Diphtheria is under control in industrialized countries. However, single cases and outbreaks still occur and the disease is not completely understood. Forty-three individuals suspected of having diphtheria who were referred to the Infectious Disease Hospital of Arkhangelsk from December 1994 to March 1995 were included in this study. Fifteen patients were diagnosed as having diphtheria and received equine hyperimmune antidiphtheria toxin antiserum, and 28 were diagnosed as carriers, 12 with nondiphtherial tonsillitis or pharyngitis and 16 without symptoms. Serum samples were obtained on admission and during the course of the disease or during follow-up of carrier status. Samples were analyzed for antibodies against diphtheria toxin with both an in vitro neutralization test (NT) and a human-specific enzyme immunoassay. All of the cases but one were confirmed by a positive culture. Twelve patients had pharyngeal diphtheria, and three had combined laryngeal and pharyngeal disease. Half of the patients had life-threatening disease, and one died. On admission, the median antibody titers measured with the NT were 0.085 IU/ml for the patients, 5.12 IU/ml for the symptomatic carriers, and 10.24 IU/ml for the healthy carriers. All of the diphtheria patients but one and nine of the carriers (six symptomatic and three healthy) had increased antibody levels during the first 7 to 10 days after admission. No obvious correlation was revealed between the antibody level or its kinetics and the course of the disease. Antibody levels on admission of >1 IU/ml were associated with a low risk of diphtheria.
Notes
Cites: Commun Dis Public Health. 1999 Dec;2(4):250-710598381
Brucellosis is a rare infectious disease in Norway.
We present a patient admitted to the department of medicine at Haraldsplass Hospital, Bergen and give a review of the epidemiology, symptoms, diagnosis and treatment of Brucellosis.
The clinical picture of Brucellosis is often non-specific, with swings in fever, general malaise and myalgia. Complications such as osteomyelitis, endocarditis and coagulase-negative staphylococcus (CNS) infection occur in rare cases. The diagnosis is established by detection of Brucella species in blood cultures or tissue aspirate. Brucella is often difficult to isolate, but the available serological tests are highly sensitive and specific. The infection is treated with long-term administration of a combination of two appropriate antibiotic drugs. Surgery may be necessary in case of serious complications. If adequately treated, Brucellosis has a good overall prognosis.
A comparison of extended spectrum ß-lactamase producing Escherichia coli from clinical, recreational water and wastewater samples associated in time and location.
Extended spectrum ß-lactamase producing Escherichia coli (ESBL-EC) are excreted via effluents and sewage into the environment where they can re-contaminate humans and animals. The aim of this observational study was to detect and quantify ESBL-EC in recreational water and wastewater, and perform a genetic and phenotypic comparative analysis of the environmental strains with geographically associated human urinary ESBL-EC. Recreational fresh- and saltwater samples from four different beaches and wastewater samples from a nearby sewage plant were filtered and cultured on differential and ESBL-selective media. After antimicrobial susceptibility testing and multi-locus variable number of tandem repeats assay (MLVA), selected ESBL-EC strains from recreational water were characterized by whole genome sequencing (WGS) and compared to wastewater and human urine isolates from people living in the same area. We detected ESBL-EC in recreational water samples on 8/20 occasions (40%), representing all sites. The ratio of ESBL-EC to total number of E. coli colony forming units varied from 0 to 3.8%. ESBL-EC were present in all wastewater samples in ratios of 0.56-0.75%. ST131 was most prevalent in urine and wastewater samples, while ST10 dominated in water samples. Eight STs and identical ESBL-EC MLVA-types were detected in all compartments. Clinical ESBL-EC isolates were more likely to be multidrug-resistant (p
Notes
Cites: Environ Sci Pollut Res Int. 2015 Aug;22(15):11488-9225821088
Cites: PLoS One. 2017 Mar 7;12 (3):e017351028267783
Despite recent advances in microbiological techniques, the etiology of community-acquired pneumonia (CAP) is still not well described. We applied polymerase chain reaction (PCR) and conventional methods to describe etiology of CAP in hospitalized adults and evaluated their respective diagnostic yields.
267 CAP patients were enrolled consecutively over our 3-year prospective study. Conventional methods (i.e., bacterial cultures, urinary antigen assays, serology) were combined with nasopharyngeal (NP) and oropharyngeal (OP) swab samples analyzed by real-time quantitative PCR (qPCR) for Streptococcus pneumoniae, and by real-time PCR for Mycoplasma pneumoniae, Chlamydophila pneumoniae, Bordetella pertussis and 12 types of respiratory viruses.
Etiology was established in 167 (63%) patients with 69 (26%) patients having =1 copathogen. There were 75 (28%) pure bacterial and 41 (15%) pure viral infections, and 51 (19%) viral-bacterial coinfections, resulting in 126 (47%) patients with bacterial and 92 (34%) patients with viral etiology. S. pneumoniae (30%), influenza (15%) and rhinovirus (12%) were most commonly identified, typically with =1 copathogen. During winter and spring, viruses were detected more frequently (45%, P=.01) and usually in combination with bacteria (39%). PCR improved diagnostic yield by 8% in 64 cases with complete sampling (and by 15% in all patients); 5% for detection of bacteria; 19% for viruses (P=.04); and 16% for detection of =1 copathogen. Etiology was established in 79% of 43 antibiotic-naive patients with complete sampling. S. pneumoniae qPCR positive rate was significantly higher for OP swab compared to NP swab (P
Notes
Cites: Thorax. 2008 Jan;63(1):42-817573440
Cites: Am Rev Respir Dis. 1989 Feb;139(2):546-82913899
Cites: Clin Infect Dis. 2008 May 15;46(10):1513-2118419484
We hereby report the detection of the plasmid borne mcr-1 gene conferring colistin resistance in an extended-spectrum ß-lactamase (ESBL) producing Escherichia coli ST10 strain retrieved from seawater at a public beach in Norway. The sample was collected in September 2010 and was investigated by whole-genome sequencing in 2016. This report illustrates that E. coli strains carrying plasmid-mediated colistin resistance genes have also reached areas where this drug is hardly used at all. Surveillance of colistin resistance in environmental, veterinary, and human strains is warranted also in countries where colistin resistance is rare in clinical settings.
OBJECTIVE: The aim of this study was to assess the association of fetal death with herpes simplex virus type-2 (HSV-2) antibody status during pregnancy: 1. presence of antibodies in first trimester; 2. appearance of antibodies (incident infection); 3. increase in antibody titre; and 4. loss of antibodies. DESIGN: Prospective study. POPULATION: The source population was a cohort of 35,940 pregnant women in Norway. METHODS: Nested case-control study within the cohort. Cases were all women in the study population who experienced a fetal death after the 16th weeks of gestation (n = 281), and controls were 961 randomly selected women with a live born child. MAIN OUTCOME MEASURES: HSV-2 antibody status. RESULTS: Twenty-nine percent (82/281) of women with a fetal death and 27% (256/961) of the controls had of HSV-2 antibodies present in the first trimester (odds ratio 1.1, 95% CI 0.8-1.5). HSV-2 antibodies appeared in 2% (3/136) of initially seronegative cases and 3% (16/623) of the controls during pregnancy (odds ratio 0.9, 95% CI 0.2-3.0). An increase in HSV-2 antibodies occurred in 4% (2/55) of initially seropositive cases and 7% (16/231) of the controls (odds ratio 0.5, 95% CI 0.1-2.3). Loss of HSV-2 antibodies in initially seropositive women was not associated with fetal death, 42% (23/55) of the cases and 45% (104/231) of the controls seroreverted (odds ratio 0.8, 95% CI 0.5-1.6). Differences in follow up time, age and parity were controlled and did not influence the comparisons between cases and controls. CONCLUSION: This study provides no evidence of an association between HSV-2 infection during pregnancy and fetal death.
Management of suspected primary Toxoplasma gondii infection in pregnant women in Norway: twenty years of experience of amniocentesis in a low-prevalence population.
Primary infection with Toxoplasma gondii during pregnancy may pose a threat to the fetus. Women infected prior to conception are unlikely to transmit the parasite to the fetus. If maternal serology indicates a possible primary infection, amniocentesis for toxoplasma PCR analysis is performed and antiparasitic treatment given. However, discriminating between primary and latent infection is challenging and unnecessary amniocenteses may occur. Procedure-related fetal loss after amniocentesis is of concern. The aim of the present study was to determine whether amniocentesis is performed on the correct patients and whether the procedure is safe for this indication.
Retrospective study analysing data from all singleton pregnancies (n?=?346) at Oslo University Hospital undergoing amniocentesis due to suspected maternal primary toxoplasma infection during 1993-2013. Maternal, neonatal and infant data were obtained from clinical hospital records, laboratory records and pregnancy charts. All serum samples were analysed at the Norwegian Institute of Public Health or at the Toxoplasma Reference Laboratory at Oslo University Hospital. The amniocenteses were performed at Oslo University Hospital by experienced personnel. Time of maternal infection was evaluated retrospectively based on serology results.
50% (173) of the women were infected before pregnancy, 23% (80) possibly in pregnancy and 27% (93) were certainly infected during pregnancy. Forty-nine (14%) women seroconverted, 42 (12%) had IgG antibody increase and 255 (74%) women had IgM positivity and low IgG avidity/high dye test titre. Fifteen offspring were infected with toxoplasma, one of them with negative PCR in the amniotic fluid. Median gestational age at amniocentesis was 16.7 gestational weeks (GWs) (Q1?=?15, Q3?=?22), with median sample volume 4 ml (Q1?=?3, Q3?=?7). Two miscarriages occurred 4 weeks after the procedure, both performed in GW 13. One of these had severe fetal toxoplasma infection.
Half of our study population were infected before pregnancy. In order to reduce the unnecessary amniocenteses we advise confirmatory serology 3 weeks after a suspect result and suggest that the serology is interpreted by dedicated multidisciplinary staff. Amniocentesis is safe and useful as a diagnostic procedure in diagnosing congenital toxoplasma infection when performed after 15 GW.
Notes
Cites: PLoS One. 2015 Dec 29;10(12):e0145519 PMID 26714282
BACKGROUND. The aim of this study was to assess the impact of maternal cytomegalovirus (CMV) antibody status in pregnancy on the risk of fetal death and of low birth weight. METHODS. The study of fetal death risk was a nested case-control study. Cases were all women within a cohort of 35,940 pregnant women in Norway 1992--94, who experienced fetal death after 16th week of gestation (n=281). Controls were 957 randomly selected women with live born children. Both groups were identified through linkage to the Norwegian Medical Birth Registry. The risk of low birth weight was studied in the live born children. RESULTS. Seventy-two percent (203/281) of the cases and 69% (662/957) of the controls had CMV immunoglobulin G (IgG) antibodies in the first trimester (P=0.3). 0.4% (1/281) of the cases and 0.7% (7/957) had CMV IgM antibodies in the first trimester (P=0.7). Among 322 initially CMV antibody-negative women, 11% (6/55) of the cases and 9% (24/267) of the controls had occurrence of CMV IgG and/or IgM antibodies (P=0.7) during pregnancy. Also, after control for maternal age, parity, and follow-up time, no association between CMV antibodies and fetal death was found. CMV antibody status was not associated with low birth weight. CONCLUSIONS. This study does not support a causal relation between CMV infection in pregnancy and fetal death or low birth weight.
Maternal Concentrations of Insulin-like Growth Factor I and Insulin-like Growth Factor Binding Protein 1 During Pregnancy and Birth Weight of Offspring.
Maternal concentrations of insulin-like growth factor I (IGF-I) and insulin-like growth factor binding protein 1 (IGFBP-1) may influence fetal growth. Offspring birth weight related to maternal IGF-I and IGFBP-1 measured in pregnancy was studied in 368 randomly selected women without preeclampsia who delivered a singleton liveborn child in Norway between 1992 and 1994. Maternal IGF-I concentrations were not consistently associated with birth weight, but a 1-standard deviation stronger increase in IGF-I from the first to second trimester was associated with an 82-g (95% confidence interval (CI): 11, 153) higher birth weight. IGFBP-1 concentrations were inversely associated with birth weight: Birth weight was 71 g (95% CI: 14, 128) lower per 1-standard deviation higher IGFBP-1 in the second trimester, and an increase in IGFBP-1 from the first (below median) to second (above median) trimester was associated with a 342-g (95% CI: 124, 560) lower birth weight, compared with having low IGFBP-1 (below median) in both trimesters. Conversely, low IGFBP-1 in both trimesters was associated with a 200-350-g higher birth weight compared with other combinations of IGFBP-1. In conclusion, persistently low IGFBP-1 in pregnancy is associated with relatively higher birth weight. Maternal insulin resistance may provide a link between IGFBP-1 and offspring birth weight.
The aim of this study was to investigate the association between maternal infection with Toxoplasma gondii (T. gondii) in pregnancy and subsequent risk of hearing loss in the offspring. The study included 27 727 children born in Norway 1992-1994. Maternal toxoplasma infection during pregnancy was ascertained by serological examination and fetal infection was ascertained by parasite detection in amniotic fluid and/or postnatal serological examination. Hearing loss was defined as mean hearing loss >35 dB HL in the better ear averaged over the pure-tone hearing thresholds at 500, 1000, and 2000 Hz, and the children were identified through linkage to the Norwegian Registry of Hearing Loss in Children. Twenty-two of the 27 727 children (0.08%) were diagnosed with hearing loss. Forty women had primary T. gondii infection in pregnancy. None of their offspring had hearing loss. There was also no association between T. gondii infection prior to pregnancy and hearing loss in the offspring. Hence, we did not find any association between T. gondii infection in pregnancy and hearing loss in the offspring.
