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Biomedical subjects

A Sivonen

Publications and source records attributed to A Sivonen.

At least 37 records · Page 2Linked to original sources
PubMed1994

Hepatosplenic yeast infection in patients with acute leukemia: a diagnostic problem.

The occurrence of hepatosplenic candidiasis following prolonged neutropenic periods has emerged as a major problem for patients with leukemia. In order to evaluate the diagnostic value of various available procedures, we analyzed our findings regarding 26 leukemic patients with hepatosplenic candidiasis. A significantly increased level (> 50 mg/L) of serum C-reactive protein (S-CRP) was significantly more common than a daily fever (for which the mean temperature peak was > 37.5 degrees C) or raised levels of liver enzymes (serum alanine transferase, aspartate transferase, or alkaline phosphatase). Focal changes in the liver, spleen, or kidneys were detected in > 90% of the patients examined by computed tomography (CT) but in < 50% of those examined by ultrasonography. Seventeen diagnoses were based on the findings from microscopy of samples obtained invasively, whereas a positive fungal culture was the basis of the diagnosis for only five patients. In conclusion, monitoring the S-CRP level after a patient's recovery from neutropenia is useful in that its elevation is cause for early suspicion of hepatosplenic candidiasis. In detection of the hepatosplenic foci, CT is superior to ultrasonography. For establishing the specific diagnosis, aggressive collection of samples for microscopy is essential.

Acute Disease↗
PubMed1994

Increased yields of pathogenic Yersinia enterocolitica strains by cold enrichment.

Yersinia strains recovered from routine stool cultures (n = 13,534) as well as clinical symptoms in the patients were analysed in order to establish whether enteric Yersinia enterocolitica strains recovered only after cold enrichment cultures shared the same pathogenicity markers and caused the same symptoms as strains from primary cultures. 93% of the 201 Yersinia isolates were Y. enterocolitica strains and 71% of these were of serotype O3. Nearly 40% of all Y. enterocolitica strains and 21% of serotype O3 strains were isolated only after 1 week's cold enrichment of stool specimens. Practically all Y. enterocolitica O3 strains, whether from primary or cold enrichment cultures, were pathogenic not only on the basis of the serotype but also on the basis of Congo-red uptake and calcium-dependent growth at 35 degrees C (CR-MOX test). The symptoms in patients with Y. enterocolitica O3 from primary and cold enrichment cultures were similar except that abdominal pains were more frequent (p < 0.05) in the former. Arthropathia, mesenteric lymphadenitis and erythema nodosum were detected in 15% of the patients with Yersinia isolates and were more frequent in patients with isolates from cold enrichment or without diarrhea.

Abdominal Pain↗
PubMed1992

Bacterial vaginosis in early pregnancy and pregnancy outcome.

OBJECTIVE: We assessed the association between bacterial vaginosis in early pregnancy and adverse pregnancy outcome. METHODS: Vaginal swabs for bacterial culture, Gram stain, and Papanicolaou stain were taken at the first prenatal visit between 8-17 weeks' gestation in 790 healthy nulliparous women. RESULTS: Culture-proven bacterial vaginosis was detected in 169 of 790 women (21.4%), 167 (98.8%) of whom could also be identified by Gram stain. Papanicolaou smears were available from 299 women, among whom 101 had bacterial vaginosis on culture; of these 101, 78 (77.2%) could be detected by Papanicolaou stain. Of the 751 women whose clinical follow-up was completed, 42 had been treated for preterm uterine contractions (preterm labor), but only 17 delivered between 20-36 weeks' gestation (preterm birth). Premature rupture of membranes (PROM) occurred more than 6 hours before delivery in 80 cases (nine preterm and 71 term). Bacterial vaginosis in early pregnancy predicted preterm labor, preterm birth, or preterm PROM with a sensitivity of 41-67%, specificity of 79%, and negative predictive value of 96-99%, but the positive predictive value was low at 4-11%. However, bacterial vaginosis was associated with a 2.6-fold risk (95% confidence interval [CI] 1.3-4.9) for preterm labor, a 6.9-fold risk (95% CI 2.5-18.8) for preterm birth, and a 7.3-fold risk (95% CI 1.8-29.4) for preterm PROM. CONCLUSIONS: Bacterial vaginosis in early pregnancy can be detected reliably by Gram stain and, in most cases, by Papanicolaou smear. Although bacterial vaginosis is associated with preterm labor, preterm birth, and preterm PROM, the clinical usefulness of its assessment is limited because of the high rate of false-positive findings.

Adult↗
PubMed1990

A cluster of seven cases of Clostridium tertium septicemia in neutropenic patients.

A cluster of seven febrile and severely neutropenic patients who developed Clostridium tertium septicemia during a 13-month period is described. The patients had received third generation cephalosporins for 7 to 13 days (mean 9 days) at the time Clostridium tertium was isolated from blood cultures. Two patients had perirectal and one patient pericaecal cellulitis. The organism was also isolated from bronchial secretions in one patient. No patient had diarrhea. Five of six strains tested were resistant to clindamycin (MIC 2-8 micrograms/ml), and six of seven strains moderately resistant to penicillin (MIC 1-4 micrograms/ml). In one patient Clostridium tertium grew from blood cultures although metronidazole had been administered for two days. Six patients recovered on antibiotic therapy. In view of the unusual susceptibility pattern of Clostridium tertium, an accurate diagnosis of infection with this organism is important for the choice of an appropriate antimicrobial treatment.

Adult↗
PubMed1989

Sero- and subtypes of group B meningococci causing invasive infections in Finland in 1976-87.

Neisseria meningitidis group B (MenB) strains isolated from 1976 to 1987 in Finland in 339 patients with invasive infection were sero/subtyped by whole cell enzyme immunoassay using monoclonal antibodies to class 1 and 2/3 outer membrane proteins. 66.7% of the strains could be serotyped (class 2/3) and 70.2% subtyped (class 1). No single phenotype was clearly predominant. The most common serotypes were 4 (18.6%) and 14 (17.4%) and the most common subtypes P1.16 (20.1%) and P1.2 (12.1%). The Norwegian phenotype B:15:P1.16 was seen only rarely (a total of 18 strains). Strains from Northern Finland did not differ from those from Southern Finland: no single phenotype caused the slight increase seen in the incidence of MenB infections in the end of 1970s in the North.

Antibodies, Monoclonal↗
PubMed1988

Fecal bacteriology and reservoir ileitis in patients operated on for ulcerative colitis.

To investigate the etiology of ileal reservoir inflammation, fecal bacteriology and ileal wall morphology were compared in three groups of 15 patients operated on for ulcerative colitis: 1) conventional ileostomy, 2) Kock ileostomy; and 3) pelvic ileal pouch. Total bacterial counts showed overgrowth of fecal bacteria in each group, but the anaerobic bacterial counts were significantly higher (P less than .05) in the two pouch groups than in the conventional ileostomy group. Mucosal morphology did not differ among the three groups showing either normal mucosa or mild chronic inflammatory changes in most patients. In contrast, five of the six patients with clinical pouchitis had acute inflammatory changes in histologic specimens. Fecal bacteriologic findings in these patients did not differ quantitatively or qualitatively from others. It is concluded that proctocolectomy for ulcerative colitis predisposes to ileal bacterial overgrowth, and after pouch operations especially, anaerobic overgrowth may be one factor in the development of pouch inflammation. Acute clinical pouchitis with clear histologic changes was, however, not connected with specific changes in fecal bacteriology.

Adult↗
PubMed1987

Optochin resistance in Streptococcus pneumoniae strains isolated from blood and middle ear fluid.

Optochin resistant Streptococcus pneumoniae having typical pneumococcal morphology in culture and Gram stain and giving clear agglutination with anti-pneumococcal polysaccharide antisera were isolated from primary cultures of blood and middle ear fluid. The isolated pneumococci were either fully sensitive to penicillin and other antimicrobial agents commonly used or relatively resistant to penicillin and resistant to cloxacillin, tetracycline, erythromycin, sulphatrimethoprim and clindamycin.

Aged↗
PubMed1987

Multiply resistant Streptococcus mitis isolated from conjunctival exudate of newborns.

Streptococcus mitis resistant to most of the commonly used antimicrobial agents but sensitive to cefotaxime, clindamycin, vancomycin and rifampicin was isolated from conjunctival exudate of newborns. The isolate had group C streptococcal antigen, was beta-haemolytic on horse but alpha-haemolytic on sheep blood agar plates and might therefore be misidentified as beta-haemolytic group C streptococci.

Conjunctiva↗
PubMed1987

Septicemia in a university pediatric hospital: a five-year analysis of the bacterial and fungal isolates and outcome of the infections.

A 5-year analysis comprising all positive blood culture isolates from a 222-bed university pediatric hospital in Helsinki revealed 369 bacteremic but only 8 fungemic cases. Haemophilus influenzae and Staphylococcus aureus, 19% of the total material each, were the most common pathogens isolated, followed by S. epidermidis (11%), Escherichia coli (8%), pneumococci (8%), and group B beta-hemolytic streptococci (6%). Remarkable differences in distribution of the pathogens were observed in different hospital units. However, 5 most common microorganisms covered 62-86% of the spectrum in each unit. Two bacteria, H. influenzae in the unit for infectious diseases and S. aureus in the hematology-oncology unit were significantly (p less than 0.001 or less than 0.01, respectively) more common than any other organism in those units. The average case fatality rate was 14% with a range from 1.5% to 40%, depending upon the causative agent isolated. Also, the mortality was much higher in neonates than in other age groups. We conclude that by monitoring the blood isolates separately in each unit one can find remarkable differences in the same hospital. On the other hand, characteristics of an individual hospital may vary significantly from those described in textbooks. These characteristics should be recognized and taken into account in the antimicrobial policy.

Bacteria↗
PubMed1983

The microbial colonization due to medical devices in intensive care patients with special emphasis on Candida albicans.

Incidence of microbial colonization related to medical devices was prospectively studied in 101 consecutive patients treated in intensive care unit ICU. Following endotracheal intubation 50% of patients had positive bacterial culture in the trachea within 24 hours irrespective of the use of antibiotics. Positive urine cultures occurred in 33% of patients with indwelling urinary catheters. Colonization of the trachea and the urinary tract with Candida albicans usually followed a few days after the bacterial colonization. However, septic Candida albicans infections seem to be rare in intensive care patients in spite of abundant colonization in the mucous membranes. Simultaneous growth of Candida albicans in the trachea and the urinary tract was associated with poor prognosis.

Candida albicans↗
PubMed1979

Serological grouping of meningococci and encapsulated Haemophilus influenzae strains by latex agglutination.

The latex agglutination method, utilizing antibody-coated latex particles, was adapted for serogrouping of Neisseria meningitidis and serotyping of encapsulated Haemophilus influenzae strains from agar plates. It was found to give more clear-cut results than conventional slide agglutination. A 100% agreement with the antiserum agar method was found for all strains isolated from blood or cerebrospinal fluid. Many meningococcal strains from nasopharyngeal carriers are autoagglutinable, but some of these gave a positive reaction with the group B latex reagent, although they were negative by the antiserum agar method. The latex agglutination method has several advantages over others: the lack of autoagglutination, easy performance, easy interpretation, and very low consumption of antisera.

Blood↗
PubMed1978

The effect of chemoprophylactic use of rifampin and minocycline on rates of carriage of Neisseria meningitidis in army recruits in Finland.

During an epidemic caused by sulfonamide-resistant group A Neisseria meningitidis (A SuR strain), rifampin (600 mg per day for four days) or minocycline (100 mg every 12 hr for five days) was administered as chemoprophylaxis to 1,540 unvaccinated recruits in the Finnish Armed Forces. Rates of carriage of all strains of N. meningitidis were initially reduced by 78% (from 60% to 13%) in the 389 men receiving rifampin and by 62% (from 70% to 26%) in the 1,151 men receiving minocycline but rose to approximately 30% in both groups four weeks after prophylaxis. The carriage of A SuR strains was similarly reduced. An individual follow-up of 636 trainees demonstrated a high rate of new infections. It is suggested that the long-term inefficiency of rifampin and minocycline is due to their inability to reduce the carriage rates enough to prevent further spread of infection after prophylaxis is descontinued. However, no new cases appeared among the men receiving the prophylaxis. Five strains highly resistant to rifampin were found after the use of rifampin (minimal inhibitory concentration, greater than or equal to 100 microgram/ml), but no minocycline-resistant strains were encountered. No unpleasant side effects were seen in subjects receiving either drug.

Finland↗
PubMed1977

Clinical efficacy of meningococcus group A capsular polysaccharide vaccine in children three months to five years of age.

We performed field trials in the course of an epidemic in Finland to learn whether Group A memingococcal capsular polysaccharide vaccine protects infants and young children from meningitis. The first trial involved 130,178 children between the ages of three months and five years; 49,295 children received the vaccine, 48,977 received a control Haemophilus influenzae Type b polysaccharide vaccine, and 31.906 remained unvaccinated. No cases of meningitis or sepsis caused by Group A meningococci were seen in the first year of observation among the children vaccinated with meningococcal vaccine whereas six occurred among those vaccinated with the H. influenzae vaccine and 13 among those not vaccinated. In the second trial 21,007 children of the same ages received the meningococcal vaccine. No cases caused by Group A occurred among those vaccinated, although five to seven would have been expected within the year. Meningococcal Group A vaccine appears efficacious in young infants and children.

Antibodies, Bacterial↗