The five departments of clinical microbiology in Greater Copenhagen have together carried out a retrospective review of bacteraemia caused by the zoonotic Salmonella serotypes in the period 1984-1988 in the municipalities of Copenhagen and Frederiksberg and in the County of Copenhagen. A gradual increase in frequency was observed from 11 cases in 1984 to 58 cases in 1988. The serotype most commonly isolated was Salmonella dublin followed by Salmonella enteritidis and Salmonella typhimurium. S. dublin was found to be more invasive and more virulent than the other serotypes. Predisposing factors were present in 56% of the patients; the commonest of these was malignant disease. Fatal or complicated course of the disease were observed more frequently in predisposed patients than in persons who had previously been healthy. A total of 17% of the patients died and one fourth of these had ruptured aortic aneurysm probably on account of Salmonella arteritis. 20% developed recurrence of bacteraemia while in the remaining patients the disease ran an uncomplicated course. It is concluded that the marked increase in the number of cases and the serious course taken by the infection demonstrate a definite need for increased prophylactic efforts in the food industry.
The public immunization program against diphtheria, established in 1941, has almost eradicated the disease in Denmark, and 1956 became the first year without any notified cases. Since then, toxigenic strains have only been isolated five times--three cases of clinical diphtheria due to Corynebacterium diphtheriae biovar. mitis and two cases of tonsillitis/pharyngitis due to Corynebacterium ulcerans. The source of the infection was not identified in any of the cases. The first case of diphtheria in 1968 was imported from abroad. The following two cases in 1983 and 1985 were due to strains of the same phage type and peptide profile as the strains isolated during the epidemic in Sweden in 1984-1986. This indicates that the Danish cases and the Swedish epidemic derived from the same source. The diphtheria immunity of the Danish population is decreasing, and the level of protection is approaching the Swedish level. The impact is that a situation like that in Sweden may be anticipated with diphtheria epidemic in the lowest socio-economical groups--the skid row dwellers, alcoholics and drug abusers--if the immunization program against diphtheria is not intensified.
During the past year five patients from countries in the Middle East admitted to a burns unit were found to harbour a strain of Staphylococcus aureus with unusual multi-resistance to antibiotics. The admission of the first patient was followed by an outbreak of infection with this strain involving ten patients in the unit. In addition five staff members were found to be nasal carriers of the strain. As a result of this incident, the following four patients admitted to the unit were isolated on admission and the spread of their strans was thus prevented. It is recommended that patients on admission to burns units, or similar departments with patients very susceptible to infection, are isolated until their bacterial floras have been examined.
Cites: N Engl J Med. 1969 Sep 18;281(12):627-355194719
A retrospective survey of non-typhoid Salmonella bacteraemia in the period 1984 to 1988 was carried out by the five departments of clinical microbiology in Greater Copenhagen. A total of 168 patients were identified. A gradual increase was observed from 11 cases in 1984 to 58 cases in 1988. The corresponding incidence per 100,000 inhabitants in Copenhagen rose from 0.9 in 1984 to 5.0 in 1988. During the same period the total registered incidence of human Salmonella infections in Denmark increased from 17.6 to 67.4 per 100,000 inhabitants. The serotype most often isolated from bacteraemic patients was Salmonella dublin followed by Salmonella enteritidis and Salmonella typhimurium. Salmonella dublin demonstrated enhanced invasive and pathogenic properties. Predisposing factors were present in 56% of the patients; the most common was malignant disease. A fatal or complicated course of the bacteraemia was observed more frequently in patients with underlying diseases than in persons who had previously been healthy. A total of 17% of the patients died; one-fifth of these had a ruptured aortic aneurysm. It is concluded that the substantial increase in the number of cases and the often serious course taken by the infection demonstrate a need for increased efforts at prophylaxis.
A 1-year prospective study of nosocomial bacteraemia was performed at Hvidovre Hospital with special reference to frequency, focus of infection and prognosis. All patients were examined clinically in order to confirm the bacteraemia. In total, 98 hospital-acquired bacteraemias were observed, giving an incidence rate of 0.28%. Bacteraemia due to Escherichia coli, Staphylococcus aureus and Staphylococcus epidermidis predominated. The overall mortality was 38%; 65% of the patients with S. aureus bacteraemia died, 25% due to the bacteraemia. The most common types of infection were urinary tract infections and intravenous catheter infections. Fifty-five of the bacteraemias were caused by foreign bodies, mostly urinary catheters and intravenous catheters, and in 14 cases the focus was unknown. The patient population was severely ill patients. We conclude that nosocomial bacteraemia occurs specially in severely ill patients often preceded by indwelling urinary or intravenous catheters. The patients seldom die due to the bacteraemia, but they die with concomitant bacteraemia.
Out of 300 newborn infants who had conjunctival swabs inoculated for detection of Chlamydia trachomatis and other bacteria, 72% had bacteria isolated 4 to 6 days after birth. Of these, Staph. albus constituted 51% and Staph. aureus 19%. None of the infants were Chlamydia positive. Five out of 112 mothers (4.5%) were Chlamydia positive from the cervix just before delivery. Nineteen of the neonates were treated for conjunctivitis within the first month of life. Chlamydia trachomatis was isolated from 2, and Staph. aureus, alpha-Streptococci, Pneumococci and Haemophilus influenzae from some of the other infants. A likely diagnosis could be made in 46% of these cases, while the remaining cultures showed only apathogenic bacteria or no growth. There was a fairly good accordance with observation of inflammatory cells in the tear fluid and the clinical picture, 17/19 = 90% showing neutrophilia. Despite failing aetiological diagnosis in several cases, the infants responded satisfactorily to local antibiotic treatment. 75% of the parents replied to questionnaires 2 months after birth concerning conjunctivitis within the first month of life. The replies showed that 58 = 25% had had conjunctivitis, of whom 17% had been treated with antibiotics.