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Mucosal and systemic immune responses to an oral enterotoxigenic Escherichia coli vaccine
Abstracts
353
admission. T h e r e was no improvement after 6 days of antibiotic therapy and the working diagnosis at this stage was of a connective tissue disease. Steroids were therefore added with a dramatic response. T h e diagnosis of Q fever was established a weeks later (Coxiella burnetti phase 2 CF I / I o to 1/64o). H e was treated with tetracycline and steroids were discontinued. This case suggests that the in vitro data on the activity of ciprofloxacin against intracellular pathogens is insufficient to guide clinical practice. Comparative studies of ciprofloxacin and tetracyclines in Q fever are needed. In addition the role of steroids in the management of this disease needs further evaluation as the response in this patient has implications for the pathogenesis.
Occurrence
of human
dermatophytes
in Northern
Finland
in
I982-I99o
Eeva Lehenkari and Sylvi Silvennoinen-Kassinen
Department of Medical Microbiology, University of Oulu, Oulu, Finland T h e epidemiology of human dermatophytes was studied in N o r t h e r n Finland in I982-I99o. T h e samples were analysed in the D e p a r t m e n t of Medical Microbiology, University of Oulu, which was responsible for the local mycology. T h e total amount of samples was I7822 and 3 I85 (I8 %) turned out to be positive. T h e n u m b e r of annual samples and positive cultures remained constant. Trichophyton rubrum was the most common finding being isolated from 2 IOI samples (66 % of all positive cultures), Trichophyton mentagrophytes being isolated from 815 samples (26%) and Epidermophyton floccosum from I93 samples (6%). Trichophyton verrucosum caused an epidemic among cattle keepers in I 9 8 7 - I 9 9 o causing 49 infections. Microsporum canis, T. terrestre and T. violaceum were exceptional. T. rubrum and T. mentagrophytes occurred most frequently in patients aged 41-45 years and as foot infections. E. floccosum affected usually toe web and groin in the age group of 21-25 years. 54 % of all positive samples came from men and 46 % from women. E. floccosum infected more often men. Conclusions: T. rubrum remained the most common dermatophyte, M. canis being rare. T h e same species affected both adults and children. Decrease of tinear groin and a slight increase of tinea pedis was found. Dermatophytosis was almost as common among female as male subjects.
Mucosal and systemic immune responses to an oral E s c h e r i c h i a coli v a c c i n e enterotoxigenic o
C. A h r ~ n , ~'2 M. J e r t b o r n ~'2 a n d A - M . S v e n n e r h o l m ~
Departments of Medical Microbiology and 1Immunology and ~Infectious Diseases, University of G6teborg, Sweden An oral vaccine against enterotoxigenic Escherichia coli ( E T E C ) , which is one of the most common causes of childhood and travellers diarrhoea, has been developed. T w o oral doses of vaccine, each consisting of IO11 formalin-killed E. coli bacteria expressing colonization factor antigens (CFA) and i m g purified cholera B subunit toxoid (CTB), were given to adult Swedish volunteers. IgA antibody responses in intestinal lavage
354
Abstracts
fluid and in serum, as well as IgA antibody-secreting cell (ASC) responses in peripheral blood against CTB and C F A / I were studied in parallel. Significant IgA anti-CTB responses in intestinal lavage fluid and in serum were seen in 22 of the 23 vaccinees, and all of them developed IgA ASC responses against this antigen. Significant intestinal IgA responses against C F A / I were seen in I9 of the 23 vaccinees; x6 of these responders also developed significant anti-CFA/I ASC responses and I2 seroconverted. In addition, 4 persons developed C F A / I ASC responses, two of whom also responded in serum. Thus, immune responses to two of the major vaccine antigens, CTB and CFA/I, were seen in all vaccinees. The ASC responses in peripheral blood seemed to reflect the intestinal immune responses to a greater extent than the serum IgA responses.
Nosocomial bloodstream infections (NBIs) at a Norwegian University Hospital I974-79 (5 years) and I988-89 (2 years) J. B. H a u g , S. H a r t h u g , T. Kalager, A. D i g r a n e s a n d C. O. S o l b e r g
Haukeland Hospital, University of Bergen, Norway All episodes of NBIs in patients admitted to a Norwegian university hospital in I974-79 (5 years) and I988-89 (2 years) were analysed, altogether 784 episodes in 644 patients. The incidence increased from 2"43 to 4"53 episodes per Iooo patient admissions and from 2"58 to 6"69 NBIs per xoooo hospital days. In both periods, about 40 % of all NBIs occurred in the departments of medicine and paediatrics while a reduction from 46"I % to 27-5 % was observed for NBIs in the surgical services. NBIs caused by gram-positive bacteria, particularly coagulase negative staphylococci, and multiple microorganisms were more frequent in x988-89 than in I974-79 while the incidence with gram-negative bacteria remained unchanged. The crude mortality rate was reduced from 34"4 % in I974-79 to 23.i % in I988-89. Clinical factors independently predicting an adverse outcome were (odds ratio first/second period, NS = n o t significant): Schock (ii.i/5.5), treatment in the intensive care unit (NS/26"8) any underlying disease (NS/7"6), malignant disease (4"3/2"8), diabetes mellitus (4"o/NS), pulmonary source of NBI (NS/3"9), age more than 60 years (NS/3'9).
Antibiotics carried in general practitioners emergency bags M. J. C o l b r i d g e , I G. Bailey, 2 E. M. D u n b a r 2 and E. L. C. O n g I
1Infectious Diseases Unit, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE and 2Monsall Unit, North Manchester General Hospital, Manchester, U.K. Following advice from the Chief Medical Officer in I988 with regard to the prompt use of parenteral penicillin in suspected acute meningococcal disease, a survey of GP's in the North West of England showed that only 49 % were carrying such treatment? Since then, there has been widespread public, media and professional pressure to carry appropriate emergency treatment in primary health care. We therefore decided to repeat the survey in both the North East and North West. 2o6I (NW) and I663 (NE) anonymous questionnaires were sent to general practitioners asking them to list which
353
admission. T h e r e was no improvement after 6 days of antibiotic therapy and the working diagnosis at this stage was of a connective tissue disease. Steroids were therefore added with a dramatic response. T h e diagnosis of Q fever was established a weeks later (Coxiella burnetti phase 2 CF I / I o to 1/64o). H e was treated with tetracycline and steroids were discontinued. This case suggests that the in vitro data on the activity of ciprofloxacin against intracellular pathogens is insufficient to guide clinical practice. Comparative studies of ciprofloxacin and tetracyclines in Q fever are needed. In addition the role of steroids in the management of this disease needs further evaluation as the response in this patient has implications for the pathogenesis.
Occurrence
of human
dermatophytes
in Northern
Finland
in
I982-I99o
Eeva Lehenkari and Sylvi Silvennoinen-Kassinen
Department of Medical Microbiology, University of Oulu, Oulu, Finland T h e epidemiology of human dermatophytes was studied in N o r t h e r n Finland in I982-I99o. T h e samples were analysed in the D e p a r t m e n t of Medical Microbiology, University of Oulu, which was responsible for the local mycology. T h e total amount of samples was I7822 and 3 I85 (I8 %) turned out to be positive. T h e n u m b e r of annual samples and positive cultures remained constant. Trichophyton rubrum was the most common finding being isolated from 2 IOI samples (66 % of all positive cultures), Trichophyton mentagrophytes being isolated from 815 samples (26%) and Epidermophyton floccosum from I93 samples (6%). Trichophyton verrucosum caused an epidemic among cattle keepers in I 9 8 7 - I 9 9 o causing 49 infections. Microsporum canis, T. terrestre and T. violaceum were exceptional. T. rubrum and T. mentagrophytes occurred most frequently in patients aged 41-45 years and as foot infections. E. floccosum affected usually toe web and groin in the age group of 21-25 years. 54 % of all positive samples came from men and 46 % from women. E. floccosum infected more often men. Conclusions: T. rubrum remained the most common dermatophyte, M. canis being rare. T h e same species affected both adults and children. Decrease of tinear groin and a slight increase of tinea pedis was found. Dermatophytosis was almost as common among female as male subjects.
Mucosal and systemic immune responses to an oral E s c h e r i c h i a coli v a c c i n e enterotoxigenic o
C. A h r ~ n , ~'2 M. J e r t b o r n ~'2 a n d A - M . S v e n n e r h o l m ~
Departments of Medical Microbiology and 1Immunology and ~Infectious Diseases, University of G6teborg, Sweden An oral vaccine against enterotoxigenic Escherichia coli ( E T E C ) , which is one of the most common causes of childhood and travellers diarrhoea, has been developed. T w o oral doses of vaccine, each consisting of IO11 formalin-killed E. coli bacteria expressing colonization factor antigens (CFA) and i m g purified cholera B subunit toxoid (CTB), were given to adult Swedish volunteers. IgA antibody responses in intestinal lavage
354
Abstracts
fluid and in serum, as well as IgA antibody-secreting cell (ASC) responses in peripheral blood against CTB and C F A / I were studied in parallel. Significant IgA anti-CTB responses in intestinal lavage fluid and in serum were seen in 22 of the 23 vaccinees, and all of them developed IgA ASC responses against this antigen. Significant intestinal IgA responses against C F A / I were seen in I9 of the 23 vaccinees; x6 of these responders also developed significant anti-CFA/I ASC responses and I2 seroconverted. In addition, 4 persons developed C F A / I ASC responses, two of whom also responded in serum. Thus, immune responses to two of the major vaccine antigens, CTB and CFA/I, were seen in all vaccinees. The ASC responses in peripheral blood seemed to reflect the intestinal immune responses to a greater extent than the serum IgA responses.
Nosocomial bloodstream infections (NBIs) at a Norwegian University Hospital I974-79 (5 years) and I988-89 (2 years) J. B. H a u g , S. H a r t h u g , T. Kalager, A. D i g r a n e s a n d C. O. S o l b e r g
Haukeland Hospital, University of Bergen, Norway All episodes of NBIs in patients admitted to a Norwegian university hospital in I974-79 (5 years) and I988-89 (2 years) were analysed, altogether 784 episodes in 644 patients. The incidence increased from 2"43 to 4"53 episodes per Iooo patient admissions and from 2"58 to 6"69 NBIs per xoooo hospital days. In both periods, about 40 % of all NBIs occurred in the departments of medicine and paediatrics while a reduction from 46"I % to 27-5 % was observed for NBIs in the surgical services. NBIs caused by gram-positive bacteria, particularly coagulase negative staphylococci, and multiple microorganisms were more frequent in x988-89 than in I974-79 while the incidence with gram-negative bacteria remained unchanged. The crude mortality rate was reduced from 34"4 % in I974-79 to 23.i % in I988-89. Clinical factors independently predicting an adverse outcome were (odds ratio first/second period, NS = n o t significant): Schock (ii.i/5.5), treatment in the intensive care unit (NS/26"8) any underlying disease (NS/7"6), malignant disease (4"3/2"8), diabetes mellitus (4"o/NS), pulmonary source of NBI (NS/3"9), age more than 60 years (NS/3'9).
Antibiotics carried in general practitioners emergency bags M. J. C o l b r i d g e , I G. Bailey, 2 E. M. D u n b a r 2 and E. L. C. O n g I
1Infectious Diseases Unit, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE and 2Monsall Unit, North Manchester General Hospital, Manchester, U.K. Following advice from the Chief Medical Officer in I988 with regard to the prompt use of parenteral penicillin in suspected acute meningococcal disease, a survey of GP's in the North West of England showed that only 49 % were carrying such treatment? Since then, there has been widespread public, media and professional pressure to carry appropriate emergency treatment in primary health care. We therefore decided to repeat the survey in both the North East and North West. 2o6I (NW) and I663 (NE) anonymous questionnaires were sent to general practitioners asking them to list which