PubMed Health⌕ Search

Biomedical subjects

P M Schneeberger

Publications and source records attributed to P M Schneeberger.

At least 19 recordsLinked to original sources
PubMed2006

[Two patients with mumps].

Two patients, men aged 17 and 19 years respectively, were admitted with parotitis epidemica and orchitis caused by mumps. The second patient also had meningitis. PCR analysis revealed that, in both cases, the causative agentwas a mumps virus that was genetically related to a wild-type virus responsible for an outbreak in Singapore. This viral strain was also responsible for a mumps outbreak at Hotel School The Hague in September 2004. Both patients were not fully vaccinated. Both patients were from regions in which clustering of patients with clinical signs of mumps has been seen. Interestingly, a number of patients with confirmed mumps had been fully vaccinated. Possible explanations for the increase in mumps cases include low vaccination and immunity levels, primary and secondary vaccine failure and the emergence of genetically disparate mumps viruses.

Adolescent↗
PubMed2006

[Two patients with Hantavirus infection in The Netherlands; substantial increase in incidence in neighbouring countries].

A 12-year-old girl and a 57-year-old woman were admitted with fever, general malaise, abdominal pain, nausea and vomiting. Both patients had acute renal insufficiency based on tubulointerstitial nephritis caused by the genus Hantavirus, which was confirmed by blood tests. Both patients recovered spontaneously. The neighbouring countries of France, Germany and Belgium have recently reported 2- to 7-fold increases in the number of Hantavirus infections. Hantavirus is a zoonotic viral disease that is transmitted by mice and is found in humans worldwide. Infection with Hantavirus is associated with severe renal impairment and thrombocytopenia, which usually resolves spontaneously. Recognition of the clinical signs and targeted serological testing can lead to adequate management of the disease. Diagnosing patients with Hantavirus infections will also help to prevent infections in The Netherlands and track epidemiological changes.

Abdominal Pain↗
PubMed2006

Quality control for handling of accidental blood exposures.

A regional counselling service was established to handle all accidental blood exposures using a standardized protocol. Levels of risk were assessed using an algorithm. Accidents that posed a risk for the transmission of hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV) were classified as 'high risk', whereas accidents that posed a risk for HBV alone were classified as 'low risk'. Medical interventions were implemented according to the level of risk. During a one-year period, all accidents were registered and analysed for adherence to the standard protocol. In 2003, the centre handled 454 incidents. Of these, 36 (7.9%) incidents were assessed as no risk, 329 (72.5%) were assessed as low risk, and 67 (14.8%) were assessed as high risk. Due to incomplete registration, 22 (4.8%) incidents could not be analysed further. In total, 36% of the incidents with risk for HBV transmission and 40% of the incidents with risk for HCV and HIV transmission were not handled according to the proposed protocol. Breaches consisted of over-reaction (25/396) as well as insufficient response (123/396). Potentially inadequate treatment occurred for HIV postexposure prophylaxis in 12 of 63 incidents. Incomplete follow-up for HCV occurred in 11 of 63 incidents, and lack of HBV immunoglobulin administration occurred in five of 396 incidents, including three high-risk incidents. In 21 of 396 low-risk exposures, the breaches in protocol resulted from late reporting. It remains difficult to achieve an acceptable level of standardized care when using standard operational procedures. Documentation and evaluation of flaws are essential to improve the system.

Accidents↗
PubMed2006

Differences between hospital- and community-acquired blood exposure incidents revealed by a regional expert counseling center.

OBJECTIVE: One year (2003) regional analysis of all blood exposure incidents from hospitals as well as from the community. DESIGN: Establishment of an easily accessible regional expert counseling center, operating 24 h a day, for all accidental blood exposures. Tasks of the center were to register incoming calls, to inform and counsel the victim, to assess the risk of the incident, and to provide a plan of further actions, including prophylactic measures. SETTING: A Dutch region (Northeast Brabant) with 500,000 inhabitants and two major hospitals (1,786 beds). RESULTS: A total of 454 incidents (1.2 per day) were recorded. Only half of the incidents occurred in the hospital setting (n = 234), whereas the others (n = 220) took place in the community setting. Nearly all (95%, n = 432) incidents occurred during work, and most of them (84%, n = 385) were related to health care activities. In the hospital setting injuries occurred with physicians (13%), nursing staff (45%), operating room (OR) staff (13%), ancillary (18%), others (10%). In the community setting, incidents took place among healthcare workers (48%), detention and police officers (10%), civilians (10%), general practitioners/dentists and their staff (8%), cleaning staff (4%) and work-related incidents not falling into any of the above categories (7%). More low risk incidents took place outside the hospital (87% vs. 68% in hospital), while high-risk incidents predominantly occurred within the hospital setting (23% vs. 6%). The hepatitis-B immunization rate was significantly lower in victims from the community than in those working in hospitals (38% vs. 96%). Reports from incidents in the community setting were delayed. CONCLUSIONS: Incidents that expose individuals to blood-borne pathogens occur equally frequent in the hospital and non-hospital (community) setting. Therefore, a regional expert counseling center, accessible around-the-clock, for all types of blood-exposure incidents is needed. Blood-exposure prevention programs should aim at a reduction of high-risk incidents within hospitals, and at increasing the awareness for vaccination and early reporting within the community setting.

Accidents, Occupational↗
PubMed2005

[Low prevalence of metronidazole- and clarithomycin-resistant Helicobacter pylori in the 's-Hertogenbosch region, 1998-2003].

OBJECTIVE: To measure the prevalence of metronidazole- or clarithromycin-resistant Helicobacter pylori. DESIGN. Retrospective. METHOD: All positive H. pylori cultures with known susceptibility to metronidazole or clarithromycin between 1998 and 2003 were selected from the database of the Microbiology Laboratory in 's-Hertogenbosch, the Netherlands. Resistance to clarithromycin and metronidazole was determined using the E-test with cut-off minimum inhibitory concentrations of > or = 2 microg/ml and > or = 8 microg/ml, respectively. RESULTS: Of the 960 cultures with known metronidazole susceptibility, 135 (14%) were resistant. Of the 959 cultures with known clarithromycin susceptibility, 26 (3%) were resistant. The percentages of resistant cultures were higher in women than in men (17% versus 12% and 4% versus 2%, respectively). There was no relationship between age and resistance. Over the course of the study period, resistance to metronidazole decreased slightly, whereas resistance to clarithromycin increased slightly. CONCLUSION: Prevalence of metronidazole- and clarithromycin-resistant H. pylori strains in the 's-Hertogenbosch region was so low that the combination of a proton pump inhibitor, clarithromycin and amoxicillin can be used in patients with H. pylori infection without first determining susceptibility.

Anti-Bacterial Agents↗
PubMed2005

[Hoarseness in a recent visitor to the tropics through infection of the larynx by Histoplasma capsulatum].

A 58-year-old man presented with hoarseness and a sore throat for the previous 3 months, which were caused by a laryngeal infection with the fungus Histoplasma capsulatum. He had been infected during a stay in Indonesia. Both his hoarseness as well as the Histoplasma antigen titres in serum responded to therapy with itraconazol. H. capsulatum is found in tropical and subtropical areas worldwide, but infections are most commonly reported from the south of the United States of America. If not asymptomatic, the disease most often presents with pulmonary symptoms. A histoplasmosis presenting as a laryngeal infection is relatively uncommon and can be mistaken for papillomatosis or carcinoma. The diagnosis can be made by microscopy and culture of the fungus; an antigen test is available in the United States.

Antifungal Agents↗
PubMed2005

[More and faster notification of infectious disease if notification is carried out by the laboratories instead of the diagnosing physician].

OBJECTIVE: To investigate if notification by the laboratories of a number of Group B diseases (meningococcal disease, whooping cough and hepatitis A) which according to the Communicable Disease Law of 999 must be reported to the local public health authority, would increase the number of reports and the speed at which the reports were made. DESIGN: Comparative study. METHOD: In the participating regions (Den Bosch and north-east Brabant) it was decided that the laboratories would notify the authorities of cases ofmeningococcal disease, whooping cough and hepatitis A. The notifications were compared with those from the middle-Brabant region which was used as a control. This took place in 1997/'98, prior to the start of the notification project and in 2000/'02 when it was running. The number of positive cases of infectious disease confirmed by the laboratories that were reported to the local health authorities and to the Inspectorate of Public Health Services was examined - this is known as the degree of notification. The number of days from diagnosis to notification of the local health authorities was also examined - this is known as the speed of notification. RESULTS: The degree of notification for these three diseases improved from 6I-89% to 87-95% if the authorities were notified by the laboratories. In the control region the degree of notification improved from 29-4I% to 54-60%. The speed of notification increased significantly if notification was done by the laboratories. CONCLUSION: Based on these results it is recommended that the Communicable Disease Law be adapted to allow the laboratories to notify the authorities of cases of infectious disease.

Communicable Disease Control↗
PubMed2005

Molecular epidemiology of hepatitis A in Noord-Brabant, The Netherlands.

BACKGROUND: Previous studies on the molecular epidemiology of hepatitis A virus (HAV) in Amsterdam, The Netherlands, show that subgenotype 1A is mainly seen among homosexual men practising anonymous oral-anal sex in saunas and darkrooms, while subgenotype 1B is usually detected among children originating from Morocco, and subgenotype 3A is mostly found among travellers to Pakistan. OBJECTIVE: We studied the genotype distribution in a more rural area of The Netherlands, Noord-Brabant, and compared it with Amsterdam. STUDY DESIGN: We collected blood and feces samples from 34 HAV IgM(+) individuals who were reported from August 2001-March 2003 at the Municipal Health Service (MHS) Heart for Brabant (Brabant). We also collected feces samples from nine household contacts of whom the HAV IgM status was not known. HAV RNA was isolated and subsequently amplified by reverse transcriptase polymerase chain reaction (RT-PCR) at the VP1-P2a and the VP3-VP1 region, sequenced and analysed. RESULTS AND CONCLUSIONS: In most cases, relations between risk groups and HAV subgenotypes in Noord-Brabant were similar to those in Amsterdam. Next to genotypes 1 and 3 we also detected a genotype 2/7 strain in a Noord-Brabant case. Also, in contrast to the Amsterdam study, sporadic transmission occurred among various risk groups. Children involved in a school-related outbreak were infected with strains identical to one that was previously isolated from a man who has sex with men (MSM). Also, Dutch patients having no epidemiological link with Turkish or Moroccan children harboured strains imported from high-endemic countries. Furthermore, we report a special case in which HAV may be causally involved in meningitis. The results of this study show that the molecular epidemiology of HAV in The Netherlands can be more complicated than previously anticipated and that HAV phylogenetic studies can provide important information for the design of appropriate public health measures.

Adolescent↗
PubMed2005

Specific and sensitive detection of Neisseria gonorrhoeae in clinical specimens by real-time PCR.

Early diagnosis of Neisseria gonorrhoeae infections is important with regard to patients' health and infectivity. We report the development of a specific and sensitive TaqMan assay for the detection of N. gonorrhoeae in clinical samples. The target sequence is a 76-bp fragment of the 5' untranslated region of the opa genes that encode opacity proteins. A panel of 448 well-defined N. gonorrhoeae isolates was used to evaluate and optimize the assay. The method employs two minor-groove binding probes, one of them recognizing a newly identified sequence in the opa genes. Testing a large panel of related and unrelated microorganisms revealed that other Neisseria strains and other microorganisms tested negative in the opa test. With a lower detection limit of one genome per reaction, the opa test appeared more sensitive than both the COBAS AMPLICOR (Roche Diagnostics Nederland BV, Almere, The Netherlands) and a LightCycler 16S rRNA test. Analysis of a panel of 122 COBAS AMPLICOR-positive samples revealed that 68% were negative in both the 16S rRNA test and the opa assay (confirming that the COBAS AMPLICOR test produces false positives), while 30% were positive in both assays. Three samples were opa positive and 16S rRNA negative, which may be due to the higher sensitivity of the opa assay. We conclude that the opa gene-based real-time amplification assay offers a sensitive, specific, semiquantitative, and reliable assay suitable for the detection of N. gonorrhoeae in clinical specimens and/or for confirmation of less specific tests.

5' Untranslated Regions↗
PubMed2004

[A fatal infection due to avian influenza-A (H7N7) virus and adjustment of the preventive measures].

In February 2003, the highly pathogenic avian influenza-A virus, subtype H7N7, was the causative agent of a large outbreak of fowl plague in the Netherlands. Two days after visiting a poultry farm that was infected by fowl plague, a 57-year-old male veterinarian developed malaise, headache and fever. After 8 days he was admitted to hospital with signs of pneumonia. Five days later, his condition deteriorated alarmingly. Despite extensive pharmacotherapy he died 4 days later of acute pneumonia. Influenza-A virus, subtype H7N7, was identified by means of reverse transcriptase/PCR in broncho-alveolar washings that had been obtained earlier; routine virus culture yielded the isolate A/Nederland/219/03, which differs by 14 amino-acid substitutions from the first isolate in a chicken (A/kip/Nederland/1/03). Partly as a result of this case, the preventive measures were then adjusted; people who came into contact with infected poultry were given increased possibilities for vaccination and the administration of oseltamivir.

Animals↗
PubMed2002

Anti-HBs levels after hepatitis B immunisation depend on test reagents: routinely determined 10 and 100 IU/l seroprotection levels unreliable.

In a large series of post-vaccination samples we compared the result of three commercially available anti-HBs assays (AxSYM, Architect and Access) on the quantitation of anti-HBs after immunisation with Engerix-B (HBsAg/ad) and GenHevacB (HBsAg/ay) vaccine. Two of the assays (AxSYM, Architect: Abbott Laboratories) gave related but not identical results with HBsAg from different sources. The result of the third assay (Access, Beckman Coulter) was related to that of AxSYM and Architect only for GenHevacB anti-HBs but differed for Engerix-B anti-HBs (P<0.001). This vaccine dependent discrepancy was also observed with the Vidas anti-HBs assay (BioMerieux). An external WHO reference panel could harmonise geometric mean anti-HBs levels from the four assays for GenHevacB but not for Engerix-B vaccination sera. We conclude that the individually determined anti-HBs level (IU/l) strongly depend on the test reagents and the vaccine under study.

Hepatitis B↗
PubMed2002

Surveillance as a starting point to reduce surgical-site infection rates in elective orthopaedic surgery.

A surveillance programme was started after a period of high infection rates in an orthopaedic surgical department. The programme was aimed at reducing infection rates in elective hip and knee replacement procedures, and at creating awareness of infection control practices in an acute hospital. Possible causes of the initial high infection rates were analysed and discussed with healthcare workers involved in orthopaedic surgery. No specific cause could be found but substantial logistic improvements were achieved by studying for five years that may have contributed to the reduction of postoperative infections. Surveillance is an important part of any hospital-acquired infection surveillance programme. Its success depends on the ability of the infection control practitioner (ICP) to form a partnership with the surgical staff. Creating a sense of ownership of the surveillance initiative amongst the surgical staff enhances co-operation and ensures that the best use is made of the information generated. It is not possible to eliminate surgical-site infections (SSI) completely, but by a process of sharing information we have been able to influence behaviour to reduce the incidence of SSI.

Arthroplasty, Replacement, Hip↗
PubMed2002

Th1/Th2 cytokine imbalance in a family with hyper-IgE syndrome.

BACKGROUND: Hyperimmunoglobulin E (hyper-IgE) syndrome is a rare immunodeficiency characterised by recurrent skin and respiratory tract infections, skeletal and dental abnormalities, chronic eczema, and elevated serum IgE. We describe a family with four hyper-IgE syndrome patients (38, 37, 30 and 7 years old), in which we investigated the cytokine response to both specific and non-specific stimulation. METHODS: Whole blood from patients and volunteers was stimulated for either 24 or 48h at 37 degrees C with heat-killed Staphylococcus, C. albicans or a combination of IL-12 and IL-18. Cytokine concentrations in the plasma were measured by specific radioimmuno-assays or ELISA. RESULTS: Serum IgE ranged from 5,000 to 16,670 IU/ml, and neutrophil chemotaxis was normal in all four patients. Tumour necrosis factor, interleukin (IL)-1beta, IL-6 and IL-8 production after stimulation of whole-blood cultures with lipopolysaccharide or heat-killed S. aureus did not differ between the adult patients and four healthy controls. In contrast, when blood from patients and controls was stimulated with heat-killed S. aureus or C. albicans, a severe imbalance towards a Th2 phenotype was found, with 10- to 30-fold reduction in the IFNgamma/IL-10 ratios in the hyper-IgE syndrome patients. The IFNgamma production in the patients was less severely impaired when blood was non-specifically stimulated with a combination of IL-18 and IL-12. CONCLUSION: In this family with hyper-IgE syndrome, the imbalance in the Th1/Th2 cytokine production may have been involved in the pathogenesis of the recurrent infections and/or chronic eczema characteristic of this disease.

Adult↗
PubMed2001

Consequences of asymptomatic bacteriuria in women with diabetes mellitus.

BACKGROUND: Women with diabetes mellitus (DM) have asymptomatic bacteriuria (ASB) more often than women without DM. It is unknown, however, what the consequences of ASB are in these women. OBJECTIVE: To compare women with DM with and without ASB for the development of symptomatic urinary tract infections (UTIs), renal function, and secondary complications of DM during an 18-month follow-up period. METHODS: In this multicenter study we monitored women with DM with and without ASB for the development of symptomatic UTIs, renal function, and secondary complications (ie, retinopathy, neuropathy, microvascular, or macrovascular diseases). Data on the first 18-month follow-up period are presented. RESULTS: At least 1 uncontaminated urine culture was available from 636 women (258 with type 1 DM and 378 with type 2 DM). The prevalence of ASB at baseline was 26% (21% for those with type 1 DM and 29% for those with type 2 DM). Follow-up results were available for 589 (93%) of the 636 women. Of these 589 women, 115 (20%) (14% with type 1 DM and 23% with type 2 DM) developed a symptomatic UTI. Women with type 2 DM and ASB at baseline had an increased risk of developing a UTI during the 18-month follow-up (19% without ASB vs 34% with ASB, P =.006). In contrast, there was no difference in the incidence of symptomatic UTI between women with type 1 DM and ASB and those without ASB (12% with ASB vs 15% without ASB). However, women with type 1 DM and ASB had a tendency to have a faster decline in renal function than those without ASB (relative increase in serum creatinine level 4.6% vs 1.5%, P = 0.2). CONCLUSION: Women with type 2 DM and ASB have an increased risk of developing a symptomatic UTI than those without ASB.

Adolescent↗
PubMed2000

The prevalence and incidence of hepatitis C virus infections among dialysis patients in the Netherlands: a nationwide prospective study.

A nationwide prospective survey on hepatitis C virus (HCV) infections among dialysis patients in The Netherlands was performed. Patients were recruited from 34 dialysis centers and were tested for antibodies and HCV RNA in 1995 and 1997. Seronegative serum samples were analyzed by reverse-transcriptase polymerase chain reaction in pools. HCV-RNA-positive serum samples were genotyped and were partly sequenced. In the first and second rounds, 67 (2.9%) of 2281 and 76 (3.4%) of 2286 patients were HCV positive, respectively. Of 960 patients with paired serum samples, 35 were HCV positive in both rounds, and 9 HCV-positive cases were newly identified in the second round. The incidence of HCV infection was 0.5 per 100 dialysis years. Phylogenetic analysis revealed clustered sequences that indicated nosocomial transmission. Sixty percent of HCV infections, however, can be attributed to 4 interdependent risk factors (i.e., hemodialysis before 1992, kidney transplantation before 1994, and birth or dialysis in a foreign country). In conclusion, the prevalence of HCV infections in The Netherlands does not decline, and transmission within dialysis units continues. Adequate screening of HCV infections and strict enforcement of universal infection control practices are required.

Case-Control Studies↗
PubMed2000

Bismuth-based quadruple therapy for Helicobacter pylori - a single triple capsule plus lansoprazole.

BACKGROUND: Recently a new 'all in one' single capsule with the three components of bismuth-based triple therapy became available in trials for treating Helicobacter pylori. AIM: To investigate the efficacy and tolerability of this new capsule when combined with lansoprazole. METHODS: A total of 66 consecutive infected patients from a single centre received two single triple capsules four times daily and lansoprazole 30 mg b.d. for 7 days. Each capsule contained 60 mg of bismuth subcitrate, 125 mg of tetracycline and 125 mg of metronidazole. Endoscopy with biopsies for CLO-test, histology and culture from antrum and corpus was performed before and at least 5 weeks after treatment. RESULTS: The per protocol cure rate was 56/64 (88%, 95% CI: 79-95%); by intention-to-treat 56/65 (86%, 95% CI: 78-95%). The per protocol cure rate in metronidazole sensitive strains was 40/43 (93%, 95% CI: 85-100%); in resistant strains 5/9 (56%, 95% CI: 23-88%). There was one drop-out due to adverse events. CONCLUSIONS: It is possible to combine the components of bismuth-based triple therapy into a single capsule. Based on the results it can be assumed that the capsule releases its content in the stomach. When combined with lansoprazole it reaches high cure rates, especially in metronidazole sensitive strains. This new approach simplifies bismuth-based anti-Helicobacter therapy.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2000

A single drug for Helicobacter pylori infection: first results with a new bismuth triple monocapsule.

OBJECTIVE: In this pilot study we investigated the efficacy and tolerability of a new monocapsule that contains a bismuth compound, tetracycline, and metronidazole. If proven to be effective, this monotherapy would turn the well-accepted multidrug regimen of standard bismuth-based triple therapy into an easy and more patient-friendly regimen. It can be used in patients allergic to penicillin. METHODS: A total of 53 consecutive H. pylori-infected patients (30 with proven ulcer disease, 23 with gastritis only) from a single center were prescribed two monocapsules q.i.d. after the three meals and after an evening snack during 10 days. Each capsule contained 60 mg colloidal bismuth subcitrate (as Bi2O3 equivalent), 125 mg tetracycline, and 125 mg metronidazole. Repeat endoscopy with biopsies for urease test, Giemsa stain, and culture was carried out > or =5 wk later. Side effect data were collected. RESULTS: One patient was lost to follow-up, two failed to respond, and 50 were cured. The intention-to-treat cure rate was 50 of 53 (94.4%, 95% CI 88.1-100%). Antibiotic sensitivity was available from 51 isolates. The cure rate in the metronidazole sensitive strains was 44 of 45 (97.8%, 95% CI: 93.5-100%), whereas it was four of five in the resistant strains. The regimen was well tolerated, with only two drop-outs (4%) because of side effects. CONCLUSIONS: The new monocapsule is an inexpensive, well tolerated, and patient-friendly formulation of a bismuth based triple therapy. A 10-day course with this multidrug capsule reached a very high cure rate in metronidazole-sensitive strains. The number of cases with resistant strains was insufficient to allow firm conclusions about its efficacy in case of resistance. The results are in agreement with previous data with bismuth triple therapy using separate drugs. From the high cure rate, we can conclude that the new capsule dissolves adequately, with proper delivery of its ingredients at the site of action.

Adult↗