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Biomedical subjects

J Kjellander

Publications and source records attributed to J Kjellander.

At least 19 recordsLinked to original sources
PubMed1992

Outbreak of group A streptococcal infection in a day-care center.

During an outbreak of streptococcal infections in a day-care center it is often difficult to determine the source and extent of the outbreak and the optimal means of management. An intervention strategy based on repeated throat cultures and initial antibiotic treatment of culture-positive individuals was used during an outbreak of respiratory tract infections with Group A streptococci at a day-care center. The spread of streptococci carriers was studied. Two weeks after the diagnosis of the index case, 61% of the 30 children were colonized with Group A streptococci. From 20 to 30% of the children remained streptococcal carriers, but they did not give rise to secondary cases. Initially the environment was heavily contaminated with Group A streptococci. Damp material might constitute a potential source of streptococcal spread. All Group A streptococcal strains belonged to the same serotype, T12M12. Prompt recognition and intervention are important to prevent spread of streptococcal infection to many day-care attenders.

Child↗
PubMed1990

A 10-year survey of clinically significant blood culture isolates and antibiotic susceptibilities from adult patients with hematological diseases at a major Swedish hospital.

In patients treated with cytotoxic drugs granulocytopenia and septicemia are commonly seen. In this 10-year survey 324 blood culture isolates from 184 patients with hematological diseases and septicemia were studied. The distribution of microbiological diagnoses in patients with hematological diseases as well as acute leukemia 1980-1986 was significantly different (p less than 0.01) from an unselected blood culture material from the same period. The differences are mainly seen between Enterobacteriaceae other than Escherichia coli, Pseudomonas aeruginosa and staphylococci. The microbiological spectrum for patients with hematological disease 1987-1989 was also significantly different (p less than 0.05) from the spectrum of the same group of patients 1980-1986 due to higher frequencies of coagulase-negative staphylococci and alpha-streptococci and lower frequency of E. coli in the latter period. 40% of the isolates were gram-positive cocci during the first period and increased to 50% during the second period. The susceptibility testing indicates that trimethoprim/sulfonamide is not as good a choice as ciprofloxacin or norfloxacin for oral antibiotic prophylaxis. For intravenous therapy imipenem/cilastatin or the combinations of an aminoglycoside/piperacillin or aminoglycoside/third generation cephalosporin have advantages over aminoglycoside/trimethoprim/sulfa in combination. However, addition of isoxazolylpenicillin or vancomycin now seems necessary to cover the increasing part of gram-positive bacteria causing septicemia in patients with hematological disease.

4-Quinolones↗
PubMed1988

Prevalence of Campylobacter pylori in an unselected Swedish population of patients referred for gastroscopy.

A survey of the prevalence of Campylobacter pylori in an unselected series of 117 patients referred for gastroscopy showed that 49.6% of the patients were infected. In 87% of infected patients both the antrum and the body of the stomach were involved. Duodenal infection occurred in only 9% of 102 studied patients. C. pylori could usually be demonstrated in mucosa showing signs of active chronic inflammation, whereas it was rarely found in histologically normal mucosa. The acridine orange staining method for demonstration of bacilli correlated well with bacteriology; identical results were obtained in 92.8% of the samples.

Adolescent↗
PubMed1985

In vitro effects of sulphasalazine, azodisal sodium, and their metabolites on Clostridium difficile and some other faecal bacteria.

The effects of sulphasalazine (SASP), azodisal sodium (ADS), and their metabolites were tested in vitro on aerobic and anaerobic faecal bacterial strains. Sulphapyridine (SP) had a mild to moderate effect on Escherichia coli and Streptococcus faecalis. SASP also had a growth-inhibitory effect on Strep. faecalis. The other substances had no effect on the aerobic strains. SASP, SP, 5-aminosalicylic acid, and, to a certain extent, N-acetyl-5-aminosalicylic acid exerted a growth-inhibitory effect on the anaerobic strains. Of special interest was the inhibitory effect on Clostridium difficile strains. In recent years the possibility that overgrowth of Cl. difficile could cause flare-ups of inflammatory bowel disease has been discussed. Some studies suggested that SASP treatment could predispose to Cl. difficile superinfection, whereas others found SASP more probable to exert a prophylactic effect. Our findings support the theory that SASP treatment reduces rather than promotes the risk of Cl. difficile superinfection.

Aminosalicylic Acids↗
PubMed1981

The effect of metronidazole and sulfasalazine on the fecal flora in patients with Crohn's disease.

Twenty patients with Crohn's disease were treated with metronidazole (Flagyl) or sulfasalazine (Salazopyrin). Before and during treatment quantitative and qualitative studies of the aerobic and anaerobic fecal bacterial flora were performed. After 1 week of metronidazole and 1 month of sulfasalazine treatment the median value of the Bacteroides concentration decreased drastically. After 4 months the Bacteroides concentration was still low in patients receiving metronidazole but normalized in patients receiving sulfasalazine treatment. The number of patients in whom the concentration of different bacteria in stool specimens showed changes during treatment of more than one 10log of colony-forming units (cfu) per gram wet weight (i.e. more than 90%) was calculated. A comparison between pretreatment samples and those taken at the end of treatment showed a statistically significant decrease of Bacteroides species (P less than 0.02) and a significant increase of fecal streptococci (P less than 0.02) in patients treated with metronidazole but not in patients treated with sulfasalazine. The relevance of these findings and the role of the bowel microflora for the pathogenesis of Crohn's disease is discussed.

Adolescent↗
PubMed1979

Culture diagnosis of meningococcal carriers: yield from different sites and influence of storage in transport medium.

Different specimens and techniques have been used in the diagnosis of carriers of Neisseria meningitidis, reflecting the uncertainty about the optimal diagnostic procedure. In the present investigation the culture yield of meningococci from throat specimens was compared to that from nasopharyngeal speimens in 178 persons: 44 carriers were diagnosed. All of them were detected by culture of throat specimens while 34% of them would have remained undiagnosed if only nasopharyngeal specimens had been examined. Storage of throat specimens in a transport medium for 24 hours before culture gave a negative culture for meningococci in 41% of the carriers. This loss was surprisingly high, the reasons for which are discussed.

Carrier State↗
PubMed1979

Changes in the fecal flora of patients with Crohn's disease during treatment with metronidazole. A preliminary report.

Six patients with Crohn's disease and three healthy volunteers were treated with metronidazole. Before and during metronidazole treatment quantitative and qualitative studies of the aerobic and anaerobic fecal bacterial flora were performed, and the minimal inhibitory concentration (MIC) values for metronidazole of the isolated bacteria were determined. There was no significant change in the fecal flora of the volunteers during metronidazole treatment, but three patients who clinically responded well to treatment had drastically changed their anaerobic flora. Two patients did not respond to the metronidazole therapy. The total anaerobic count for one of them was unchanged, and the number of isolated anaerobic species was high during the treatment. The total anaerobic counts of the other non-responder decreased, but metronidazole-resistant (MIC greater than or equal to 40 microgram/ml) Gram-negative rods remained in the fecal samples. Furthermore, after 2 months his condition worsened, and he was given corticosteroids and parenteral nutrition. The result in one patient with a moderate response to therapy was intermediate. Our observations may explain why some patients benefit from metronidazole therapy and others do not.

Adult↗
PubMed1979

Meningitis and bacteremia due to Neisseria meningitidis: clinical and laboratory findings in 69 cases from Orebro county, 1965 to 1977.

The records for 69 patients with meningococcal disease during 13 years in Orebro County were reviewed. The mean incidence during this period was 2.0/100 000 persons/year. The age group less than 1 year had the highest incidence, 15/100 000 infants/year. The mortality was 7.2% and sequelae were found in 13% of the patients. Four factors were significantly more frequent in the 7 patients with psycho-neurological sequelae: (1) Age greater than 40 years; (2) A condition prior to meningococcal disease that might have been associated with a lowered resistance; (3) Muscular hypertonia and/or marked irritability on admission; (4) Fever greater than 8 days after initiation of adequate treatment. Prodromal symptoms from the upper respiratory tract were noted in 50% of the cases. Signs and symptoms before and on admission, laboratory data and complicating events were analysed for each of 4 groups: meningitis without meningococcemia (12 patients); meningitis with meningococcemia (46): fulminant meningococcemia without meningitis (6); and benign meningococcemia (5).

Adolescent↗
PubMed1979

Investigation of the immune response to aerobic and anaerobic intestinal bacteria in a patient with Crohn's disease.

The immune response to aerobic and anaerobic intestinal bacteria in a patient with Crohn's disease with an intestinal fistula was investigated with various serological techniques. Two aerobic bacterial species, E. dispar and P. mirabilis, and four strict anaerobic bacterial species, B. fragilis ss. fragilis, F. varium and two different strains of C. perfringens, were isolated from fistula secretion of the patient. These strains were used as antigens for tube agglutination, passive hemagglutination, indirect immunofluorescence and immune hemolysis assays with serum specimens obtained before and after operation of the patient. Immune responses were demonstrated to the aerobic as well as to the anaerobic bacterial strains isolated from the patient's fistula. In connection with the operation an active immune response was demonstrated to the aerobic and anaerobic bacterial isolates. Antibodies belonging to IgG and IgA took part in the active immune response while IgM was very little involved. Antibodies responsible for passive hemagglutination reactions were resistant to treatment with beta-mercaptoethanol. Antibodies to aerobic and anaerobic Gram-negative rods were shown to have complement fixing activity. The importance of the demonstrated antibodies for the host's defence against normal intestinal microorganisms and the inflammatory reaction as a consequence of chronic antigenic stimulation in the diseased part of the intestine in patients with Crohn's disease is discussed.

Adult↗
PubMed1978

Use of a rapid fermentation test for indentification of anaerobic bacteria.

Rapid fermentation tests of carbohydrates were performed on 84 strains of anaerobic bacteria, and the result is compared with a commercially available micromultitest, API. An overall correlation of 87% was achieved between the two systems. The rapid fermentation test is easy to perform, since it is done aerobically, and easy to read. This study shows that RFT is useful in routine diagnosis of anaerobic bacteria, if it is used in combination with other relevant biochemical tests, morphologic examination, and gas chromatography.

Anaerobiosis↗
PubMed1978

Laboratory identification of pathogenic Neisseria with special regard to atypical strains: an evaluation of sugar degradation, immunofluorescence and co-agglutination tests.

Sugar degradation tests (SDT) were compared with immunofluorescence (IFL) and co-agglutination (COA) tests for the diagnosis of Neisseria gonorrhoeae (GC) and Neisseria meningitidis (MC). Somewhat more than 5% of the GC strains and 8% of the MC strains were misinterpreted by SDT. On most occasions the disagreement between SDT and serological tests was due to the inability of the MC strains (less so for GC strains) to degrade sugars correctly. Because of this, three out of 15 strains (20%) from pharyngeal specimens were primarily considered to be GC by SDT but were identified as MC by COA tests. Deficiencies in sugar degradations were also found in a group of clinical problem strains. Many of them were unable or had a decreased ability to degrade glucose or maltose but were diagnosed distinctly as MC by the COA test. There were no false positives with the IFL or COA tests, but 2% of the GC strains and 26% of the MC carrier strains (non-groupable) were not identified by COA. Both IFL and COA tests are good adjuncts to SDT for the diagnosis of GC and clinically significant MC, since the results are reliable and the tests rapid and simple to perform.

Agglutination Tests↗
PubMed1978

Bacteriological and clinical studies of sulbenicillin.

A new semi-synthetic penicillin, sulbenicillin, was evaluated with regard to clinical effect on infections caused by Pseudomonas aeruginosa and other bacteria, serum concentrations obtained after intravenous administration and antibacterial spectrum, in comparison with the closely related antibiotic carbenicillin. The antibacterial spectra of sulbenicillin and carbenicillin were similar but the MIC values were lower for sulbenicillin against most of the bacterial strains tested. The serum concentrations obtained after administration of 5 g sulbenicillin were significantly higher than those obtained after 5 g carbenicillin although no significant differences in serum half-lives were observed. The clinical effect of sulbenicillin--alone or alternating with carbenicillin--on pseudomonas infections with varying localisation was found to be good in 11 and fair in 3 of 16 treated patients. Two treatment failures were cases of chronic wound infection. In addition to the pseudomonas infections, 9 of the patients also had concurrent infections with other bacteria, e.g. pencillinase-producing staphylococci and Klebsiella, and in all these cases bacterial growth was eliminated during therapy. No serious side effects were observed during sulbenicillin treatment but some of the patients developed massive growth of fungi in the urine, which disappeared after the treatment was stopped.

Aged↗
PubMed1978

Antibiotic prophylaxis in operations on trochanteric femoral fractures.

Short-term prophylaxis against infection using cephalothin and cephalexin was studied in 140 patients operated on for trochanteric fractures of the femur. The group given the drug during preparation for anesthesia, intraoperatively, and for two days postoperatively had an infection rate of 1.8 per cent (one patient), whereas the group without prophylaxis had a rate of 16.9 per cent (twelve patients). The two groups were similar with regard to factors that may have influenced the infection rate, for example, age, time required for surgery, and blood loss. Staphylococcus aureus was the most common infecting organism, but several patients had mixed infections with intestinal bacteria.

Aged↗
PubMed1978

Culture diagnosis of gonorrhoea--a comparison between two standard laboratory methods and a commercial gonococcal culture kit (Kvadricult).

The efficiency of a commercial kit--Kvadricult--intended for the culture diagnosis of gonorrhoea and specially designed to simplify "bedside" inoculation, was compared in two laboratories with their standard laboratory gonococcal (GC) culture methods. The yields of specimens inoculated "bedside" were compared with those inoculated after transport for 4-18 hrs in a modified Stuart transport medium. The highest positive yield was obtained by "bedside" inoculation with approximately equal results for the conventional methods and the Kvadricult system. Compared with "bedside" inoculation, the loss of positive specimens after transport was less than 10% in one laboratory but more than 17% in the other, which was found to be due to inferiority of the GC medium used in this laboratory, the reasons for which are discussed. Prolonged transportation of specimens for 2 days increased the loss of positive specimens, rising to as much as 55% even at the laboratory with the more efficient GC medium. These losses can obviously be avoided by transport for less than 24 hours--or better still, by "bedside" inoculation. From this point of view we have found the Kvadricult system efficient and easy to handle.

Bacteriological Techniques↗