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Biomedical subjects

K Alestig

Publications and source records attributed to K Alestig.

At least 19 recordsLinked to original sources
PubMed1992

Incidence, serogroups and case-fatality rate of invasive meningococcal infections in a Swedish region 1975-1989.

In a retrospective study of invasive meningococcal infections in Greater Gothenburg, Sweden, 213 cases of culture-verified meningitis or septicaemia were identified during the 15-year period 1975-1989. The annual incidence was 2.0/100,000. Cases were seen in all age-groups with the highest rates in the 0-4 and 15-19 year-old groups, 9.5 and 6.2/100,000 respectively. 20% of the patients were less than 2 years. 91% of the patients had no known risk factors. In only 10 cases (5%) was contact with another case of meningococcal infection known. The main clinical manifestations were meningitis (57%), septicaemia with no sign of focal infection (25%) and septic shock (17%). The case-fatality rate for all the patients was 6.6% and did not change during the 15-year period. One-third of the patients who presented with septic shock died. The serogroup was known for strains from 192 patients. 51% of the strains belonged to serogroup B, 10% to group A and 23% to group C. In conclusion, the incidence of meningococcal infection was low but the relatively high case-fatality rate warrants a search for effective prophylaxis. About 30% of the cases were potentially preventable by the currently available tetravalent (A, C, Y and W135) polysaccharide vaccine, which is immunogenic in children greater than 2 years. Widespread use of antibiotic prophylaxis to close contacts of known cases would not lower the incidence markedly.

Adolescent↗
PubMed1990

Neurovirulence of herpes simplex virus types 1 and 2 isolates in diseases of the central nervous system.

Herpes simplex virus (HSV) isolates derived from the central nervous system of ten patients with HSV-1-induced encephalitis, one patient with multiple sclerosis, and 14 patients with HSV-2-induced meningitis were investigated for neurovirulence by assaying the LD50 after nose and intracerebral (i.c.) inoculation of mice. HSV-1 encephalitis strains were significantly more virulent after nose inoculation (i.e. neuroinvasive) when compared with HSV-1 isolates from patients with oral lesions only, whereas HSV-2 meningitis strains were significantly more virulent after i.c. inoculation when compared with HSV-2 isolates from patients with genital lesions only. No correlation between high neurovirulence (defined as low LD50 for both routes of infection) and replication in cell cultures of neuronal and non-neuronal cell lines was found, but the weakly neurovirulent HSV-1 strain isolated from a patient with multiple sclerosis gave low replication yields. After nose inoculation, a highly neuroinvasive HSV-1 laboratory reference strain replicated to high titers in nose tissue, the trigeminal ganglia and brainstem, while a strain with low neuroinvasiveness but high i.c. virulence replicated less well in the brainstem. Neuroinvasiveness of the virus strain might be one factor of relevance in the pathogenesis of HSV-1 encephalitis in man.

Animals↗
PubMed1990

Primary and recurrent herpes simplex virus type 2-induced meningitis.

In 27 patients with a first episode of herpes simplex virus type 2 (HSV-2)-induced meningitis, confirmed by virus isolation from the cerebrospinal fluid (CSF) or seroconversion to HSV-2, initial neurologic complications were found in 10 (37%) but subsided before 6 months in all patients. Long-term complications were recurrent meningitis in 5 (19%) and periodic headache related to genital HSV recrudescences in 4 (15%). Seven additional patients had possible HSV-2-induced recurrent meningitis. In contrast to the first episode of meningitis, virus isolation, HSV antigen detection, and IgG analyses in consecutive serum samples were of no diagnostic value in episodes of HSV-2-induced recurrent meningitis. Instead, immunoblotting was used to assay intrathecally produced IgG antibodies to the HSV-2 type-specific protein gG-2 in recurrent meningitis, when CSF was collected at a minimum of 3 days after onset.

Antibodies, Viral↗
PubMed1990

A prospective study of neutropenia induced by high doses of beta-lactam antibiotics.

A prospective study on the effect of beta-lactam antibiotics on granulopoiesis was carried out in 29 consecutive patients with bacterial endocarditis. Fourteen patients received a high dose of benzylpenicillin, up to 18 g/day, but in only three of them could the treatment be fulfilled as planned, for a mean time of 25 days. In 11 benzylpenicillin treated patients treatment had to be discontinued because of fever, rash or neutropenia. Neutropenia appeared in seven patients after 14-24 (mean 22) days. No superinfection occurred during the neutropenic phase which lasted 2-12 days. Patients with neutropenia differed significantly from others in having a lowered pretreatment neutrophil count (3.2 vs 10.4). In 15 patients treated with other beta-lactams, three cases of fever and rash and one case of neutropenia were seen in patients treated with cloxacillin 12 g daily. It was concluded that a daily dose of 18 g of benzylpenicillin is too high for longer treatment periods and that patients with initial low counts of neutrophils have an increased risk of developing neutropenia.

Adult↗
PubMed1990

Treatment of primary and recurrent herpes simplex virus type 2 induced meningitis with acyclovir.

We describe therapy with acyclovir in 1 patient with acute meningitis induced by herpes simplex virus type 2 (HSV-2) and in 1 patient with ascending myelitis in connection with meningitis after a primary genital HSV-2 infection. In addition, intermittent or continuous acyclovir prophylaxis against meningitis was employed in 3 patients with recurrent meningitis of probable HSV-2 etiology. Possible beneficial effects of the treatment were seen.

Acyclovir↗
PubMed1990

The pharmacokinetics of oral quinolones (norfloxacin, ciprofloxacin, ofloxacin).

The newer fluoro-quinolones including norfloxacin, ciprofloxacin and ofloxacin are all characterized by a good penetration into tissues and cells. In contrast to beta-lactam antibiotics, these quinolones often achieve tissue concentrations which are several times higher than concurrent serum levels. Therefore, MIC values should not be related to serum concentrations only, when possibilities for the use of quinolones in tissue infections are discussed. Following oral administration, norfloxacin and ciprofloxacin are well absorbed and the bioavailability of ofloxacin is almost 100%. Absorption is delayed but not reduced by food. Ofloxacin is mainly excreted unchanged; norfloxacin and ciprofloxacin are metabolized to some extent, but most metabolites are biologically active. Half-lives of the drugs are 3-6 hours and they may therefore be administrated twice daily. These quinolones are excreted by glomerular filtration and tubular secretion but also via faeces. Dose reduction is needed only in patients with severe reduction of kidney function. It has been suggested that when renal function is reduced an increased transintestinal passage of the quinolones may result. In the intestines the quinolones seem to be bound to faeces; anaerobes are mainly unaffected by these antibiotics.

Administration, Oral↗
PubMed1989

Short-term self-treatment of travellers' diarrhoea with norfloxacin: a placebo-controlled study.

In a randomized, double blind, placebo-controlled, multicentre trial, 447 travellers to Africa, Asia or Latin America started three days treatment with norfloxacin 400 mg bd or placebo within 24 h after the onset of travellers' diarrhoea. One hundred and four subjects developed diarrhoea and of those 94 (46 in the norfloxacin group and 48 in the placebo group) could be analysed for efficacy. By the last treatment day, 34 patients in the norfloxacin and 18 in the placebo group were cured (P = 0.0001), four and three improved and five and 19, respectively, were failures. Recurrences were seen in three patients on norfloxacin and eight on placebo. The mean time to cure was 3.2 days in the norfloxacin group and 4.4 days in the placebo group (P less than 0.005). The number of loose stools was significantly lower in the norfloxacin group. Nine adverse events were reported; seven in the placebo and two in the norfloxacin group. Pre- and post-travel faecal samples were studied in 19 patients treated with norfloxacin, 21 treated with placebo and 21 untreated subjects without diarrhoea. In treated subjects, increased frequencies of Escherichia coli resistant to ampicillin, co-trimoxazole, doxycycline and chloramphenicol were found in both groups, though more frequently in the placebo one. No subject had norfloxacin resistant Esch. coli pre- and post-travel.

Adolescent↗
PubMed1989

Campylobacter strains from Swedish patients with diarrhoea. Distribution of serotypes over a five year period.

Serotyping, HS antigen and HL antigen, was performed on 105 Campylobacter jejuni/coli isolates from the same number of consequtive patients seeking medical attention for diarrhoea. The results were compared to a similar study performed five years earlier. It was found that there were only minor differences in frequency of the serotypes commonly isolated during the two different periods.

Antigens, Bacterial↗
PubMed1988

Efficacy and safety of cefpirome (HR810).

Sixty adult patients with suspected systemic bacterial infections were treated with cefpirome 1 g or 2 g twice daily for 5-22 days. Forty-seven patients were evaluable for clinical efficacy. Diagnoses in evaluable patients were urinary tract infections (20), pneumonia (10), soft tissue infections (17), and bone and joint infections (4); four patients had two infections each. Nine patients were bacteraemic and all were cured; the responsible bacteria were Escherichia coli (6), Streptococcus pneumoniae (1), Pseudomonas aeruginosa (1), and Haemophilus influenzae (1). One patient with a soft tissue infection failed to respond clinically to cefpirome. Bacteriologically, 41 of 48 isolated pathogens (85%) were eradicated. In wound cultures, three strains of Staphylococcus aureus and one each of Ps. aeruginosa and Str. faecalis persisted. One Enterobacter sp. relapsed in urine. Of isolated strains, only Str. faecalis and methicillin resistant Staph, epidermidis were resistant to cefpirome. Staph, aureus strains were inhibited in vitro by 0.25 to 2 mg/l of cefpirome in agar dilution. Adverse effects, probably or possibly related to cefpirome, were skin reactions (3), fever (1), Clostridium difficile diarrhoea (2), and disturbed taste sensation (1). Tolerance was good. Cefpirome is suitable for large-scale comparative trials.

Adult↗
PubMed1988

Prediction of glomerular filtration rate from changes in serum creatinine.

The glomerular filtration rate (GFR) was estimated from serum creatinine concentration in patients in whom the individual relation between GFR and serum creatinine had been previously determined. 51Cr-EDTA plasma clearance was used as reference method for GFR. The relation between 51Cr-EDTA clearance and estimated GFR was determined from 340 investigations in 197 adult patients with a variety of infectious and internal diseases. The imprecision of estimated GFR was 46% (1 CV) at 20 ml/min, 23% at 45 ml/min, 20% at 75 ml/min and 18% at 110 ml/min. This poor precision was probably due to the fact that many patients with acute infectious diseases, congestive heart failure, diabetes mellitus, etc., have an unstable renal function and therefore their creatinine distribution is not under steady state. This must always be considered when serum creatinine is used to estimate GFR.

Chromium Radioisotopes↗
PubMed1988

The use of doxycycline in nervous system Borrelia burgdorferi infection.

Alternatives to high dose benzylpenicillin treatment are sought for in patients with mild Borrelia burgdorferi nervous system infection. Doxycycline 100 mg twice daily for 10-20 days was used in nine patients with radicular pains, vertigo or weakness in the legs caused by B. burgdorferi infection. The patients had suffered from neurologic symptoms for a median time of five months. In eight patients doxycycline was orally administered and in one intravenously. All nine patients had remission of radicular pain and vertigo during the treatment period. Two patients with weakness in the legs improved slowly in muscle strength over a three month period. The doxycycline concentration in the cerebrospinal fluid was 0.2-1.0 mg/l and in serum 1.9-7.1 mg/l after five days treatment. Doxycycline treatment was found successful in our patients with mild tick borne neuroborreliosis.

Adult↗
PubMed1987

Treatment of septicaemia in immunocompromised patients with ceftazidime or with tobramycin and cefuroxime, with special reference to renal effects.

Fifty-two immunocompromised patients with suspected septicaemia were randomized on 61 occasions to treatment with ceftazidime or with tobramycin and cefuroxime. Most (90%) of the patients had haematological malignancies and were neutropenic (granulocytes less than 1 X 10(9)/1 in 40 of the 61 episodes). Blood cultures were positive in 22 (39%) febrile episodes and in four other instances positive cultures were obtained from other sources. Clinical cure or improvement was noted in 10 of 12 culture verified infections in the tobramycin and cefuroxime group and 11 of 14 episodes in the ceftazidime-group. The effect on the kidney of the two antibiotic regimens was studied by following the serum levels of creatinine, urea and beta 2-microglobulin and the urinary excretion of alanine aminopeptidase, N-acetyl-beta-D-glucosaminidase (beta-NAG) and beta 2-microglobulin. No clinically important renal side effects were observed. However, an increase in the urinary excretion of AAP was seen in both groups with significantly greater elevation in the tobramycin and cefuroxime group. Urinary beta-NAG increased only in the tobramycin and cefuroxime group.

Adult↗
PubMed1987

Prediction of glomerular filtration rate from serum creatinine, age, sex and body weight.

The accuracy and precision of estimates of glomerular filtration rate (GFR) from serum creatinine, age, sex and body weight using the methods proposed by Cockroft and Gault and by Siersbaeck-Nielsen et al, were determined in 234 subjects on 574 occasions. The two methods gave almost identical estimates of GFR. As reference for determination of GFR plasma clearance of 51Cr-EDTA as described by Bröchner-Mortensen was used. The estimates of GFR gave a systematic deviation of about 10 ml/min and a precision of about +/- 15 ml/min (1 SD) in the GFR range between 30 and 90 ml/min.

Adult↗
PubMed1987

Culture from epipharynx of little value in bacterial pneumonia.

In 75 patients with acute pneumonia of moderate severity a comparative study between transtracheal aspiration (TTA), sputum culture and epipharynx culture was carried out. Organisms considered as the probable etiological agent were found in 53% with TTA. The same organisms were found in only 27% in sputum samples and in 21% in epipharynx samples. No serious complications with TTA was noted.

Adult↗