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P Ruutu

Publications and source records attributed to P Ruutu.

At least 19 recordsLinked to original sources
PubMed2000

An outbreak of Listeria monocytogenes serotype 3a infections from butter in Finland.

In February 1999, an outbreak of listeriosis caused by Listeria monocytogenes serotype 3a occurred in Finland. All isolates were identical. The outbreak strain was first isolated in 1997 in dairy butter. This dairy began delivery to a tertiary care hospital (TCH) in June 1998. From June 1998 to April 1999, 25 case patients were identified (20 with sepsis, 4 with meningitis, and 1 with abscess; 6 patients died). Patients with the outbreak strain were more likely to have been admitted to the TCH than were patients with other strains of L. monocytogenes (60% vs. 8%; odds ratio, 17.3; 95% confidence interval, 2.8-136.8). Case patients admitted to the TCH had been hospitalized longer before cultures tested positive than had matched controls (median, 31 vs. 10 days; P=.008). An investigation found the outbreak strain in packaged butter served at the TCH and at the source dairy. Recall of the product ended the outbreak.

Adolescent↗
PubMed2000

Molecular epidemiology of an outbreak caused by Salmonella enterica serovar Newport in Finland and the United Kingdom.

Between December 1997 and January 1998 an increase in the number of isolates of Salmonella enterica serovar Newport, a serotype rarely causing indigenous infections in Finland, was detected. This included two clusters of gastroenteritis following funeral meals. An inquiry via Enter-net revealed a concomitant increase in cases of S. Newport in the United Kingdom. To investigate the Finnish outbreak, a total of 56 S. Newport strains (22 from the outbreak period, 27 from pre- and post-outbreak period, and 7 from imported food producing animals) were studied by pulsed-field gel electrophoresis (PFGE); selected isolates were also phage typed. Two retrospective questionnaire studies evaluating food exposures among the funeral attendants were conducted. All isolates from the clusters had an identical PFGE pattern which was also found in 13 infections temporally close to but not associated with the clusters. The Finnish outbreak was caused by the same phage type as the one in the United Kingdom. In both clusters, an epidemiological link between illness and exposure to cured ham was found. In conclusion, the outbreak was not limited to the two clusters but was more widely spread both in and outside Finland. Early alarm systems of food-borne outbreaks and collaboration between European countries are needed for investigating international outbreaks.

Abdominal Pain↗
PubMed2000

Diagnostic aspects of invasive Aspergillus infections in allogeneic BMT recipients.

To investigate diagnostic aspects of invasive aspergillosis (IA) in allogeneic BMT recipients, the charts of 22 consecutive patients with IA transplanted in 1989-1995 were reviewed. IA was diagnosed 69-466 days (median 131 days) post BMT. In 16 patients (73%), a definite or probable diagnosis of IA was made during life. Respiratory symptoms were the presenting feature in half of the patients followed by neurological symptoms (27%). Chest X-ray revealed single or multiple nodular lesions in 10 patients; cavitation was observed in five patients. Tissue biopsy was the most common method of diagnosis (nine patients: lungs 6, liver 1, subcutaneous tissue 1, brain 1). Five IA cases were detected by nine guided fine needle lung biopsies in eight patients and without complications. Bronchoalveolar lavage was performed in 14 patients with findings suggestive of invasive pulmonary aspergillosis in eight cases. Lungs were the most common organ affected (90%) followed by central nervous system (41%). The diagnosis of IA is still difficult, and a large number of patients have advanced infection at diagnosis. Methods for early diagnosis are needed. Patients with a clinical suspicion of IA should be treated vigorously with antifungal agents during the diagnostic work-up.

Adolescent↗
PubMed2000

Treatment and outcome of invasive Aspergillus infections in allogeneic BMT recipients.

The outcome of invasive aspergillosis (IA) has been considered poor in allogeneic BMT recipients. We analyzed retrospectively the treatment and outcome of IA diagnosed during life in a recent cohort of 20 allogeneic BMT recipients. All patients were initially treated with amphotericin B (AmB) (conventional 16, liposomal 4). Due to toxicity, conventional AmB was changed to a liposomal preparation in 10 patients. Five patients also received itraconazole and three underwent surgery. Of 19 evaluable patients, two patients achieved a complete response and a partial response was observed in five patients (response rate 37%). The median survival was 37 days after the diagnosis. Only two patients (10%) were cured. The prognosis of allogeneic BMT recipients with IA has remained poor. Although treatment responses are common, immunosuppression aggravated by GVHD and its treatment, as well as the commonly disseminated presentation of IA, seem to be major obstacles to the success of therapy. Bone Marrow Transplantation (2000) 26, 759-762.

Adolescent↗
PubMed2000

Invasive bacterial infections of children in a rural province in the central Philippines.

The etiology of invasive bacterial infections was studied among 956 Filipino children less than five years old who fulfilled the World Health Organization criteria for severe or very severe pneumonia or had suspected meningitis or sepsis. The most common invasive infections were due to Streptococcus pneumoniae (12 [1.3%]) and Haemophilus influenzae (12 [1.3%]); including four cases of pneumococcal meningitis and 11 cases of H. influenzae meningitis. Type 1 was the most common (six of the 12 isolates) of the pneumococcal serotypes. Serotypes/groups 1, 6, 14, and 23 accounted for 91.7% of the invasive isolates. The majority of the H. influenzae strains from blood (10 out of 10) and cerebrospinal fluid (6 out of 7) were type b. Almost all of the invasive S. pneumoniae (9 out of 12) and H. influenzae (11 out of 12) infections were seen before one year of age, which stresses the need to investigate early immunization of children for H. influenzae type b and S. pneumoniae, as well as maternal immunization to maximize the potential of immunoprophylaxis.

Bacterial Infections↗
PubMed1999

Swimming-associated outbreak of Escherichia coli O157:H7.

In 1997 the first outbreak of Escherichia coli O157:H7 infections involving 14 cases occurred in Finland. A case was defined as a resident of Alavus with an episode of diarrhoea between 5 and 17 July 1997, and from whom E. coli O157:H7 was isolated from stool. The investigation included case searching and a population-based case control study. Five primary and eight symptomatic secondary cases of E. coli O157:H7 illness were detected. In the 10 days before the outbreak, all 5 primary patients (aged 3-8 years), but only 6 of 32 population controls from the same age range (Fisher's test, P < 0.001) and 4 of 10 sibling controls (P < 0.05) had visited (but had not necessarily bathed in) a shallow beach popular among young children. Four out of 5 primary cases had remained within 5 m of the beach while swimming and had swallowed lake water compared to 1 of 5 population controls. These analytical epidemiologic findings incriminated fresh lake water as the vehicle of E. coli O157:H7 transmission.

Age Distribution↗
PubMed1999

An international outbreak of Vero cytotoxin-producing Escherichia coli O157 infection amongst tourists; a challenge for the European infectious disease surveillance network.

In March 1997, an outbreak of Vero cytotoxin-producing Escherichia coli O157 (VTEC) infection occurred amongst holidaymakers returning from Fuerteventura, Canary Islands. For the investigation, a confirmed case was an individual staying in Fuerteventura during March 1997, with either E. coli O157 VTEC isolated in stool, HUS or serological evidence of recent infection; a probable case was an individual with bloody diarrhoea without laboratory confirmation. Local and Europe-wide active case finding was undertaken through national centres, Salm-Net and the European Programme of Intervention Epidemiology, followed by a case-control study. Fourteen confirmed and one probable case were identified from England (7), Finland (5), Wales (1), Sweden (1) and Denmark (1) staying in four hotels. Three of the four hotels were supplied with water from a private well which appeared to be the probable vehicle of transmission. The case-control study showed illness was associated with consumption of raw vegetables (OR 8.4, 95% CI 1-5-48.2) which may have been washed in well water. This investigation shows the importance of international collaboration in the detection and investigation of clusters of enteric infection.

Adolescent↗
PubMed1999

IgG subclasses and avidity of antibodies to polysaccharide antigens in allogeneic BMT recipients after vaccination with pneumococcal polysaccharide and Haemophilus influenzae type b conjugate vaccines.

In a randomized study, 20 adult allogeneic BMT recipients were vaccinated at 6 months and 22 at 18 months after BMT with Haemophilus influenzae type b (Hib)-diphtheria toxoid conjugate vaccine (PRP-D), and 23 recipients at 8 months and 21 at 20 months with pneumococcal polysaccharide (Pnc PS) vaccine. IgG1 and IgG2 subclasses of Pnc PS and Hib antibodies and avidities of Pnc PS IgG antibodies were determined by EIA in sera from patients with at least a two-fold total antibody response to Pnc type 3, 6B, 19F or PRP-D. The Pnc PS vaccine induced predominantly IgG1 Pnc 3 antibody production. Anti-Pnc 6B and 19F responses were mainly IgG2. The time of the Pnc PS vaccination, at 8 or 20 months after BMT, did not influence the IgG subclass response pattern. The PRP-D vaccine induced predominantly IgG2 anti-Hib production in the patients vaccinated at 6 months after BMT. The patients vaccinated at 18 months produced IgG1 and IgG2 antibodies more evenly. The same patient was able to produce predominantly IgG1 subclass antibodies to one antigen, Pnc 3, 6B, 19F or Hib, and IgG2 antibodies to another. The avidities of anti-Pnc 6B and 19F 1 month after vaccination were similar to those before vaccination, anti-Pnc 3 avidity was lower than before vaccination but matured in 15 months. The IgG subclass distribution and avidity were similar in the patients with and without chronic GVHD. In conclusion, the IgG response to Pnc type 3 was predominantly IgG1 as in infants and IgG2 to PRP-D, Pnc 6B, and 19F as in adults. Early vaccination after BMT or the presence of chronic GVHD did not impair the quality of response to Pnc PS and PRP-D vaccines.

Adolescent↗
PubMed1999

Changing epidemiology of hepatitis B infection in Finland.

Finland has, until recently, had a very low incidence of hepatitis B infection, reflected in transmission mainly amongst adolescent and adult age-groups with high-risk behaviour. Several recent local outbreaks of acute hepatitis B in Finland may indicate a change in the epidemiology of this infection. We examine time trends of hepatitis B notifications to the new national infectious disease registry. We also analyse all hepatitis B cases notified over the 2-y period from 1 January 1995 to 31 December 1997 by age, sex, place of residence, country of birth and reported route of transmission. The reported incidence of acute hepatitis B increased 3-fold over this period. The main reported route of transmission was related to injecting drug use, although a significant proportion of adolescent female cases was reportedly infected through heterosexual intercourse. A critical evaluation of the current targeted vaccination approach and other prevention policies is required.

Adolescent↗
PubMed1999

Pneumococcal pneumonia diagnosis by demonstration of pneumolysin antibodies in precipitated immune complexes: a study in 350 Philippine children with acute lower respiratory infection.

In searching for suitable methods for aetiological diagnosis of pneumococcal disease we determined capsular polysaccharide, C-polysaccharide and pneumolysin antibodies bound in immune complexes (IC) in Filipino children. Sera were obtained from 150 healthy infants (all under 12 months old) and from 350 paediatric patients (mean age 18 months) hospitalized with severe pneumonia. The findings in healthy children were not associated with age, sex or pneumococcal carrier status; 3-7% exceeded the cut-off limits for positivity in different antibody assays. By contrast, 97 (51%) of the 190 patients with a complete 3-sample series exceeded the cut-off limit for IC-bound pneumolysin-IgG in at least 1 of the serum samples studied. Positivity rates for IC-bound pneumolysin-IgG in the admission day, in-patient and convalescent sample of the 350 patients were 25%, 25% and 34%. Pneumolysin-IgM, capsular polysaccharide and C-polysaccharide antibodies in the IC were positive in only 4-6% of the patients' samples. IC-bound pneumolysin-IgG antibody assay seem to be a useful method for species-specific diagnosis of pneumococcal infections.

Antibodies, Bacterial↗
PubMed1999

Effect of transplacentally acquired tetanus antibodies on the antibody responses to Haemophilus influenzae type b-tetanus toxoid conjugate and tetanus toxoid vaccines in Filipino infants.

BACKGROUND: Pregnant women in developing countries are vaccinated with tetanus toxoid (TT) to prevent neonatal tetanus. In populations in which the maternal TT-vaccination program is efficiently implemented, responses of the infant to TT and TT-conjugated vaccines such as Haemophilus influenzae type b (Hib) capsular polysaccaride (PS) TT-conjugate (Hib-TT) vaccine may be depressed. OBJECTIVES: To study the influence of transplacentally acquired anti-TT antibodies on responses to TT vaccination and to Hib-TT vaccine. METHODS: One hundred ninety-four healthy Filipino infants received three doses of a Hib conjugate (either Hib-TT, PRP-OMP or HbOC) with diphtheria-tetanus-pertussis vaccine (DTP) given simultaneously but in a separate syringe at the age of 6, 10 and 14 weeks (primary series). In addition 54 of the study children received a booster dose of Hib-TT at 9 months simultaneously with the measles vaccine. RESULTS: Transplacentally acquired anti-TT did not interfere with the anti-Hib PS antibody (anti-Hib PS) response to any of the conjugates. The transplacentally acquired anti-TT was not significantly associated with the concentration of anti-Hib PS either before or after the booster dose of Hib-TT. High concentrations (> or =1 IU/ml) of transplacentally acquired anti-TT inhibited the infants' anti-TT responses. CONCLUSIONS: High concentration of transplacentally acquired anti-TT did not depress anti-Hib PS responses to the Hib-TT vaccine. On the other hand the high anti-TT concentrations somewhat depressed the anti-TT responses of the infants. However, the anti-TT concentrations attained were in the protective range in all study children after either the primary series (DTP + Hib-TT) or the booster dose of Hib-TT.

Antibodies, Bacterial↗
PubMed1999

Establishing a laboratory for surveillance of invasive bacterial infections in a tertiary care government hospital in a rural province in the Philippines.

A clinical bacteriologic laboratory was established in a tertiary care government hospital in The Philippines, where expert bacteriologic laboratories do not usually exist at this level of health care. The laboratory was jointly established by the Research Institute for Tropical Medicine (RITM) (Manila, The Philippines) and the National Public Health Institute (KTL) (Helsinki, Finland). The laboratory was planned, its personnel were trained, and its functioning was continuously supported by the RITM and KTL. The following aspects were of utmost importance in establishing the laboratory and launching its work: 1) the support of the RITM bacteriologic laboratory, with back-up and consultations from KTL; 2) creation and maintenance of personal contacts between clinicians and laboratory staff with an emphasis on clinical relevance and rapid reporting of laboratory results; 3) the consideration of the quality aspects of the work from the start; and 4) keen follow-up of the bacteriologic results and their clinical significance and use, of practical laboratory work, and of quality assurance aspects. In the first two years of its operation, the laboratory identified Streptococcus pneumoniae and Haemophilus influenzae as the most important causes of severe pneumonia, sepsis or meningitis in children less than two years of age, and Salmonella typhi as the most frequent significant isolate from the blood cultures, being found most often in school age children and young adults.

Adolescent↗
PubMed1999

Reliability of parental history of antibiotic use for Filipino children admitted with acute lower respiratory tract infection.

Parental history on antibiotic use and the urine antibacterial assay (UABA) result were compared in a study on Filipino children with acute lower respiratory tract infection (ALRI). Among 108 patients in whom urine for the UABA could be collected prior to starting antibiotic treatment in the hospital, 59 (55%) guardians reported preceding antibiotic use, 54% of whom were positive in the UABA. In another 37 (34%), the UABA result was positive, indicating nonreported use of antibiotics. Among 190 patients in whom urine could be collected only after intravenous administration of antibiotic, the UABA demonstrated large inhibition zones after the first dose in most patients but a negative result was seen in 14 cases. The inhibition zone radius was significantly smaller for chloramphenicol than for beta-lactam antibiotics (8.3 mm versus 16.1 mm after one dose; 95% confidence intervals = 7.0-9.7 and 14.9-17.2, respectively). Parental history on antibiotic use gives an underestimate of preceding antibiotic use in children with ALRI in the Philippines. The result partly explains the low yield of blood culture in many studies on ALRI, and stresses the need to develop new diagnostic methods not based on culture for those organisms highly sensitive to antibiotics such as Streptococcus pneumoniae and Haemophilus influenzae.

Acute Disease↗
PubMed1998

Evaluation of clinical and laboratory findings in leukaemic patients with blood cultures positive for Staphylococcus epidermidis.

It is not certain whether clinical or laboratory findings help to distinguish true bacteraemia from contamination among acute leukaemic patients with one or more blood cultures positive for Staphylococcus epidermidis. We studied 31 patients treated at the Haematological Unit between 1 January, 1992 and 30 June, 1995 who were considered to have 'true bacteraemia', indicated by at least two positive blood cultures, and 20 considered to have probable 'contamination', indicated by a single positive culture. Fever at onset of positive blood culture, level of C-reactive protein (CRP) one day after the first positive blood culture and mortality did not differ between the groups. However, the median increase in CRP over 24 h from the first positive blood culture was significantly higher in true bacteraemias than among contaminants (median 35 mg/L vs 5 mg/L, P < 0.05). Patients with true bacteraemia were more likely than those with contaminants to have central catheters in situ (95 vs 75%, P < 0.05) and previous oral antibiotic prophylaxis (29 vs 5%, P < 0.05). Also clinical signs of catheter infection (30 vs 7%) were more common in true bacteraemias. In conclusion, central catheterization, antibiotic prophylaxis and clinical signs of catheter infection increase the likelihood of true bacteraemia; however, these factors have limited clinical utility in differentiation of true bacteraemia from contamination. Daily monitoring of serum CRP levels may help in the clinical decision-making.

Adolescent↗
PubMed1998

Foodborne outbreaks of hepatitis A in a low endemic country: an emerging problem?

This paper describes 2 outbreaks of hepatitis A infection in Finland, a very low endemic area of hepatitis A infection, where a large proportion of the population is now susceptible to infection by hepatitis A virus (HAV). The first outbreak involved people attending several schools and day-care centres; the second employees of several bank branches in a different city. The initial investigation revealed that both were related to food distributed widely from separate central kitchens. Two separate case-control studies implicated imported salad food items as the most likely vehicle of infection. HAV was detected in the stool of cases from both outbreaks using reverse-transcriptase polymerase chain reaction; however, comparison of viral genome sequences proved that the viruses were of different origin and hence the outbreaks, although occurring simultaneously, were not linked. Foodborne outbreaks of HAV may represent an increasing problem in populations not immune to HAV.

Adolescent↗
PubMed1998

Coinfection is common in measles-associated pneumonia.

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.

Child, Preschool↗