Biomedical subjects
Publications and source records attributed to M Kalin.
The case fatality rate among adults with community-acquired bacteremic pneumococcal pneumonia (Pnb) in Stockholm in 1984 was 11% (7/62), corresponding to an incidence of fatal Pnb of 0.5/100,000. This figure is low compared to data from the US and the UK, but corresponds well to our finding of a 7% mortality among patients with Pnb in a recent study covering part of the Stockholm population (2 hospitals).
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An enzyme-linked immunosorbent assay (ELISA) with a highly purified pneumolysin as the antigen was evaluated for serological diagnosis of pneumococcal pneumonia. One hundred four healthy controls were tested, and the specificity of the test was set to 95%. In samples from patients with bacteremic pneumococcal pneumonia, 82% (18 of 22) were positive, i.e., at least one serum sample had a titer above the upper normal limit or at least a twofold rise in antibody titers was noted. In nonbacteremic pneumococcal pneumonia, 45% (21 of 47) of samples were positive. All sera were negative for patients with pneumonia caused by Haemophilus influenzae, Legionella pneumophila, Chlamydia psittaci, and influenza A virus. However, in patients with a diagnosis of Mycoplasma pneumoniae infection, 8 of 25 (32%) samples were positive for antibodies to pneumolysin. All sera, including those from patients with mycoplasma infection, were negative to a protein control antigen by ELISA. Serum immunoglobulin G response to pneumolysin as measured by ELISA might thus be an aid in the laboratory diagnosis of pneumococcal pneumonia. This assay may also help to further elucidate the occurrence of dual infections with pneumococci.
The IgG and IgM type specific anticapsular pneumococcal antibody titres were studied with ELISA during one year following vaccination with a 14-valent pneumococcal polysaccharide vaccine in four different patient groups: 41 children splenectomized after a traumatic rupture, 16 splenectomized because of disease, 15 non-surgically managed after splenic rupture, and 19 healthy controls. Serum samples were obtained before vaccination and after 14, 60, 180, and 360 days. The IgG antibody responses were equally good in all of the patient groups, while the IgM antibody responses were less pronounced in the splenectomized. In the non-surgically managed patients, the IgM antibody titres after vaccination, as well as antibody responses per se, were significantly higher for all 12 pneumococcal types studied than in the patients who were splenectomized. Both the IgG and the IgM antibody titres were highest at 14 days after vaccination. However, while the IgG titres for most pneumococcal types remained elevated at 360 days, the IgM titres soon fell to prevaccination levels. The antibody response was less good for the types 3 and 6 A. The results indicate that the IgG antibody response to pneumococcal polysaccharide vaccination is unaffected in splenectomized individuals, but the IgM antibody response is decreased. In patients with a healed traumatically damaged spleen, both the IgG and IgM responses seem to be normal.
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The enzyme linked immunosorbent assay (ELISA) was used for estimation of the IgG and IgM antibody responses against 13 type specific pneumococcal capsular polysaccharides, individually and in a pool, in 52 patients with pneumococcal pneumonia and in 20 control patients with non-pneumococcal pneumonia or enterobacterial septicemia. By use of the isolated type 3 polysaccharide as antigen a greater than or equal to 50% increase in absorbance from acute to convalescence phase serum, equivalent to a doubling in antibody titer, was seen significantly more often in 22 patients with type 3 pneumococcal pneumonia than in the 20 control patients (for IgG 14 vs. 3, p less than 0.01; for IgM 14 vs. 4, p less than 0.01). However, for an acceptable degree of specificity to be obtained (less than or equal to 10% control patients positive) a doubling of the IgG or IgM absorbance values had to be demanded. With this criterium only half of the patients infected with pneumococcal types included in the antigen set up used, showed a type specific antibody response and only one third of all patients with pneumococcal pneumonia could be diagnosed by use of the 13 polysaccharides as a pool antigen.
Recurrent epidemic spread of beta-hemolytic streptococci of Lancefield group A was seen in our maternity wards during a period when 70% ethanol was used for umbilical care. This prompted us to compare this regimen with one using 4% chlorhexidine in detergent for a period of 9 consecutive months. 2016 infants were studied. Umbilical colonization with group A, C and G streptococci was almost eliminated by use of 4% chlorhexidine in detergent and epidemic spread was not seen. Colonization rate of Staphylococcus aureus at the umbilical cord was reduced from 92% to 27%. The incidence of superficial infections during the first 4 postnatal weeks was reduced. Following the 9 months of comparative study 4% chlorhexidine in detergent has been routinely used in umbilical cord care at our hospital for more than 1 year without any epidemic spread of streptococci and with the same antibacterial efficiency.
Of 191 consecutive clinical isolates of Streptococcus pneumoniae tested for antibiotic susceptibility with the agar dilution technique 87% were fully sensitive to all of 11 antimicrobial agents examined. 90% of the strains were inhibited by 0.016 micrograms/ml of benzylpenicillin, by 0.032 micrograms/ml of ampicillin, cefuroxime, erythromycin, clindamycin or rifampicin, by 0.13 micrograms/ml of cephalothin, oxacillin or doxycycline, by 4.0 micrograms/ml of chloramphenicol and by 8.0 micrograms/ml of cotrimoxazole. 18 strains exhibited a reduced susceptibility to one (11 strains) or more (7 strains) of erythromycin, doxycycline, chloramphenicol and cotrimoxazole. One of these strains also showed a reduced susceptibility to all 5 examined beta-lactam antibiotics, as did another 4 strains. Two of these 5 strains were isolated from small children recently adopted from 2 Asian countries. Cotrimoxazole-resistant strains were significantly more often isolated from children 1 yr of age or less than from older patients. All strains were fully sensitive to clindamycin and rifampicin. The existence of pneumococcal strains with resistance or reduced susceptibility to antibiotics commonly used for treatment of pneumococcal infections is important to bear in mind and necessitates antibiotic susceptibility testing of strains isolated from patients with severe infections.
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An enzyme-linked immunosorbent assay (ELISA) was developed for determination of the IgA, IgM and IgG antibody responses against a lipopolysaccharide antigen representing Shigella sonnei phase I bacteria. Two or more sera from 33 patients infected with Shigella sonnei were collected during a 12 month period after onset of the disease. Convalescent sera from 56 patients with other enteric infections (salmonellosis, yersiniosis, campylobacteriosis) and sera drawn from 40 healthy blood donors served as controls. Twenty-eight of the 33 patients (85%) had at least one serum specimen where two or three of the immunoglobulin titres were classified as positive (greater than + 2SD above mean titres seen in healthy blood donors), whereas only ten of 56 patients (18%) with other enteric infections had similarly elevated titres (p less than 0.001). The Shigella sonnei ELISA using purified lipopolysaccharide as antigen is considered more sensitive and specific than the formerly used agglutination tests.
Sputum samples from 151 patients admitted to Roslagstull Hospital for Infectious Diseases, Stockholm, from Sept. 1978 through May 1979 with acute community-acquired lower respiratory tract disease and roentgenological evidence of acute pneumonia were examined by direct microscopy of gram-stained smears and semiquantitative culture. It was carefully noted if the specimen was collected before or after initiation of antibiotic therapy. For an estimate of the suitability of the samples for bacteriological examination 2 criteria were applied: (i) presence of alveolar macrophages, and (ii) purulence, i.e. a ratio leukocytes/squamous epithelial cells of greater than 5. The latter was found to be a good indicator of sample suitability, while the presence of macrophages was not. Of the 266 samples examined 76% were deemed purulent. Potentially pathogenic bacteria in numbers of greater than or equal to 10(5) colony forming units/ml were found in 67% of the purulent sputum samples obtained before antibiotic therapy but in only 36% if such treatment had already been started. Pneumococci were isolated from 52% of pre-treatment samples but from only 8% after treatment. H. influenzae was found as often in post-treatment samples (17%) as in pre-treatment ones (15%) and enteric gram-negative rods twice as often in post-treatment samples (11 vs. 6%). The use of gram-stained smears was a valuable aid in the interpretation of the culture results and the results could be made available to the clinician within minutes after receipt of the specimen. The results were in agreement with those of the cultures for about 75% of the purulent samples.
Attempts to demonstrate Streptococcus pneumoniae, or its soluble type-specific polysaccharide antigen were made on specimens from 205 patients with acute community-acquired pneumonia by (i) blood, nasopharynx and sputum culture, (ii) counterimmunoelectrophoresis (CIE) of serum, urine and sputum specimens utilizing omni-, pool- and type-specific rabbit antisera, and (iii) microscopy of gram-stained sputum smears. Pneumococci could be cultured and/or pneumococcal antigen detected in specimens from 93 (45%) of the patients with the following frequencies in samples obtained before (and after) start of antimicrobial treatment: culture from blood 25% (6%), nasopharynx 59% (18%) and sputum 80% (13%), CIE on serum 3% (9%), urine 8% (18%), urine 20X concentrated 18% (24%), and sputum 56% (56%). Microscopy of sputum smears revealed pneumococci in 65% (17%) of the 93 patients. The value of cultures from blood and sputum was most evident when the samples were obtained early in the course of the disease. With nasopharynx culture and CIE on sputum the number of positive results was doubled if the sampling was repeated. For rapid diagnosis direct Gram stain and CIE on sputum were about equally effective and also strikingly complementary, alone diagnosing 42% and 48% of the patients, respectively, but together detecting 65% of them. Gram stain was most rewarding on early pretreatment samples and CIE on post-treatment samples.
Isolates of Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus pyogenes and Branhamella catarrhalis were collected from five laboratories in different geographical areas in Sweden. Nine hundred and fortyfour strains were tested by the agar dilution method for susceptibility to seven oral antibiotics: phenoximethylpenicillin, ampicillin, cefaclor, erythromycin, doxycycline, trimethoprim-sulfamethoxazole and chloramphenicol. The H. influenzae and B. catarrhalis strains were also tested for beta-lactamase production. Of the H. influenzae strains, 8% were beta-lactamase-producing, while 35% of B. catarrhalis strains produced beta-lactamase. The latter value is higher than has earlier been reported in Sweden. Five S. pneumoniae strains showed decreased sensitivity to penicillin, and 9.5% of the S. pneumoniae strains showed a decreased sensitivity to one or more of the seven antibiotics tested. The S. pyogenes strains were sensitive to all the antibiotics tested with the exception of 4% of the strains, which showed a decreased sensitivity to doxycycline.
A comparison was made of the methods of coagglutination (using sensitized staphylococci) and counterimmunoelectrophoresis with regard to (i) sensitivity in detecting capsular polysaccharides from 14 different types of pneumococci, and (ii) sensitivity and specificity in detecting pneumococcal antigen in sputum samples from patients with pneumonia. Counterimmunoelectrophoresis was 20-150 times less sensitive than coagglutination in detecting purified type 7F and 14 polysaccharide preparations, and was as sensitive as or slightly more sensitive than coagglutination in detecting the other 12 polysaccharide types. Of 331 sputum samples examined, 94 were antigen positive, 87 by coagglutination and 76 by counterimmunoelectrophoresis; strong reactions were obtained with 85 and 63 samples, respectively. Moreover, with counterimmunoelectrophoresis 24 samples gave rise to probably non-specific precipitates, while with coagglutination either a strong positive or an unequivocally negative result was obtained in all but six samples. It is concluded that coagglutination is not only simpler and faster than counterimmunoelectrophoresis, but also appears to be more specific and sensitive for the detection of pneumococcal antigen in sputum samples.
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A 22-year-old woman had a remarkable late and poor inflammatory response to pneumococci invading the cerebrospinal fluid. Splenectomy 5 years previously following trauma and oral doxycycline therapy for 4 days prior to admission may explain the usual course. The importance of correct handling and of giving proper information to the splenectomized patient is stressed.
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