Spondylodiscitis: an unusual complication after lumbar myelography.
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Discitis↗
Biomedical subjects
Pirkko Kotilainen
Publications and source records attributed to Pirkko Kotilainen.
Quantitative analysis of complement receptors, CR1 (CD35) and CR3 (CD11b), on neutrophils improves distinction between bacterial and viral infections in febrile patients: comparison with standard clinical laboratory data.
There is an ongoing need for sensitive and specific markers of bacterial infection. In this prospective study, standard clinical laboratory data (neutrophil count, serum C reactive protein level, erythrocyte sedimentation rate) and quantitative flow cytometric analysis of neutrophil complement receptors, CR1 and CR3, were obtained from 289 hospitalized febrile patients. After microbiological confirmation or clinical diagnosis, 135 patients were found to have either bacterial (n = 89) or viral (n = 46) infection. The patient data was compared to 60 healthy controls. In bacterial infections, all measured variables were significantly increased, particularly the average amounts of CR1 and CR3 on neutrophils were over three-fold and two-fold higher, respectively, compared to viral infections and controls. We described a novel marker of local and systemic bacterial infections designated 'clinical infection score (CIS) point', which incorporates quantitative analysis of complement receptors on neutrophils and standard clinical laboratory data. CIS point varied between 0 and 8, and displayed 98% sensitivity and 97% specificity in distinguishing between bacterial and viral infections [average (S.D.); CIS points: 6.2 (1.7) vs. 0.6 (1.0); p < 0.001]. These findings suggest that the proposed CIS-based diagnostic test could potentially assist physicians in deciding whether antibiotic treatment is necessary.
Bacterial Infections↗
Reduction in fluoroquinolone susceptibility among non-typhoidal strains of Salmonella enterica isolated from Finnish patients.
OBJECTIVES: The proportion of Salmonella isolates with reduced susceptibility to fluoroquinolones has increased during recent years in many countries, especially in South-east Asia. The present study was performed to evaluate the incidence of and changes in quinolone resistance in Salmonella isolates of either foreign or domestic origin in Finland. METHODS: A total of 1004 Salmonella isolates collected from Finnish patients between 2000 and 2004 were analysed for ciprofloxacin susceptibility. Of these isolates, 504 were of domestic origin and 500 were of foreign origin, collected from travellers to 43 different countries. The Salmonella collection consisted of 89 different serotypes. All isolates belonged to non-typhoidal Salmonella enterica. RESULTS: Of all isolates, 3 (0.3%) were ciprofloxacin-resistant (MIC > or = 4 mg/L) and 214 (21.3%) exhibited reduced susceptibility to ciprofloxacin (MIC > or = 0.125-2 mg/L). The annual proportion of reduced susceptibility varied between 3 and 15% among the domestic Salmonella isolates (P = 0.123). Between 2000 and 2004, the annual proportion of reduced susceptibility increased significantly (from 23 to 39%; P = 0.001) among all foreign isolates as well as among those from Spain alone (from 4 to 73%; P < 0.001). Among the isolates from Thailand, reduced ciprofloxacin susceptibility remained at a constantly high level (52-66%) throughout the study. CONCLUSIONS: Our results show that reduced fluoroquinolone susceptibility in S. enterica is not restricted to South-east Asia alone but continues to grow rapidly in many parts of the world including countries of the European Union.
Anti-Bacterial Agents↗
Measurement of complement receptor 1 on neutrophils in bacterial and viral pneumonia.
BACKGROUND: A reliable prediction of the causative agent of community-acquired pneumonia (CAP) is not possible based on clinical features. Our aim was to test, whether the measurement of the expression of complement receptors or Fcgamma receptors on neutrophils and monocytes would be a useful preliminary test to differentiate between bacterial and viral pneumonia. METHODS: Sixty-eight patients with CAP were studied prospectively. Thirteen patients had pneumococcal pneumonia; 13 patients, influenza A pneumonia; 5 patients, atypical pneumonia, and 37 patients, aetiologically undefined pneumonia. Leukocyte receptor expression was measured within 2 days of hospital admission. RESULTS: The mean expression of complement receptor 1 (CR1) on neutrophils was significantly higher in the patients with pneumococcal pneumonia than in those with influenza A pneumonia. The mean expression of CR1 was also significantly higher in aetiologically undefined pneumonia than in influenza A pneumonia, but there was no difference between pneumococcal and undefined pneumonia. CONCLUSION: Our results suggest that the expression of CR1 is higher in classical bacterial pneumonia than in viral pneumonia. Determination of the expression of CR1 may be of value as an additional rapid tool in the aetiological diagnosis, bacterial or viral infection, of CAP. These results are preliminary and more research is needed to assess the utility of this new method in the diagnostics of pneumonia.
Adolescent↗
Spinal epidural lipomatosis caused by corticosteroid treatment in ulcerative colitis.
Spinal epidural lipomatosis is the result of deposition of unencapsulated fat in the extradural space of the spinal canal. Most commonly, this rare condition is a complication secondary to corticosteroid treatment. We describe a 49-year-old patient with ulcerative colitis who developed paraparesis due to overgrowth of epidural fat tissue. This is the second patient with ulcerative colitis described in the literature who developed symptomatic epidural lipomatosis secondary to corticosteroid treatment. All internists tending patients with chronic diseases that require corticosteroid treatment should be aware of this rare clinical entity.
Journal Article↗
Myopericarditis in a patient with Campylobacter enteritis: a case report and literature review.
Myocarditis sometimes occurs as a complication of bacterial infection, including enteric infections caused by Salmonella, Shigella and Yersinia. Only a few cases of Campylobacter-associated myocarditis are known. We describe a 47-y-old patient with myopericarditis in association with Campylobacter spp. enteritis, and review similar cases previously described in the English literature.
Campylobacter Infections↗
Aetiological diagnosis of infective endocarditis by direct amplification of rRNA genes from surgically removed valve tissue. An 11-year experience in a Finnish teaching hospital.
BACKGROUND/AIMS: The aetiology of infective endocarditis (IE) can be determined directly from surgically removed valve tissue using broad-range bacterial rDNA polymerase chain reaction (PCR) followed by sequencing. We sought to assess the value of this methodology in a routine clinical setting. METHODS: Broad-range PCR with primers targeting conserved bacterial rDNA sequences was applied to directly analyse valve samples from 56 patients operated on for diagnosed or suspected IE. Identification of the aetiological agent was performed by partial DNA sequencing of the 16S and 23S rDNA genes. RESULTS: The final diagnosis was definite IE in 36 patients and possible IE in 2 patients, while the diagnosis of IE was rejected in 18 patients. PCR analysis from removed valve tissue was positive in 25 patients with IE. Molecular identification was consistent with the blood culture finding in 20 of these patients. The PCR approach was the only method to yield the aetiological diagnosis in additional 4 patients (2 Staphylococcus species, 1 Streptococcus bovis, 1 Bartonella quintana), all of whom had received antimicrobials before blood cultures were taken. The mean duration of preoperative antimicrobial treatment for the patients with PCR-positive valves was 19.6 (range 1-58) days. CONCLUSIONS: Bacterial DNA may persist during treatment in infected valves for long periods. The PCR method is especially useful when the causative agent of IE is fastidious or when the specimen is taken during antimicrobial treatment.
Bacterial Typing Techniques↗
In vitro activities of 11 fluoroquinolones against 226 Campylobacter jejuni strains isolated from Finnish patients, with special reference to ciprofloxacin resistance.
OBJECTIVES: Although Campylobacter jejuni is naturally susceptible to fluoroquinolones, the resistance to these antimicrobials has increased rapidly during the recent years. The aim of this study was to compare the activities of various older and newer fluoroquinolones towards C. jejuni, with special attention on ciprofloxacin-resistant strains. METHODS: We analysed the in vitro activities of 11 fluoroquinolones against 226 C. jejuni strains collected from Finnish patients between 1995 and 2000. RESULTS: Of all 226 C. jejuni strains, 134 (59.3%) were resistant to ciprofloxacin (MIC > or = 4 mg/L), 1 (0.4%) was intermediately resistant (MIC = 2 mg/L) and 91 (40.3%) were ciprofloxacin-susceptible (MIC < or = 1 mg/L). The MIC50 and MIC90 values of ciprofloxacin for the 91 ciprofloxacin-susceptible strains were 0.25 and 0.5 mg/L, respectively. The corresponding MIC50 and MIC90 values of levofloxacin were 0.25 and 0.5 mg/L, and those of moxifloxacin were 0.125 and 0.25 mg/L, these being lower than those of norfloxacin and ofloxacin. The two newer fluoroquinolones, sitafloxacin and clinafloxacin, exhibited the lowest MIC50 and MIC90 values: 0.016 and 0.064 mg/L of sitafloxacin and 0.032 and 0.125 mg/L of clinafloxacin, respectively. Sitafloxacin and clinafloxacin exhibited the lowest MIC50 and MIC90 values also for the 134 ciprofloxacin-resistant C. jejuni strains: 0.25 and 1 mg/L of sitafloxacin and 1 and 4 mg/L of clinafloxacin, respectively. CONCLUSIONS: Of the newer fluoroquinolones presently under development, sitafloxacin is in vitro highly effective towards C. jejuni, with low MIC values also for the ciprofloxacin-resistant strains. Sitafloxacin might be a candidate for clinical trials on campylobacteriosis.
Anti-Bacterial Agents↗
In vitro activities of 11 fluoroquinolones against 816 non-typhoidal strains of Salmonella enterica isolated from Finnish patients with special reference to reduced ciprofloxacin susceptibility.
BACKGROUND: The number of Salmonella strains with reduced susceptibility to fluoroquinolones has increased during recent years in many countries, threatening the value of this antimicrobial group in the treatment of severe salmonella infections. METHODS: We analyzed the in vitro activities of ciprofloxacin and 10 additional fluoroquinolones against 816 Salmonella strains collected from Finnish patients between 1995 and 2003. Special attention was focused on the efficacy of newer fluoroquinolones against the Salmonella strains with reduced ciprofloxacin susceptibility. RESULTS: The isolates represented 119 different serotypes. Of all 816 Salmonella strains, 3 (0.4%) were resistant to ciprofloxacin (MIC > or = 4 microg/ml), 232 (28.4%) showed reduced susceptibility to ciprofloxacin (MIC > or = 0.125-2 microg/ml), and 581 (71.2%) were ciprofloxacin-susceptible. The MIC50 and MIC90 values of ciprofloxacin for these strains were 0.032 and 0.25 microg/ml, respectively, being lower than those of the other fluoroquinolone compounds presently on market in Finland (ofloxacin, norfloxacin, levofloxacin, and moxifloxacin). For two newer quinolones, clinafloxacin and sitafloxacin, the MIC50 and MIC90 values were lowest, both 0.016 and 0.064 microg/ml, respectively. Moreover, clinafloxacin and sitafloxacin exhibited the lowest MIC50 and MIC90 values, 0.064 and 0.125 microg/ml, against the 235 Salmonella strains with reduced susceptibility and strains fully resistant to ciprofloxacin. CONCLUSION: Among the registered fluoroquinolones in Finland, ciprofloxacin still appears to be the most effective drug for the treatment salmonella infections. Among the newer preparations, both clinafloxacin and sitafloxacin are promising based on in vitro studies, especially for strains showing reduced ciprofloxacin susceptibility. Their efficacy, however, has not been demonstrated in clinical investigations.
Anti-Infective Agents↗
Utility of serum C-reactive protein in assessing the outcome of infective endocarditis.
AIMS: To evaluate the diagnostic usefulness of serial serum C-reactive protein determinations in monitoring the outcome of infective endocarditis (IE). METHODS AND RESULTS: C-reactive protein, erythrocyte sedimentation rate (ESR), and white blood cell count (WBC) were measured from admission until week 10 in 129 patients with 134 episodes of IE. Need for cardiac surgery and final outcome were assessed until 3 months from admission. Data were evaluated using extensive statistical analyses. The fall in serum C-reactive protein or WBC was significantly faster when a patient had an uncomplicated recovery than when complications developed or death ensued, but no such behaviour was observed in ESR. None of the 80 patients who had normal C-reactive protein by week 10 died of IE. Moreover, none of the 22 patients who had normal C-reactive protein by week 4 needed cardiac surgery and only two of the 33 patients who had normal C-reactive protein by week 6 needed cardiac surgery, both after successful medical treatment of IE. Of the 87 patients whose WBC normalized within 4 weeks, six died and 15 needed valve surgery. CONCLUSION: The normalization of C-reactive protein proved to be a good predictor of a favourable late outcome (surgery, death) of IE. Also WBC count proved useful in the assessment of patients with IE, but the value of ESR was negligible.
Adolescent↗
Diagnosis of enteroviral meningitis by use of polymerase chain reaction of cerebrospinal fluid, stool, and serum specimens.
BACKGROUND: Because enteroviruses can be detected in various clinical samples during enteroviral meningitis, we analyzed the combined diagnostic utility of polymerase chain reaction (PCR) of cerebrospinal fluid (CSF), feces, and serum for detection of enterovirus in specimens obtained from adults with aseptic meningitis or encephalitis. METHODS: PCR results were analyzed for 34 adults for whom enteroviral meningitis was diagnosed on the basis of virus isolation and antibody detection in our hospital during 1999-2003. PCR results were also analyzed for 77 adults with meningitis or encephalitis of another defined cause for whom this assay was used for diagnostic evaluation during that period. RESULTS: Twenty-six (76%) of 34 CSF samples and 24 (96%) of 25 fecal samples collected from patients with enteroviral meningitis had positive PCR results. The diagnostic yield of the test was lower for CSF specimens obtained >2 days after clinical onset, compared with CSF collected < or =2 days after onset. Instead, PCR of feces was highly useful also later, because 12 of the 13 fecal specimens obtained 5-16 days after clinical onset had positive test results. None of 75 CSF samples and 2 of 48 fecal samples obtained from patients with nonenteroviral infection had positive PCR results. All serum samples were PCR negative. CONCLUSIONS: PCR of fecal specimens obtained throughout the course of enteroviral meningitis had the highest clinical sensitivity for detecting enterovirus. It is recommended that, in addition to performance of CSF PCR, fecal samples collected from patients with suspected enteroviral meningitis should be tested by PCR, especially when the duration of symptoms is >2 days.
Adult↗
New quinolone resistance phenomenon in Salmonella enterica: nalidixic acid-susceptible isolates with reduced fluoroquinolone susceptibility.
We describe the emergence of a new quinolone resistance pattern in Salmonella enterica isolates from Southeast Asia. These isolates are susceptible to nalidixic acid but exhibit reduced susceptibility to ciprofloxacin. The increase of such strains may threaten the value of the nalidixic acid disk test to screen for reduced fluoroquinolone susceptibility in salmonellas.
Anti-Infective Agents↗
Riedel's thyroiditis in a patient with multiple sclerosis.
Our patient developed Riedel's thyroiditis soon after having an exacerbation of multiple sclerosis (MS). MS has been associated with other autoimmune diseases, including thyroiditis, and both Hashimoto's thyroiditis and subacute thyroiditis have been described in connection with MS. Yet, we are not aware of any other patient reported to have concomitant MS and Riedel's thyroiditis. The association between MS and Riedel's thyroiditis remains obscure but may reflect an autoimmune disorder common to both diseases.
Adult↗
Recurrent lymphocytic meningitis: the role of herpesviruses.
BACKGROUND: Herpes simplex virus 2 (HSV-2) and HSV-1 have been recognized as causes of recurrent aseptic lymphocytic meningitis (RALM). However, the role of other herpesviruses has not been systematically assessed. OBJECTIVES: To evaluate the cause of RALM by using polymerase chain reaction (PCR) tests detecting varicella-zoster virus (VZV), cytomegalovirus (CMV), or human herpesvirus 6 (HHV-6), in addition to HSV, on cerebrospinal fluid (CSF) samples; and to assess the utility of PCR and antibody analyses in consecutive episodes of RALM. DESIGN: The PCR and antibody results for herpesviruses were analyzed from 14 patients having 48 episodes of RALM. RESULTS: The CSF PCR results for VZV, CMV, and HHV-6 were negative in 12, 10, and 11 patients investigated, respectively, and antibodies against VZV, CMV, and HHV-6 showed only old immunity. Herpes simplex virus 2 was detected from the CSF in 10 patients, and HSV-1 in 1 patient. In 6 of these 11 patients, the HSV PCR result was positive in more than one disease episode. A significant increase of serum antibodies for HSV was seen in only 1 of 15 episodes examined. An intrathecal antibody response to HSV was not recognized in 9 episodes investigated in these 11 patients. CONCLUSIONS: We could not find evidence of VZV, CMV, or HHV-6 in the pathogenesis of RALM, although most patients were previously infected by those viruses. Herpes simplex virus 2 was detected from the CSF in most patients, and often repeatedly, which further confirms the role of this virus in RALM. The causative diagnosis was obtained only by PCR, whereas antibody analysis was not clinically useful.
Adult↗
Positron emission tomography as an aid in the diagnosis and follow-up of Riedel's thyroiditis.
We describe the usage of positron emission tomography (PET) as an aid in the initial diagnosis and follow-up of Riedel's thyroiditis. A 41-year-old patient was admitted for an enlarged and tender thyroid gland in association with severe systemic symptoms of inflammation. Imaging with fluorine-18 fluorodeoxyglucose (FDG) and PET demonstrated an intensive uptake of FDG in both lobes of the thyroid gland as an indication of severe inflammation. The diagnosis of Riedel's thyroiditis was confirmed by the histological findings of biopsy specimens taken during a palliative thyroid resection. The inflammatory symptoms and local pain dramatically disappeared after commencement of high-dose corticosteroid therapy. A follow-up PET scan after 2 weeks of corticosteroid treatment showed a 60% decrease in the uptake of FDG in the thyroid. This indicates that FDG metabolic activity can also be used to assess a patient's response to therapy in Riedel's thyroiditis.
Journal Article↗
Diagnostic value of bronchoalveolar lavage in community-acquired pneumonia in a routine setting: a study on patients treated in a Finnish university hospital.
Only a few previous studies have focused on the use or bronchoalveolar lavage (BAL) in patients with community-acquired pneumonia (CAP). Our aim was to evaluate the diagnostic value of BAL in CAP in a routine clinical setting. 71 disease episodes were retrospectively analysed. The patients had undergone BAL for serious or slowly responding pneumonia. All procedures were performed during antimicrobial treatment of the patient. BAL fluid was cultivated for bacteria, fungi, and viruses. In 68 episodes, 1 or several specific polymerase chain reaction tests were performed. Only 1 (1.3%) quantitative bacterial culture was considered diagnostic for CAP, and indicated a change of antimicrobial treatment. The diagnostic yield increased to 9.8% when other methods were used. A respiratory virus was the only aetiology in 3 (6.0%) patients. In slowly responding pneumonia, also hospital-acquired pathogens and malignancies were identified, resulting in a total diagnostic yield of 20.0%. Thus, even when a large array of diagnostic assays was applied, the value of BAL in pretreated patients with CAP was very small, and its therapeutic implications minimal. In a subgroup of slowly responding pneumonia, the procedure was of some usefulness even after commencement of antimicrobial treatment.
Adult↗
Interstitial pneumonitis and coinfection of human herpesvirus 6 and Pneumocystis carinii in a patient with hypogammaglobulinemia.
Human herpesvirus 6 (HHV-6) has occasionally been associated with cases of interstitial pneumonitis, mainly in individuals with impaired cellular immunity. Here we report for the first time severe interstitial pneumonitis with simultaneous HHV-6 and Pneumocystis carinii infections in the lung tissue of a young patient with hypogammaglobulinemia.
Adult↗
Multidrug resistance in Campylobacter jejuni strains collected from Finnish patients during 1995-2000.
OBJECTIVES: The resistance of Campylobacter jejuni to fluoroquinolones is increasing globally. This study was performed to delineate those antimicrobial agents that are effective in vitro against ciprofloxacin-resistant C. jejuni isolates and potentially suitable for the treatment of severe disease when fluoroquinolone resistance or multidrug resistance is known or suspected. METHODS: During 1995-2000 we collected 376 C. jejuni strains, of which 354 were of foreign origin from multiple countries and 22 were of domestic origin. The MICs of 12 antimicrobial agents against the isolates were determined. RESULTS: Of the 376 strains, 174 (46%) were resistant to ciprofloxacin. Among other antimicrobials, resistance was most common to tetracycline (46%) and ampicillin (17%). Of the ciprofloxacin-resistant strains, 68% and 25%, respectively, were resistant to tetracycline and ampicillin, and 3% were resistant to erythromycin, gentamicin or clindamycin. One (0.6%) ciprofloxacin-resistant isolate was resistant to co-amoxiclav and none was resistant to imipenem. Resistance to three or more antimicrobial groups was detected in 22% of the isolates. Multidrug resistance was significantly associated with ciprofloxacin resistance (33% versus 12%; P<0.01). Eight (2%) strains were resistant to macrolides, of which 75% were also resistant to ciprofloxacin, but none was resistant to co-amoxiclav or imipenem. CONCLUSIONS: Macrolides still appear to be the first-choice alternative for suspected C. jejuni enteritis, if antimicrobial treatment is needed. The in vitro susceptibilities suggest that clinical trials to treat enteritis caused by multidrug-resistant C. jejuni with co-amoxiclav, and life-threatening infections with a carbapenem, may be valuable.
Anti-Bacterial Agents↗