Bacteremia due to Streptococcus gallolyticus, or the perils of revised nomenclature in bacteriology.
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Bacteremia↗
Biomedical subjects
H A Bijlmer
Publications and source records attributed to H A Bijlmer.
Changing epidemiology of melioidosis? A case of acute pulmonary melioidosis with fatal outcome imported from Brazil.
Melioidosis is an infectious disease caused by Burkholderia pseudomallei. It is endemic in South East Asia and tropical regions of Northern Australia. Sporadic cases have been described elsewhere. In this article we present a case of acute pulmonary melioidosis with fatal outcome imported from Brazil. The most common pathogen causing severe community-acquired pneumonia in Brazil is Streptococcus pneumoniae. Other possible pathogens include Legionella spp., Mycoplasma pneumonia, Gram-negative rods and viruses. There are few reports of melioidosis in the Americas. This article represents the second known human case of melioidosis from Brazil. Recognition of melioidosis as a possible cause of severe pneumonia, even if a patient has not been travelling in a highly endemic area, is important because of the therapeutic consequences. The epidemiology of melioidosis will be reviewed.
Acute Disease↗
Upper respiratory tract infection, heterologous immunisation and meningococcal disease.
To test the hypothesis that an episode of upper respiratory tract infection or heterologous immunisation is a predisposing factor for the occurrence of meningococcal disease, data from 377 cases of meningococcal disease and their household contacts (n = 1124) were analysed by conditional logistic regression analysis with stratification for household. The odds ratio for a recent upper respiratory tract infection for patients versus household contacts, adjusted for age and the presence of an underlying predisposing disease, was 2.8 and that for recent heterologous immunisation 1.0. These results support previous observations regarding the association between a preceding upper respiratory tract infection and the occurrence of meningococcal disease; however, no association was found between preceding heterologous immunisation and meningococcal disease. Therefore, increased alertness after heterologous immunisation does not seem warranted.
Adolescent↗
[Campylobacter infections in pregnancy].
In two pregnant women aged 39 and 35, who presented with fever and diarrhoea, Campylobacter was cultured from a blood sample. They were treated with antibiotics. One had a healthy neonate, in the other intrauterine foetal death had occurred. Campylobacter species have increasingly been recognized as possible causes of septic abortion, premature labour and neonatal sepsis. Early recognition and treatment of maternal Campylobacter infection may reduce the risk of serious foetal or neonatal complications.
Adult↗
[Myiasis caused by Dermatobia hominis].
In two patients, a woman of 35 and a man of 62 years old, myiasis caused by the larvae of the fly Dermatobia hominis was diagnosed. Both patients had recently returned from a visit to Central America. This ectoparasitosis is found in Central and South America. Patients present themselves with an insect bite which fails to heal. If the clinical presentation is unknown, the disease may well be mistaken for furunculosis. The condition may be easily treated by applying vaseline to the insect bite, which causes extrusion of the larva.
Adult↗
Prognostic indicators of the outcome of meningococcal disease: a study of 562 patients.
To assess prognostic indicators of a fatal outcome in patients with meningococcal disease, data from 562 patients with culture-proven meningococcal disease, reported in the Netherlands between 1 April 1989 and 30 April 1990, were collected prospectively by means of a questionnaire completed by the specialist in attendance. Analysis was done by the chi2 test and multiple logistic regression. During the study period 43 patients (7.7%) died. The risk of a fatal outcome was increased in patients aged 0-5 months, 10-19 years, and > or = 50 years, in female patients and in patients presenting with coma, temperature < or = 38.0 degrees C, mean arterial pressure < or = 70 mmHg, white blood cell count < or = 10 x 10(9)/L and platelet count < or = 100 x 10(9)/L. Predisposing factors and duration of disease before admission were significantly associated with outcome, but these associations disappeared in the multivariate analysis. Race, the administration of antibiotics prior to admission, seizures and haemorrhagic skin lesions were not associated with outcome. In conclusion age, gender, coma, temperature, mean arterial pressure, white blood cell count and platelet count were independent prognostic indicators of the outcome of meningococcal disease. The assessment of these characteristics may be helpful for the identification of high risk patients, whose prognosis might be improved by prompt transfer to an intensive care unit.
Adolescent↗
Clinical manifestations and course of meningococcal disease in 562 patients.
To describe the clinical manifestations and course of meningococcal disease (MD) data were collected on patients with culture-proven MD, reported in the Netherlands between April 1, 1989 and April 30, 1990 by means of a questionnaire completed by the specialist in attendance. During the study period, 562 patients (295 males, 267 females) were reported. The age of the patients ranged from 2 weeks to 88 years. Of the patients, 57.8% were classified as meningitic, 20.3% as bacteraemic and 21.9% as both meningitic and bacteraemic. In 4.6% of the patients a predisposing factor was present, and in 1.4% a previous episode of meningitis had occurred. A positive family history of meningitis was reported in 12.9% of the patients. On admission, 65.2% of the patients had haemorrhagic skin lesions, 7.9% coma and 4.2% seizures. During admission, 17.8% of the patients developed serious complications. The fatality rate was 7.7%. In 73.2% of the deceased, death occurred within 2 days after admission. Of the survivors, 8.5% recovered with serious sequelae. In conclusion, 16% of the patients with meningococcal disease either died or became severely disabled. Prevention of this putative life-threatening disease seems to be the only means of circumventing the problems caused by this serious condition.
Adolescent↗
Excess female fatalities among patients with meningococcal disease.
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Adolescent↗
Antibody responses to the capsular polysaccharide of Neisseria meningitidis serogroup B in patients with meningococcal disease.
We measured antibody responses to meningococcal serogroup B (MenB) polysaccharide (PS) by enzyme-linked immunosorbent assay (ELISA) in sera from 94 patients from The Netherlands with disease caused by Neisseria meningitidis group B. The patients ranged in age from 3 to 73 years (mean age, 18.8 years). In initial studies we showed that the binding of a panel of MenB PS-reactive human immunoglobulin M (IgM) paraproteins to biotinylated MenB PS bound to avidin-coated microtiter wells was inhibited > 90% by the addition of soluble MenB PS or encapsulated group B meningococci. In contrast, inhibition of IgM anti-MenB PS antibody-binding activity in many of the patient sera was less than 50% (range, 20 to 94%). These data suggested a high frequency of nonspecific binding in the patient sera. Therefore, all serum samples were assayed in replicate in the presence or absence of soluble MenB PS, and only the inhibitable fraction of the binding signal was used to calculate the anti-MenB PS antibody concentrations. In 17 control patients with meningococcal disease caused by serogroup A or C strains, there was no significant difference in the respective IgM or IgG anti-MenB PS antibody concentrations in paired acute- and convalescent-phase sera. In contrast, in patients with MenB disease, the geometric mean IgM anti-MenB PS antibody concentration increased from 3.9 units/ml in acute-phase serum to 10.5 units/ml in convalescent-phase serum (P < 0.001). The corresponding geometric mean IgG anti-MenB PS antibody titers were 1:27 and 1:36 (P < 0.05). There was only a weak relationship between age and the magnitude of the logarithm of the antibody concentrations in convalescent-phase sera (for IgM, r2 = 0.06 and P < 0.05; for IgG, r2 = 0.08 and P < 0.01). Our data indicate that precautions are needed to avoid nonspecificity in measuring serum antibody responses to MenB PS by ELISA. Furthermore, although this PS is thought to be a poor immunogen, patients as young as 3 years of age recovering from MenB disease demonstrate both ImG and IgG antibody responses in serum.
Adolescent↗
Patient and strain characteristics in relation to the outcome of meningococcal disease: a multivariate analysis.
To investigate the joint association of patient and strain characteristics with the outcome of meningococcal disease (MD), data were collected on 563 consecutive cases of MD reported between 1989 and 1990 in The Netherlands. The meningococcal isolates were characterized with regard to their surface characteristics. Sequelae occurred in 8.5% of the patients, and were only associated with the presence of bacteraemia. The case-fatality rate was 7.7%. Infants aged < or = 5 months and patients in the age-groups of 10-19 years and > or = 50 years had an increased risk for a fatal outcome compared with children from 6 months to 9 years old (Odds Ratios [ORs]: 5.1, 3.4 and 9.8, respectively). The OR for females versus males was 2.3. The ORs for patients with bacteraemia, or a combination of bacteraemia and meningitis, compared with meningitic patients, were 2.3 and 3.1. Meningococcal strain characteristics did not influence the case-fatality rate substantially. In conclusion, host factors were found to be determinants for a fatal outcome of MD in The Netherlands from 1989 to 1990.
Adolescent↗
Phenotypic and genotypic changes in a new clone complex of Neisseria meningitidis causing disease in The Netherlands, 1958-1990.
To characterize the phenotypic and genotypic changes that occurred in a new clone lineage of Neisseria meningitidis (lineage III) in the Netherlands, the electrophoretic type (ET) was determined for 79 serogroup B isolates of serotype 4 or subtype P1.4 (or both) obtained between 1958 and 1990 from patients with systemic meningococcal disease. Thirty-five previously described isolates were also included. After its appearance in 1980, lineage III started homogeneously with regard to both genotype (ET-24) and phenotype (B:4:P1.4). After 1984, other clones appeared in the lineage, and the various clones acquired other serotypes (serotypes 14 and 15) and subtypes (P1.2, P1.7, and P1.12), indicating frequent exchange of genetic material between clones. These results indicate that basing a serogroup B vaccine on outer membrane components from a single strain is not a valid strategy for the prevention of meningococcal disease.
Cloning, Molecular↗
Antibiotic susceptibility of invasive and non-invasive isolates of Haemophilus influenzae from the Gambia, west Africa.
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Anti-Bacterial Agents↗
[Secondary cases of meningococcal disease in The Netherlands, 1989-1990; a reappraisal of chemoprophylaxis].
OBJECTIVE: To assess the secondary attack rate (SAR) of meningococcal disease among the household contacts of primary patients and to describe the use of chemoprophylaxis in the Netherlands. DESIGN: Descriptive, nation-wide survey. METHODS: Information was collected of patients with meningococcal disease, reported between April 1st, 1989 and April 30th, 1990, and their household contacts. A household contact suffering from meningococcal disease between 24 hours and 1 month after hospital admission of the primary patient, was considered to be a secondary case. Chemoprophylaxis was considered appropriate if rifampicin or minocycline had been prescribed to all household contacts within a maximum of one day after admission of the primary patient. RESULTS: There were 5 secondary cases (SAR: 0.3%). Chemoprophylaxis was prescribed to 627 of 1130 household contacts (55%). Of those the prophylaxis was considered appropriate in 46%. 2 secondary cases were not given any prophylaxis, 2 received penicillin and 1 rifampicin. Of the primary patients, 6% were given prophylaxis during their hospital stay. All meningococci, isolated from pairs of secondary and primary patients, were rifampicin sensitive. CONCLUSIONS: The SAR of meningococcal disease in the Netherlands is similar to that in other countries. Although prescription of chemoprophylaxis is not recommended by the government, it is prescribed to 55% of the household contacts, and in almost half of these instances it was considered to be appropriate. Chemoprophylaxis is rarely prescribed to primary patients. Recommendations concerning chemoprophylaxis in the Netherlands are in need of reappraisal. Based on the results from this study and the literature, the prescription of chemoprophylaxis to all household contacts of a patient with meningococcal disease, and to the index patient, is recommended.
Adult↗
Meningococcal disease in The Netherlands, 1958-1990: a steady increase in the incidence since 1982 partially caused by new serotypes and subtypes of Neisseria meningitidis.
In order to explain a threefold increase in the incidence of meningococcal disease in the Netherlands during the 1980s, we serotyped and subtyped Neisseria meningitidis isolates recovered between 1958 and 1990 from > 3,000 patients with systemic disease. No single strain could be held responsible for the increase. Apart from the newly introduced strain B:4:P1.4, which became the most prevalent phenotype in 1990 (21% of all isolates), the majority of the cases in 1990 were caused by many different strains that were already present in the Netherlands before 1980. For the period 1980-1990, a shift in the age distribution of patients with meningococcal disease from younger to older age categories was found, particularly with regard to cases due to meningococci of serogroup B; this shift is explained by the changing distribution of serotypes and subtypes within serogroup B. A polyvalent group B, class 1 outer-membrane-protein vaccine of a stable composition could theoretically have prevented approximately 80% of all group B meningococcal infections in the Netherlands during the past 30 years.
Adolescent↗
A prospective, population-based study of Haemophilus influenzae type b meningitis in The Gambia and the possible consequences.
A prospective population-based field study on Haemophilus influenzae type b (Hib) meningitis was carried out in The Gambia, West Africa. The annual incidence was 60 cases/100,000 children less than 5 years old and 297 cases/100,000 less than 1 year. The peak incidence was in those 5 months old, and 45% of cases occurred in those less than 6 months. The case fatality rate was 37%. Because the outcome did not appear to be affected by the logistics of receiving care, and resistance to chloramphenicol and ampicillin is not yet a problem, prevention of Hib disease at an early age seems the best solution. There are several options for vaccine trials. On the basis of available data, at least one of these trials seems warranted before Hib vaccination can be introduced in developing countries. Extrapolation of successful results in industrialized countries to a population of different genetic origin and living under different conditions seems questionable.
Age Factors↗
Molecular epidemiology of Haemophilus influenzae type b in the Gambia.
One hundred two invasive and 64 noninvasive isolates of Haemophilus influenzae were collected in the course of a 2-year prospective field study on the epidemiology of H. influenzae meningitis in The Gambia. The isolates were serotyped, biotyped, and subtyped by outer membrane protein (OMP) profile analysis (OMP subtyping). H. influenzae meningitis was found to be caused by serotype b (95%). In invasive disease, serotype a, although present in the throat of healthy children, caused only occasionally (5.9%) disease. The distribution of biotypes of H. influenzae appeared to be very similar to that found outside The Gambia. A distinct pattern of OMP subtypes, different from other parts of the world, is prevalent in H. influenzae type b (Hib) in The Gambia. OMP subtypes 2, 4, 5, 8, and 9 were observed to be predominant. These subtypes, except subtype 2, have not been described. L subtypes (subtypes 2, 4, and 8) were associated with invasive disease, whereas non-L subtypes (subtypes 5 and 9) were found more often in healthy carriers (P less than 0.001). A significant difference in geographical distribution was found in subtypes of noninvasive Hib strains (P less than 0.05). We conclude that in The Gambia H. influenzae invasive disease is caused mainly by type b strains with a limited number of OMP subtypes, which are different from the subtypes found elsewhere in the world. These data are important for the surveillance of Hib disease in developing countries and are baseline data for a Hib polyribosyl-ribitolphosphate-conjugated vaccine trial in The Gambia. Alternative Hib OMP vaccines should include a set of representative OMPs.
Bacterial Capsules↗
World-wide epidemiology of Haemophilus influenzae meningitis; industrialized versus non-industrialized countries.
The epidemiology of Haemophilus influenzae meningitis in non-industrialized areas shows considerable differences from that in the industrialized world. The incidence rates among Alaskan Eskimos, Navaho and White Mountain Indians, Australian Aboriginals and among populations in Africa such as Gambians and Senegalese are three- to fourfold higher than those in the USA and up to ten times higher than those in Europe. The peak age in populations with a high incidence is around 5 to 6 months of age compared to 9 months of age in other countries. The case fatality rate (CFR) is not related to the state of industrialization but seems to be more dependent on the accessibility of health care facilities. Africa the CFR is about ten times higher than that seen elsewhere. Apart from other dissimilarities such as the pattern of serotypes causing disease and the transmission rate, the epidemiology of Hib disease is sufficiently different from industrialized areas that it demands a thorough testing of a conjugated Hib vaccine before it can be introduced on a large scale in populations in non-industralized areas.
Age Factors↗
[Meningococcal disease in the winter season 1988-1989].
We describe the 304 cases of meningococcal disease notified from week 45 of 1988 and up to week 21 of 1989, and compare these data with those for 1966, the year of the last epidemic in The Netherlands. During the epidemic the interval between the first day of illness and the moment of reporting shortened.
Adolescent↗