county of Troms in Northern Norway were followed until 6 weeks of age, regarding the development of ophthalmia neonatorum. Conjunctivitis was found in 364 cases (189 per 1000 neonates), including mild and self-limiting cases. In 14.5 cases per 1000 neonates the ophthalmia neonatorum was recorded as severe. Boys were more often affected than girls (P = 0.001). The age of the mother and obstetric events did not significantly influence the occurrence of conjunctivitis. 31.4% of the neonates received silver nitrate instillation. The frequency of conjunctivitis in the group with and without prophylaxis was 15.9 and 20.3%, respectively (P = 0.023). The incidence of chlamydial ophthalmia was 8 per 1000 neonates. At present, chlamydial ophthalmia is a common disease in neonates. Efforts should be made to screen fertile women for chlamydial genital infection and to encourage prompt microbiological examination in cases of ophthalmia neonatorum.
Adolescent↗
Ophthalmia neonatorum in northern Norway. II. Microbiology with emphasis on Chlamydia trachomatis.
In a population of 1928 neonates in Northern Norway, ophthalmia neonatorum was diagnosed in 18.9%, including mild and self-limiting cases. Sixteen out of 269 (6.0%) cultured cases were positive for Chlamydia trachomatis. No gonococcal ophthalmia was seen. In neonates whose symptoms began in the maternity wards, the distribution of the isolated microorganisms (mainly Staphylococcus aureus) was different from those in whom symptoms began after discharge (mainly S. aureus, Staphylococcus species (coagulase-negative), Streptococcus viridans and C. trachomatis). Growth of C. trachomatis was significantly associated with the intensity of conjunctivitis (P less than 0.001). However, no sequelae could be demonstrated in the eyes at the age of 6 months. 60% of the neonates with chlamydial ophthalmia also suffered from rhinitis. 31.4% of the neonates received silver nitrate instillation, which had no significant influence on the frequency of chlamydial ophthalmia. General practitioners are often faced with chlamydial ophthalmia. In cases of ophthalmia neonatorum, a microbiological examination is recommended, as a guide to appropriate antibiotic treatment. The result of microbiological examination may also indicate other infections in mother and child. In areas with a readily available health service, including an adequate microbiological laboratory service, prophylaxis in the eyes does not seem to be necessary.
Adolescent↗
Fasting hypochlorhydria with gram positive gastric flora is highly prevalent in healthy old people.
Fifteen healthy old people mean age 84 years (range 80-91 years), were examined to assess the effect of advanced age on the microecology of the upper gastrointestinal tract. Twelve of 15 (80%) were hypochlorhydric with pH 6.6 (0.3) (mean (SEM) and a mean bacterial count of 10(8) colony forming units (CFU) per ml (range 10(5)-10(10)) in fasting gastric aspirate. Normochlorhydric subjects had low counts (< or = 10(1) CFU/ml). The microbial flora was dominated by viridans streptococci, coagulase negative staphylococci, and Haemophilus sp. Only one subject harboured significant concentrations of Gram negative bacilli with Escherichia coli (10(4-5) CFU/ml) and Klebsiella (10(4-5)). Strict anaerobes were not found. The total concentration of short chain fatty acids in gastric aspirate was 10.6 (2.9) mmol/l (mean (SEM). Absence of significant, intraluminal fermentation of xylose to CO2 was shown by the 14C-d Xylose breath test, and ambulatory manometry showed preserved fasting motility pattern of the small intestine. Serum immunoglobulins were normal. Advanced age is accompanied by fasting hypochlorhydria and colonisation with mainly Gram positive flora in the upper gut. Other factors than old age and fasting hypochlorhydria are required for colonisation with Gram negative bacilli.
Achlorhydria↗
[Epidemiologic outbreak of Campylobacter infection].
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Adolescent↗
[Should ulcer treatment be aimed against Helicobacter pylori?].
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Duodenal Ulcer↗
Waterborne campylobacteriosis in northern Norway.
A suspected waterborne outbreak of presumed campylobacteriosis involving approximately 680 of the 1000 inhabitants in a community is described. Twenty-two strains of Campylobacter jejuni were isolated from patients. Ten randomly chosen isolates were identified as biotype 1 LAU 0:1 (n = 9) and biotype 2 PEN 0:6, 7 (n = 1) and one from tap water as biotype 1 PEN 0:19, 22. The majority of cases occurred within a period of 1 week. Examination of human sera obtained during the first 2 weeks of the epidemic (n = 38) revealed two patients producing antibodies directed only against the water isolate. The majority (89%) of sera collected 4 weeks later (n = 18) had antibodies directed against the most common human isolate. We suggest that all three serotypes of C. jejuni were involved in this outbreak, stressing the need for continuous surveillance and treatment of public drinking water sources.
Antibodies, Bacterial↗
[Mastitis in general practice. Is bacteriologic examination useful?].
For a period of 22 months, postpartial women in Oslo were asked to consult one of several specific general practitioners in the event of mastitis. Clinical symptoms, bacteriological findings in breast milk and treatment were recorded in 43 patients. Patients with a favourable (n = 35) and with an unfavourable outcome (n = 8) defined as abscess, relapse and/or relief of symptoms after more than seven days, were compared. Unfavourable outcome was characterized by higher score of clinical symptoms and a higher isolation frequency of Staphylococcus aureus. The occurrence of fever did not differ between the groups. Bacteriological findings in milk from both breasts were compared with the findings from 100 milk donors. Staphylococcus aureus was more frequently isolated in milk from affected breasts than from unaffected and control breasts (17/40 versus 4/40 versus 4/100). Most of the Staphylococcus aureus strains (70%) were betalactamase producers. Coagulase negative staphylococci were a frequent finding in all milk samples, whereas Gram-negative bacteria were frequent only in the controls. The presence of pathogenic bacteria, as well as high bacterial counts, were associated with a higher number of symptoms. However, the predictive value of the bacteriological examination was low. Our study indicates that bacteriological examination of breast milk is justified only in patients with severe, acute symptoms and recurrences when betalactamase producing Staphylococcus aureus are suspected.
Family Practice↗
Clinical and serological manifestations in patients during a waterborne epidemic due to Campylobacter jejuni.
A clinical and serological investigation of an epidemic due to Campylobacter jejuni in a community with a population of 1026 is presented. Altogether, 22 faecal samples from 27 patients were positive, with serotypes O 2 (n = 21) and O 6, 7 (n = 1) being identified. Serotype O 19, 21 was isolated from drinking water which had been consumed by 89.5% households answering a questionnaire, thereby indicating an attack rate of 66.5% (i.e. 680 persons). Mean duration of illness was 6.5 +/- 4.6 days. Diarrhoea (82.3%), abdominal pains (62.8%) and fever (41.8%) were the most common symptoms. Acute stage samples of serum from Campylobacter-positive patients had lower concentrations of IgG antibodies against the most common serotype (O 2) than against serotype O 6, 7 (P = 0.05), which had previously been implicated in epidemics in the region. More than 80% samples drawn after 1-2 weeks of illness were positive for either IgA, IgM or IgG antibodies to serotype O 2 with a dominance of IgA. In the convalescent group (n = 24), serum from only one patient who developed a long-lasting reactive arthritis had antibodies to all serotypes.
Adolescent↗
Chlamydia trachomatis: in vitro susceptibility of genital and ocular isolates to some quinolones, amoxicillin and azithromycin.
The minimum inhibitory concentration (MIC) of ofloxacin, ciprofloxacin, norfloxacin, amoxicillin and a new erythromycin analogue (azithromycin or CP 62993) against Chlamydia trachomatis was determined. There was a large difference between the MICs (microgram/ml) of different quinolones (median of 3 independent measurements; range): ofloxacin (0.5; 0.5-1) less than ciprofloxacin (1; 1-2) less than norfloxacin (16; 16-32). The MIC of amoxicillin varied from 0.25 to 1 (median 0.5) in different experiments. The MIC of azithromycin (0.125; 0.063-0.25) was lower than that of erythromycin (0.25; 0.125-0.5). The minimum lethal concentration (MLC) of ofloxacin and azithromycin was determined with and without passage of the McCoy cells. Both methods gave the same results. Ofloxacin seemed to have a lethal effect on C. trachomatis, as the MIC and MLC were equal. In contrast, the effect of the MIC of azithromycin on C. trachomatis was bacteriostatic. The MLC of azithromycin was 2-4 times higher than the MIC (p less than 0.001).
Amoxicillin↗
How reliable are the 14C-urea breath test and specific serology for the detection of gastric Campylobacter?
Detection of gastric Campylobacter by the 14C-urea breath test and serology were correlated to biopsy culture in 25 unselected outpatients referred for gastroscopy. All the 17 culture-positive patients had positive 14C-urea breath test, and 16 had positive serology. Of eight culture-negative patients, six patients had negative breath test and seven negative serology. A high degree of reproducibility was found when two subsequent breath tests were performed in 11 healthy volunteers. The breath test values obtained at 10 min showed a strong correlation (r = 0.97, p less than 0.001) to the accumulated values within 30 min. Breath sampling once, 10 min after intake of 2.5 microCi 14C-urea, seems sufficient for the detection of gastric Campylobacter. The 14C-urea breath test correlates well with biopsy culture and provides a sensitive tool for the detection of gastric Campylobacter. Serology also corresponds well with biopsy culture and should provide a useful tool for epidemiologic studies.
Adult↗
Detection of serum antibodies against Borrelia burgdorferi with some commercially available serological tests.
Sixty-three sera were analysed for antibodies against Borrelia burgdorferi with an in-house indirect immunofluorescence assay. Thirty-nine sera were positive (titer greater than or equal to 256), seven borderline (titer 128) and 17 negative (titer less than or equal to 64). These results were compared with results obtained with four different commercial assays for detection of such antibodies. Indirect immunofluorescence tests yielded most positive results. The flagellin ELISA test detected antibodies in patients with erythema chronicum migrans (ECM) more often than the other test systems. Sera from patients with acrodermatitis chronica atrophicans (ACA) were positive in all systems. The serological diagnosis of borreliosis is difficult and direct methods for detecting the presence of the microbe are highly needed.
Antibodies, Bacterial↗
Cultivation of Chlamydia trachomatis. Different methods of treating the specimens.
Specimens of Chlamydia trachomatis were treated either by five different detergents, by ultrasound sonication or by four different buffers before cultivation in cycloheximide-treated McCoy cells. The chlamydial yield by cultivation and the variance of the yield were compared to a standard method using 0.2 molar sucrose in phosphate buffered saline (2SP) without application of detergents or sonication. 2SP was superior to the other buffers. None of the detergents increased the chlamydial yield. Sonication at energy-levels above approximately 1200 Ws/ml reduced the chlamydial yield significantly. Sonication just below this threshold doubled the yield. None of the methods reduced the variance of the yield.
Analysis of Variance↗
[Surgical treatment of necrotizing fasciitis].
We present nine patients with necrotizing fasciitis. Two of them had Fourniers gangrene. Predisposing factors included diabetes mellitus, alcohol and drug abuse. Local signs were redness, swelling and pain rapidly followed by fever and deterioration in the patient's general condition. Soft tissue-gas was observed in all patients. It was found either clinically, on roentgenograms or by CT. Bacteria were found in blood cultures and/or necrotic tissues in all patients. The dominating treatment was radical surgical excision and early reexplorations. Antibiotics, intensive care support and early parenteral nutrition were given. Four patients were given hyperbaric oxygen treatment. The overall mortality rate was 11%. Amputation of one lower extremity became necessary in three patients. In these cases 4-8 days had elapsed between the onset and the first surgical excision. We find it important to underline early diagnosis and radical surgical excision in patients with necrotizing fasciitis.
Adult↗
[Campylobacter pylori. Determination of gastric colonization and its clinical relevance].
While evidence suggesting a statistical association between Campylobacter pylori and chronic active antral gastritis is convincing, the role which the organism may play in the pathogenesis of this condition and in the case of peptic ulcer remains to be elucidated. The development of safe, non-invasive diagnostic tests suitable for population studies greatly facilitates this investigative process. This article presents a brief review of currently available methods of diagnosing C pylori colonization in the stomach and discusses their possible application in the field of clinical gastroenterology.
Campylobacter↗
[Intestinal spirochetes].
We report a case of intestinal spirochaetosis. The bacteria were seen by light microscopy and reacted in an indirect immunofluorescence test on the biopsy material with serum with high levels of IgG antibodies against Borrelia burgdorferi. The patient's own serum had no detectable antibody activity against the bacteria. No inflammatory response was observed. Aspects of these findings are discussed.
Adult↗
The in vitro activity of norfloxacin, ofloxacin and ciprofloxacin and other antibiotics in current use against Neisseria gonorrhoeae.
One hundred non-beta-lactamase-producing and 50 beta-lactamase-producing strains of Neisseria gonorrhoeae serogroup WI and WII/III were tested in vitro by an agar dilution method against a panel of antibiotics including ciprofloxacin, ofloxacin and norfloxacin. All strains irrespective of beta-lactamase production and serogroup allocation, were inhibited by 0.125 mg/l of all quinolones. Ciprofloxacin turned out to be most active followed by ofloxacin and norfloxacin. All strains were also inhibited by low concentrations of cefotaxime (MIC less than 0.25 mg/l). Many strains mostly among the beta-lactamase-producing strains were resistant (MIC greater than 4 mg/l) to doxycycline. Ampicillin is still active against the majority of non-beta-lactamase-producing strains. The majority of the strains belonged to serogroup WII/III which are known to be less sensitive to penicillin G and ampicillin.
Ampicillin↗