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T W Gedde-Dahl

Publications and source records attributed to T W Gedde-Dahl.

At least 19 recordsLinked to original sources
PubMed1990

Some arguments on early hospital admission and treatment of suspected meningococcal disease cases.

Arguments are presented which indicate or show that: (1) Diagnostic precision and severity level of systemic meningococcal disease (MCd) both seem to rise exponentially with the developmental stage of the disease at referral. Lowering of the clinical admission threshold improves early coverage of vaguely suspected cases and should probably be implemented in Norway. (2) Fear that cell wall active bactericidal antibiotics could trigger important endotoxin release may cause unnecessary treatment delays. (3) Although risk of death due to meningococcal septicemia is the main indication for early treatment of MCd, the risk of sequelae may also become a major cause for very early treatment of MCd. (4) Treatment delays for MCd cases could have been substantially reduced by implementing reasonable guidelines. (5) In the relations between the public and the health service both organizational and psychological factors are operating. (6) Increased awareness among professionals and lay people of some key symptoms and signs may facilitate earlier diagnosis of MCd. (7) Earlier treatment of meningococcal disease is now feasible and does seldom preclude the possibility of etiological diagnosis. (8) More relevant studies and information on the early phases and rapid management of MCd are highly desirable. Rapid diagnosis and treatment of MCd are very important to reduce death, sequelae and community costs and should be more advocated in training of health personnel and in public information.

Anti-Bacterial Agents↗
PubMed1986

Antibody response in group B meningococcal disease determined by enzyme-linked immunosorbent assay with serotype 15 outer membrane antigen.

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.

Adolescent↗
PubMed1984

Late sequelae after meningococcal disease. A controlled study in young men.

The occurrence of sequelae 3-15 years after meningococcal disease has been investigated in a study on 71 patients and 64 controls. The patients were young men, aged 18 to 24 years at the time the disease was contracted. Participants filled in a questionnaire on possible symptoms. Audiometry and EEG were also carried out. The response rates were 84% among patients and 75% among controls. We found that 61% of the patients had one or more symptoms of possible sequelae compared to 20% in the control group (p less than 0.001). The symptoms were generally light and of mental or neurological type. Among the patients 13% stated that they had obvious complaints commonly attributed to meningococcal disease, compared to 2% only in the controls (p less than 0.05). Twenty-nine per cent of the patients stated that the disease had affected their education or working capacity. No statistical differences between patients and controls were demonstrated by audiological or EEG examinations. In only one single ear could deafness unequivocally be attributed to the disease.

Adolescent↗
PubMed1984

Late sequelae after meningococcal disease as related to anamnestic and clinical factors recorded during the acute illness.

In 71 males who survived acute meningococcal disease 3 to 15 years ago at an age of about 20, associations between acute clinical conditions (including a few pre- and post-admission variables) and late sequelae have been studied. There was a higher rate of sequelae symptoms (mainly light neurological and mental disturbances) among survivors from meningitis (76%) than among those who had had both meningitis and septicemia (58%) or pure septicemia (50%). Twenty percent of control persons experienced such symptoms. "Changed Life" because of serious educational and working problems followed in 29% of the meningitis cases and 70% of the septicemia cases. Most of the clinical and laboratory factors separately examined were not significantly correlated to the sequelae rates. However, less than 2.5 mmol/l glucose in the cerebrospinal fluid (CSF) on admission (p less than 0.01), more than 1000 X 10(6) white blood cells per 1 in the cerebrospinal fluid (p less than 0.05), fever for more than 8 days (p less than 0.05), and probable cerebral symptoms the first week (p less than 0.05), were all positively correlated to a high rate of late sequelae. Well documented early sequelae correlated with serious late sequelae (p = 0.05). No conspicuous associations between acute antibiotic treatment and late sequelae were found. A combination of CSF glucose, blood thrombocytes, and cells in CSF on admission yielded a multiple regression score which seems to be a moderately reliable predictor of sequelae (R = 0.46). Hospital treatment should both aim at avoiding death and escaping residual effects. Because many prognostic factors for sequelae on admission are different from those for lethality, scoring for sequelae may be helpful in such secondary prevention of sequelae. Early standardized registration of sequelae may also be of value in tertiary prevention.

Acute Disease↗
PubMed1983

Sequelae of meningococcal disease - studied about six weeks after hospital admission.

As part of a greater project (MenOPP), the type, distribution and frequency of sequelae after meningococcal disease (MCd) were estimated on the basis of examinations carried out about six weeks after hospital admission. Well documented sequelae were found in about 18% of 102 MCd cases compared to about 3% in 61 control patients. In 18 control patients with meningitis/septicemia due to other bacteria, the sequelae frequency was 11%. Our MCd sequelae results correspond with many of those published during the last few years. The frequency of uncertain sequelae was about the same (16%) in the MCd and the control group patients. A routine examination six weeks and one year after a MCd episode seems to be useful for the individual patient and for the research on better prophylaxis and improved treatment.

Female↗
PubMed1983

An epidemiological, clinical and microbiological follow-up study of incident meningococcal disease cases in Norway, winter 1981-1982. Material and epidemiology in the MenOPP project.

To investigate the relative importance of the many possible influencing factors and developmental traits of systemic meningococcal disease (MCd) in the practical Norwegian context, a comprehensive multipurpose case control study was carried out during the winter of 1981-1982 on incident cases in the whole country. The design of the study, the MenOPP project, is outlined. The main inclusion criteria for patients were suspected bacterial meningitis and/or septicemia on referral to hospital. This resulted in 115 verified or probable cases of MCd and 61 patient controls. Randomly drawn from three age strata, 320 population controls were actually approached and 293 (92%) of these responded to the "environmental questionnaire". So did most of the patients (98%). The clinical data mainly comprised information from the commencement of the disease to a sequelae check about six weeks after hospital admission. Laboratory data on strain and serum characteristics were, and still are, collected. The results are to be published in several papers. Here, some epidemiological characteristics of the material are given. Regional, seasonal, and age/sex differences in case fatality are reported and discussed.

Adolescent↗
PubMed1983

Factors preceding the onset of meningococcal disease, with special emphasis on passive smoking, symptoms of ill health.

In a prospective study of 115 patients with systemic meningococcal disease, 61 control patients and 293 population controls, environmental and other factors which preceded the illness and which might have influenced the acquisition and case fatality rate of the meningococcal disease were investigated. Passive smoking in children under 12 year of age, stressful events, and symptoms and signs of preceding illness within the last two weeks were significantly more frequent in meningococcal patients than among the population controls. In contrast, those patients who had been exposed to stressful events, or who had symptoms or signs of ill-health preceding the meningococcal disease, had significantly reduced case fatality rates as compared to those who had not had any such experiences. Passive smoking remains a factor of great interest for further studies and intervention.

Adolescent↗
PubMed1980

Meningococcal disease in the Norwegian Armed Forces 1967-1979. Some epidemiological aspects.

The epidemiology of meningococcal disease in the Norwegian Armed Forces has been studied for the years 1974-79 and compared with the situation in the years 1967-73. The clustering of cases was examined with special reference to vaccination. The annual incidence rate increased from 24 to 43 cases per 100,000 men. However, this is only half the relative total increase in Norway in the same period. When 1975-79 figures were weighted according to the military age distribution, the combined rate for conscripts was four times the civilian rate. The weekly risk during the three month recruit training was three to ten times greater than later on. A malignancy change was demonstrated by a fourfold increase in the proportion of septicaemia and a fivefold increase in the case fatality.

Adolescent↗