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- Hugosson, Anna, et al.
(författare)
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A community outbreak of Legionnaires' disease from an industrial cooling tower: assessment of clinical features and diagnostic procedures.
- 2007
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Ingår i: Scandinavian journal of infectious diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 39:3, s. 217-24
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Tidskriftsartikel (refereegranskat)abstract
- An outbreak of Legionnaires' disease (LD) occurred in Lidköping, Sweden, in August 2004. A cooling tower was identified as the probable source of infection. During the outbreak period an unexpected 3-6-fold increase in pneumonia patients was noted at the local hospital. During 7 weeks LD was diagnosed in 15 patients by urinary antigen and/or sputum culture. Additionally, 15 LD patients were diagnosed later by serology. Patients with LD were generally younger, more healthy, and more often smokers compared to other pneumonia patients. On admittance they had more severe symptoms with high fever and raised CRP levels, and more often hyponatraemia, gastrointestinal and CNS symptoms. A causative agent besides Legionella was found in 2 patients only. A significant titre rise for Mycoplasma and/or Chlamydophila pneumoniae was found in 13 of 29 tested patients with confirmed LD. We conclude that the clinical diagnosis of LD is difficult and that available diagnostic methods detect only a minority of patients in the acute phase. Therefore in severe pneumonia, empirically targeted therapy should be instituted on clinical grounds irrespective of the results of diagnostic tests. The observation of increased antibody levels for M. and C. pneumoniae suggests an unspecific immune reaction and merits further study.
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| 2. |
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| 3. |
- Ulleryd, Peter, 1958, et al.
(författare)
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Legionnaires' disease from a cooling tower in a community outbreak in Lidkoping, Sweden-epidemiological, environmental and microbiological investigation supported by meteorological modelling
- 2012
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Ingår i: BMC Infectious Diseases. - : Springer Science and Business Media LLC. - 1471-2334. ; 12, s. 313-
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Tidskriftsartikel (refereegranskat)abstract
- Background: An outbreak of Legionnaires' Disease took place in the Swedish town Lidkoping on Lake Vanern in August 2004 and the number of pneumonia cases at the local hospital increased markedly. As soon as the first patients were diagnosed, health care providers were informed and an outbreak investigation was launched. Methods: Classical epidemiological investigation, diagnostic tests, environmental analyses, epidemiological typing and meteorological methods. Results: Thirty-two cases were found. The median age was 62 years (range 36 - 88) and 22 (69%) were males. No common indoor exposure was found. Legionella pneumophila serogroup 1 was found at two industries, each with two cooling towers. In one cooling tower exceptionally high concentrations, 1.2 x 10(9) cfu/L, were found. Smaller amounts were also found in the other tower of the first industry and in one tower of the second plant. Sero-and genotyping of isolated L. pneumophila serogroup 1 from three patients and epidemiologically suspected environmental strains supported the cooling tower with the high concentration as the source. In all, two L. pneumophila strains were isolated from three culture confirmed cases and both these strains were detected in the cooling tower, but one strain in another cooling tower as well. Meteorological modelling demonstrated probable spread from the most suspected cooling tower towards the town centre and the precise location of four cases that were stray visitors to Lidkoping. Conclusions: Classical epidemiological, environmental and microbiological investigation of an LD outbreak can be supported by meteorological modelling methods. The broad competence and cooperation capabilities in the investigation team from different authorities were of paramount importance in stopping this outbreak.
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| 5. |
- Grahn, Anna, 1973, et al.
(författare)
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Imported case of lassa fever in Sweden with encephalopathy and sensorineural hearing deficit
- 2016
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Ingår i: Open Forum Infectious Diseases. - : Oxford University Press (OUP). - 2328-8957. ; 3:4
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Tidskriftsartikel (refereegranskat)abstract
- © The Author 2016.We describe an imported case of Lassa fever with both encephalopathy and bilateral sensorineural hearing deficit. Absence of fever during hospitalization, initially nonspecific symptoms, and onset of hearing deficit in a late stage of disease probably contributed to delayed diagnosis (14 days after admittance to hospital). The pathogenesis of neurological manifestations of Lassa fever is poorly understood and no specific treatment was given. A total of 118 personnel had close contact with the patient, but no secondary cases occurred. This case highlights the importance of considering Lassa fever as a differential diagnosis in patients with recent travel to endemic areas.
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| 6. |
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| 7. |
- Johnson, James R., et al.
(författare)
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Phylogenetic and pathotypic comparison of concurrent urine and rectal Escherichia coli isolates from men with febrile urinary tract infection.
- 2005
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Ingår i: Journal of Clinical Microbiology. - 0095-1137. ; 43:8, s. 3895-900
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Tidskriftsartikel (refereegranskat)abstract
- Among men with febrile urinary tract infection (FUTI), whether the host's fecal flora is the source for the urine strain ("fecal-urethral" hypothesis), and whether pathogenesis is driven by prevalence versus special pathogenicity, are unknown. Accordingly, pretherapy urine isolates from 65 men with FUTI were compared with concurrent rectal isolates from the same hosts according to serotype, genomic profile, phylogenetic group, and virulence genotype. The host's multiple rectal colonies included only the urine clone in 25% of subjects, the urine clone plus additional clones in 22%, and only nonurine clones in 54%. Compared with the 67 unique rectal clones, the 65 urine isolates were significantly enriched for phylogenetic group B2, virulence-associated serotypes, and specific virulence genes and contained more virulence genes (median, 10 versus 6: P < 0.001). In multivariable models, phylogenetic group B2, hlyD (hemolysin), cnf1 (cytotoxic necrotizing factor), iroN (siderophore receptor), ompT (outer membrane protease), and malX (pathogenicity island marker) most strongly predicted urine source. These findings challenge the fecal-urethral and prevalence hypotheses for FUTI pathogenesis and instead strongly support the possibility of alternate infection routes in some men and the special pathogenicity hypothesis. They also identify specific bacterial traits as potential targets for anti-FUTI interventions.
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| 9. |
- Karlsson, Lisbeth, et al.
(författare)
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Mindre antibiotika bland äldreboenden i Västra Götaland
- 2011
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Ingår i: Läkartidningen. - 0023-7205. ; 108:32-33, s. 1498-1500
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Tidskriftsartikel (refereegranskat)abstract
- I en punktprevalensundersökning av 16089 vårdtagare i Västra Götalands särskilda äldreboenden behandlades 4,2 procent med antibiotika 2009 jämfört med 5,3 procent 2004. Antibiotikabehandlade urinvägsinfektioner hade minskat mest. Hud- och mjukdelsinfektioner var den vanligaste indikationen för antibiotikabehandling och utgjorde 40 procent, urinvägsinfektioner 29 procent och luftvägsinfektioner 15 procent. Andelen vårdtagare i korttidsboenden hade ökat, och där var andelen antibiotikabehandlade 8,0 procent. Vårdhygieniska riskfaktorer i form av sår och kvarliggande urinkateter förekom i 48 procent respektive 15 procent hos vårdtagare som antibiotikabehandlades och i 7 procent respektive 8 procent hos vårdtagare utan antibiotikabehandling. Följsamheten till Stramas antibiotikarekommendationer hade förbättrats.
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| 10. |
- Otto, Gisela, et al.
(författare)
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Virulence factors and pap genotype in Escherichia coli isolates from women with acute pyelonephritis, with or without bacteremia.
- 1993
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Ingår i: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. - 1058-4838. ; 17:3, s. 448-56
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Tidskriftsartikel (refereegranskat)abstract
- Bacteremia develops in a subgroup of patients with acute pyelonephritis. This study examined isolates of Escherichia coli from the urine and the blood of 25 bacteremic and 67 nonbacteremic women with this acute disease. P-fimbriated strains were found in 100% of bacteremic patients without complicating factors but in only 71% of nonbacteremic patients without complications (P < .05). Non-P-fimbriated strains were only found to cause bacteremia in three patients with compromising host factors. Strains from the bacteremic group and those from the nonbacteremic group did not differ significantly in terms of hemolysin or aerobactin production or of serum resistance. The P-fimbriated strains from both groups of patients carried pap DNA sequences of the papGIA2 adhesin type; prsGJ96 homologous DNA sequences were rare. The results suggested that P fimbriae and compromising host conditions independently increase the risk for bacteremia during acute pyelonephritis.
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