Biomedical subjects
Publications and source records attributed to S Harthug.
We describe the case of a patient who developed bilateral loss of hearing during intravenous treatment with erythromycin. Predisposing factors may have been reduced renal and hepatic function and treatment with diuretics and aminoglycosides. Recovery was late, but hearing was probably restored to almost pre-treatment level. Patients receiving high doses of erythromycin should, as a routine, be questioned about hearing loss and tinnitus.
A study was performed in order to determine the prevalence of anti-hepatitis C virus (HCV) antibodies, the risk factors for HCV infection and the markers of hepatic disease in a population of prisoners. Of 101 new prisoners admitted to a Norwegian national prison over a three month period, 70 were included in the study, of whom 32 (46%) were anti-HCV positive. Intravenous drug abuse was the predominant risk factor for HCV infection, although a history of tattooing was found by logistic regression analysis to be a significant risk factor independent of intravenous drug abuse. Most anti-HCV positive prisoners had a history of previous incarcerations. Among the anti-HCV positive subjects, increased alanine aminotransferase (> 50 U/l) was found in 23 (72%). HCV infection was the major cause of hepatic abnormalities in the study population. Only 15 (47%) of the anti-HCV positive prisoners reported knowledge of previous hepatic disease.
Antibody responses of adult volunteers given a vaccine containing meningococcal capsular polysaccharides (serogroups A, C, Y, and W-135) noncovalently complexed with serotype 2b:P1.2 and 15:P1.16 outer membrane proteins have been studied. Sera were analyzed by enzyme-linked immunosorbent assay methods for immunoglobulin G (IgG), IgM, and IgA antibodies and for bactericidal activities against the homologous strains. The vaccination was performed as a double-blind experiment with 47 volunteers, of whom 23 received the protein-polysaccharide vaccine and 24 received the control preparation containing the polysaccharides only. Ten additional persons volunteered for the protein-polysaccharide vaccine. Before vaccination, carriers of meningococci had significantly higher levels of specific IgG and IgA and also higher bactericidal activities than noncarriers. At 2 weeks postvaccination we found significant IgG and bactericidal antibody responses against both the 2b:P1.2 and 15:P1.16 strains in about 70% of the protein-polysaccharide vaccinees. The immune response induced by disease was compared with that induced by vaccination by analyzing paired sera from 13 survivors of serogroup B serotype 15 meningococcal disease. We found that the mean specific IgG level in acute-phase sera was lower than average in prevaccination sera from the vaccinees but similar to that of healthy noncarriers before vaccination. The convalescent-phase sera showed IgG responses similar to those of the vaccinees, but the IgM response to disease was significantly higher than after vaccination. The immune response to disease caused by serogroup B serotype 15 meningococci was found by enzyme-linked immunosorbent assay analysis to be about the same with outer-membrane antigens from a serotype 2b strain as it was with antigens from a serotype 15 strain.
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To elucidate pathogenic aspects and serodiagnostic possibilities for meningococcal disease, we investigated levels of specific antimeningococcal immunoglobulin G (IgG), IgA, and IgM in serum by using an enzyme-linked immunosorbent assay with outer membrane antigen prepared from a Neisseria meningitidis B:15:P1.16 strain. Serum samples were drawn on hospital admission as well as during convalescence from patients suspected of purulent meningitis or meningococcal septicemia, and single samples were drawn from population controls. A total of 637 samples were examined blindly. On admission, the average antimeningococcal immunoglobulin levels were about the same in the meningococcal disease patients as in the population controls. Septicemic patients, however, had significantly lower values. During one week the mean specific immunoglobulin levels in meningococcal-disease patients increased 6 times for IgG, 14 times for IgA, and 5 times for IgM. Children younger than 1 year showed a modest and more slowly developing antibody response. There were no statistically significant differences in average antibody responses among patients infected with meningococci of different serotypes. At 100% specificity, the increase in IgG, IgA, and IgM yielded diagnostic sensitivities for meningococcal disease of 84, 52, and 66%, respectively. One of seven serum pairs from the patient control group with unknown etiology was positive for meningococcal disease in this assay. The patients with meningococcal disease originally diagnosed only by clinical signs and symptoms showed a slightly lower rate of seroconversion than the patients in whom the diagnosis was supported by test results showing a systemic Neisseria meningitidis isolate.
The levels of endotoxin in blood were determined using the Limulus lysate test in combination with a chromogenic substrate. Plasma was analyzed from four patients with fatal meningococcal septicaemia and from one patient who survived meningococcal meningitis. All septicaemia patients showed high levels of endotoxin in their blood during the early stage of their disease. In two of these patients, blood samples collected at intervals of two days revealed a gradual disappearance of measurable endotoxin from the circulation. The patient with meningitis had no clinical signs of circulatory deficiency or coagulopathy and was consistently negative for endotoxin using this test procedure. Pretreating the plasma with heat and alkali and combining the Limulus lysate test with a chromogenic substrate seem to provide a sensible method for the detection and quantitation of endotoxin in blood.
The importance of amino acid sequence differences in the C-terminal part and levels of mRNA expression of penicillin-binding protein 5 (PBP5) for ampicillin resistance in Enterococcus faecium was investigated. Seventeen isolates from Norwegian hospitalized patients (ampicillin MIC 0.064->256 mg/L) with different C-terminal pbp5 DNA sequences encoding 11 different amino acid sequences were analyzed with a 14C-radiolabeled penicillin- binding assay to PBP5 and with real-time PCR quantification of pbp5 mRNA expression. Using multiple logistic regression analysis the amino acid substitution Met 485 was linked to ampicillin MIC and levels of 14C-radiolabeled penicillin bound to PBP5; however, there were isolates with identical PBP5 alleles and different ampicillin MICs. There was no relation between the quantity of pbp5 mRNA transcripts and ampicillin resistance. The results cannot explain ampicillin resistance in Norwegian clinical strains of E. faecium and indicate that other factors besides the properties of the C-terminal part of PBP5 are most likely involved.