A 37-year-old man was admitted to hospital with fever, muscle tenderness, headache and mild exanthema on the right thigh. During his hospital stay, the headache worsened and aseptic meningitis was diagnosed. A bilateral iritis developed, and the exanthema developed into an atypical erythema nodosum. In liver function tests, pathological results were recorded. Vasculitis was suspected but could not be confirmed. All serological tests proved negative except for a fourfold titre rise to Chlamydia pneumoniae. We concluded that the meningitis, hepatitis, iritis and atypical erythema nodosum were most probably due to a C. pneumoniae infection.
Chlamydia pneumoniae infections have earlier been described as mycoplasma-like illnesses in young people, and also appear to be associated with community-acquired pneumonia in adults. In this retrospective study, 12.2% (23/188) of patients with pneumonia who required hospitalization during the 3 years 1985-87 had serological evidence of recent C. pneumoniae infection. Many of these patients had symptoms similar to ornithosis. The most interesting finding was that half of the patients with a 4-fold IgG antibody titre rise to C. pneumoniae also had an increased alkaline phosphatase concentration.
The prevalence rate of hospital-associated infections in 5 Swedish hospitals on November 4, 1975 is reported. In all, 4246 patients were included in the study, 3657 in acute disease clinics and 589 in chronic disease clinics. The overall prevalence rate was 17%, 11% in acute disease clinics and 59% in chronic disease clinics. The highest rate was found in intensive care units (72%), while in ophthalmological units it was 1%. 50% of all hospital-associated infections were urinary tract infections, 68% of which occurred in patients with an indwelling urinary catheter. 25% of all infections in acute disease clinics were postoperative wound infections, and 20% in chronic disease clinics were skin infections, including infections in varicose and decubital ulcers. 58% of the bacterial isolates from hospital-associated infections were gram-negative rods, while 12% were Staphylococcus aureus. Also in postoperative wound infections the gram-negative rods dominated over Staph. aureus, 35 vs. 23%. A prevalence study of this order of size seems adequate to assess the overall rate of hospital-associated infections in Sweden as compared to other countries. However, differences in prevalence rates between hospitals and clinics should be interpreted with great care. The seriousness and effect of reported infections must be evaluated otherwise, as well as the day-to-day infection control and the evaluation of prophylactic measures need other methods.
BACKGROUND: We assessed the effectiveness of a 23-valent pneumococcal vaccine in the prevention of pneumococcal pneumonia and of pneumonia overall in non-immunocompromised middle-aged and elderly people. METHODS: The prospective, multicentre, double-blind, randomised, placebo-controlled trial was carried out across departments of infectious diseases at six tertiary-care or university hospitals in Sweden. 691 non-immunocompromised patients aged 50-85 years who had been treated as inpatients for community-acquired pneumonia (CAP) were randomly assigned either 23-valent pneumococcal capsular polysaccharide vaccine or placebo (sodium chloride). We used Cox regression models to estimate the relative risks of pneumonia overall and pneumococcal pneumonia for the placebo group compared with the vaccine group. FINDINGS: 63 (19%) of 339 patients in the vaccine group and 57 (16%) of 352 patients in the placebo group developed a new pneumonia, corresponding to a relative risk over time for the placebo group compared with the vaccine group of 0.83 (95% CI 0.58-1.12, p=0.31). Pneumococcal pneumonia was diagnosed in 16 (4.5%) patients in the placebo group and in 19 (5.6%) in the vaccine group, corresponding to a relative risk for the placebo group of 0.78 (95% CI 0.40-1.51, p=0.45). We found no difference in the death rate between the two study groups. INTERPRETATION: The 23-valent pneumococcal polysaccharide vaccine did not prevent pneumonia overall or pneumococcal pneumonia in middle-aged and elderly individuals.