Search

Exposure to moulds is thought to cause adverse health effects ranging from vague subjective symptoms to allergy and respiratory diseases. Until now, most studies have been emphasizing low levels of exposure. In Norwegian sawmills during the 1980s, extensively high spore counts up to 107 spores/m3 air were reported. By using serum samples obtained from sawmill workers during that period, in addition to control sera, we studied the antibody response of all classes and IgG subclasses to Rhizopus microsporus at different levels of exposure. Antigen specificity was further studied by Western blotting. Exposure to R. microsporus was accompanied by R. microsporus-specific antibody production against a wide range of antigenic components most likely of both protein and carbohydrate nature. Increasing levels of mould-specific IgG1, IgG2, IgG4 and IgA antibodies were associated with increased exposure, while the highest levels of exposure were associated with a somewhat reduced level of mould-specific IgE antibodies. In conclusion, the present study strongly suggests that high mould exposure can induce a strong IgG and IgA response in a dose-dependent manner. [ABSTRACT FROM AUTHOR]

The study evaluates the clinical and microbiological data from patients with documented invasive fungal infections at a comprehensive cancer centre in Norway. Relevant microbiology and pathology databases were screened and medical records were reviewed. 17 yeast infections, including 1 case of cryptococcal meningitis, and no mould infections were found. Diagnostically, in 30% of the positive blood cultures Candida only grew in the Mycosis IC/F bottle. Half of the patients had febrile neutropenia, and 30% had undergone complicated abdominal or pelvic surgery. 12 out of 13 positive blood cultures were Candida albicans. 30% of the patients died of acute septic candidiasis. Within 14 months 90% of the patients were dead from their underlying diseases. A diagnosis of invasive fungal infection is an ominous sign for the patient's overall prognosis. [ABSTRACT FROM AUTHOR]

Multidrug-resistant tuberculosis has become common all over the world, necessitating the inclusion of second-line drugs in treatment regimens. In the present study, the susceptibility of a selection of multidrug-resistant strains ofMycobacterium tuberculosisisolated in the Archangel oblast, Russia, to second-line anti-tuberculosis drugs was analysed. Susceptibility testing of 77Mycobacterium tuberculosisstrains was performed by the Bactec method using the following recommended drug concentrations: capreomycin 1.25 µg/ml; ethionamide 1.25 µg/ml; kanamycin 5 µg/ml; and ofloxacin 2 µg/ml. The majority of strains (92.2%) were resistant to ethionamide. High rates of drug resistance were also found for capreomycin (42.9%) and kanamycin (41.6%), while nearly all strains (98.7%) were susceptible to ofloxacin. The high rates of resistance to ethionamide, capreomycin, and kanamycin show the real burden of drug resistance in the region and pose a serious problem for the treatment of patients with multidrug-resistant tuberculosis. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the outcome of treatment of culture-positive cases of tuberculosis registered in Archangel, Russia, in 1999, and to analyse the influence of Mycobacterium. tuberculosis drug resistance on treatment outcome. The outcome of tuberculosis treatment was evaluated for 235 new and 61 previously treated culture-positive cases diagnosed in 1999. Of the 235 new cases, there were 150 (63.8%) cases of treatment completion, 20 (8.5%) cases of treatment failure, 29 (12.3%) cases of death during treatment, and 29 (12.3%) cases in which the patient failed to pick up medications for at least 2 consecutive months. The outcome in 7 (3%) cases was unknown, as the patients were transferred outside the oblast region. Among the 61 previously treated cases, the rate of treatment completion was low (26.2%), and rates of treatment failure (23%) and failure to pick up medications for at least 2 consecutive months (29.5%) were high. The relation between the susceptibility pattern of the infecting strain as determined by the Bactec method and tuberculosis treatment outcome was analysed for 76 patients. The majority (69%) of patients infected with drug-susceptible strains was cured. A large proportion (58.8%) of patients infected with Mycobacterium, tuberculosis resistant to more than two drugs did not respond to treatment, i.e. the treatment failed or the patients died. The high rates of death (16.7%) and failure (66.7%) among patients infected with multidrug-resistant strains illustrate the negative impact of multidrug resistance on the outcome of tuberculosis treatment. Pan- resistance was significantly associated with treatment failure (P < 0.001). The spread of resistant Mycobacterium. tuberculosis has a serious negative impact on the outcome of tuberculosis treatment in Archangel, Russia. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate whether HIV-infected patients, a group that is supposedly at risk for infection with antibiotic-resistant microbes, really does so, and to assess possible risk factors for acquiring these organisms. During the period from January 1998 to July 1999, samples of normal flora were obtained from 107 HIV-infected patients attending an outpatient clinic in Oslo, Norway. The samples were cultured for Streptococcus pneumoniae, Haemophilus influenzae, Escherichia coli, coagulase-negative staphylococci and Candida spp., and the resulting isolates were tested for antimicrobial susceptibility. The patients studied represented all stages of HIV infection, from recently infected to severely immunocompromised. Samples were taken at one, two or three time-points to determine whether antimicrobial resistance in colonising microorganisms increases over time. Antimicrobial resistance was linked primarily to antimicrobial prophylaxis, but it did not increase during the observation period. The level of a patient's immunodeficiency and the consequently intensified medical care was also of some importance. Even though about 50% of the patients were receiving antimicrobial agents at the time of sampling, the level of resistance found in these patients was very similar to that found in other patient groups in Norway; except for Candida albicans isolates, which were less susceptible to fluconazole. Overall, antimicrobial resistance was uncommon in the HIV-seropositive patients studied, a finding that is probably related to the overall low prevalence of antimicrobial resistance in the general population in Norway. [ABSTRACT FROM AUTHOR]

A prospective study was conducted to determine (i) the degree of yeast colonization in surgical patients with intra-abdominal perforations and (ii) whether the frequency of colonization is different in patients with a complicated postoperative course than in patients recovering uneventfully. A total of 1,496 specimens taken per- and post-operatively from the mouth, stomach, feces, urine, trachea, and abdomen of 109 surgical patients with intra-abdominal perforations were examined. Yeast was recovered from 98 (90%) of the patients and from 634 (42%) of the specimens. Approximately 70% of the specimens from the mouth and stomach, 47% of fecal specimens, and 31% of abdominal specimens were positive for yeast. A total of 42 patients had a complicated postoperative course. The majority of these patients were colonized with yeast at multiple body sites: yeast was recovered on one or more occasions from two or more body sites in 90% and from three or more body sites in 71%. Many of the patients with an uncomplicated postoperative course also were colonized: yeast was recovered from two or more body sites in 69% and from three or more body sites in 34%. The results of this study indicate that treatment recommendations based on yeast colonization will expose a large number of patients to unnecessary or even harmful antifungal treatment. This does not mean that yeast colonization is insignificant; however, more accurate criteria and methods based on prospective clinical studies are needed to detect patients at risk of developing severe Candida infection. [ABSTRACT FROM AUTHOR]

The incidence of systemic Candida infections in patients requiring intensive care has increased substantially in recent years as a result of a combination of factors. More patients with severe underlying disease or immunosuppression from anti-neoplastic or anti-rejection chemotherapy and at risk from fungal infection are now admitted to the ICU. Improvements in supportive medical and surgical care have led to many patients who would previously have died as a result of trauma or disease surviving to receive intensive care. Moreover, some therapeutic interventions used in the ICU, most notably broad-spectrum antibiotics and intravascular catheters, are also associated with increased risks of candidiasis. Systemic Candida infections are associated with a high morbidity and mortality, but remain difficult to diagnose and ICU staff need to be acutely aware of this often insidious pathogen. A number of studies have identified risk factors for systemic Candida infection which may be used to identify those at highest risk. Such patients may be potential candidates for early, presumptive therapy. Here we review the epidemiology, pathogenesis, morbidity and mortality of systemic Candida infections in the ICU setting, and examine predisposing risk factors. Antifungal treatment, including the use of amphotericin B, flucytosine and fluconazole, and the roles of early presumptive therapy and prophylaxis, is also reviewed. [ABSTRACT FROM AUTHOR]

A 32-yr-old white North American male resident of Norway presented with an asymptomatic radiolucency first identified 3 yr after the removal of an impacted mandibular right third molar in Southern California 16 yr previously. Surgical exploration revealed an intraosseous cavity filled with a black, homogeneous, gelatinous substance thought to be foreign material, but which was diagnosed histologically as containing black yeasts. Cultivation of a microbiologic sample for 6 wk grew black yeast-like colonies. The yeast isolate was identified as an Aureobasidium species different from the typical A. pullulans. A blood sample was negative with regard to antibodies both with double diffusion technique and ELISA. Also, examination with respect to dermatologic manifestations gave negative results. Flucytocin 10 g/d was administered systemically for 30 d. Six months postoperatively bone regeneration was satisfactory radiologically. [ABSTRACT FROM AUTHOR]

Background: Traditional contact investigation is an important tool for controlling tuberculosis. It may also help to indicate drug susceptibility patterns when Mycobacterium tuberculosis cultures are not, available. Such investigations often underestimate the degree of transmission found by genotyping, but overestimation may also occur. This report is the result of a routine successive DNA restriction fragment length polymorphism (RFLP) analysis of M tuberculosis isolated in Norway., Method: Fifteen immigrants belonging to the same community were notified with tuberculosis during February to September 2003. The mycobacterial isolates were analysed by RFLP. Results: All 15 patients had social contact with each other and 3 belonged to the same church community. A total of 14 cultures were positive for M tuberculosis. Among these isolates, six different genotypes were found. Five patients had not acquired the infection from the putative source. Conclusions: Reactivation of tuberculosis may occur in contacts during the development of an outbreak. In such situations, traditional contact investigations may overestimate the rate of transmission Found by genotyping of M tuberculosis. When cultures are unavailable and presumed drug susceptibility patterns are based on that of contacts, such overestimation may lead to incorrect treatment of a patient. Contact investigations must be combined with genotyping of M tuberculosis to conclude how tuberculosis is transmitted. This is especially important in persons with several risk factors for infection. [ABSTRACT FROM AUTHOR]