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Human Legionella infections mainly consist of community-acquired and nosocomial pneumonia and rarely affect children. We describe a nosocomial infection with Legionella pneumophila, serogroup 1, subgroup OLDA, in an immunocompromized 2-y-old girl at a paediatric clinic. L. pneumophila identical to that of the patient was found in the hospital's cold-water but not in the hot-water distribution system. Transmission of Legionella to the girl most probably occurred by Legionella-contaminated cold water mixed and heated by water from the hot-water system. Mixing of hot and cold water probably occurred through thermostatic water mixing valves connected to showers regulated by a handle at the shower head. Nosocomial Legionella infection might thus have occurred, although circulating hot water temperatures never dropped below 53 degrees C and cultures for surveillance of Legionella from central parts of the hot-water system have been consistently negative. Legionellae were successfully eliminated from the hospital's cold-water distribution system by hot water flushing at 73 degrees C for 1h.

In order to evaluate the value of bacterial cultures taken from the throat, 266 patients with MRSA were retrospectively assessed. At the time when MRSA was first detected in the patient, the most frequent sites positive for MRSA were a skin lesion (110 patients, 41%), the anterior nares (109 patients, 41%), and the throat (102 patients, 38%). In 26%, 17%, and 17% of the patients, a skin lesion, the anterior nares, and the throat, respectively, were the only site where MRSA was seen. In 123 patients cultured for MRSA because of a close contact with an already known MRSA patient, 65 patients (53%) were positive for MRSA in their throat and in 40 patients (33%), throat was the only sample site with MRSA at the time when the patient was found to be MRSA positive. 146 of the 266 patients (55%) were colonized with MRSA in the throat any time throughout the period they were MRSA positive. We conclude that throat is an important reservoir for MRSA and that samples taken from the throat should be included in screening patients for MRSA.

The human caliciviruses norovirus and sapovirus are leading causes of acute, non-bacterial gastroenteritis. In contrast to norovirus, sapovirus is known to give infections mainly in infants and young children. We describe a nosocomial outbreak of gastroenteritis associated with sapovirus involving 23 adult patients and medical staff. The mean age of the patients and medical staff was 52 y and the major signs and symptoms were nausea, diarrhoea, vomiting, abdominal cramp, headache, myalgia and fever. More patients had diarrhoea (72%) than vomiting (56%) and the mean duration of symptoms was 6 d. A secondary attack rate of 45% was seen affecting in all 10 persons with a mean age of 29 y. Sequences of the capsid gene revealed a 97% nucleotide homology to the sapovirus genogroup IV reference strain Chiba/000671T/1999. This is one of the first reported nosocomial outbreaks of sapovirus infection among adults and shows that a diagnostic test for sapovirus should be included in investigation of gastroenteritis among adults.

An outbreak of gastroenteritis affecting 158 of 219 (72%) guests and employees at a hotel is described. Food served at the hotel restaurant is believed to have been the source of the outbreak and to have been contaminated by sick employees working in the restaurant. A secondary attack rate of 22% was seen involving 43 persons in all. In stool specimens from seven of eight patients, Norwalk-like viruses (NLVs) were detected by electron microscopy. While NLV-specific PCR using primers JV12 and JV13 were negative, all specimens examined with primers NVp69 and NVp110 were positive. The failure of primers JV12 and JV13 was attributed to several mismatches in the JV12 primer. Genotyping and sequence analysis revealed that all samples had identical sequences and clustered with genogroup I, and the most closely related well-characterized genotype is Desert Shield. This is the first described food-borne outbreak associated with genogroup I virus in Sweden.

Human cytomegalovirus (HCMV)-infected cells express a virus-encoded receptor that is able to bind the Fc part of IgG. Some basic binding properties of this Fc receptor (FcR) have been examined. The affinity constant (Ka) for human IgG Fc fragment in its interaction with acetone-fixed, HCMV-infected human embryonic lung fibroblasts was estimated to be around 2×108M−1and the number of binding sites was estimated to be around 2×106per cell. Of the human IgG, IgA, IgM and IgD classes, only IgG reacted with the receptor, and all four of the IgG subclasses were reactive. IgG from rabbit, hamster, cat, swine and horse exhibited binding to the HCMV FcR, in contrast to IgG from mouse, rat, guinea pig, dog, sheep, goat, cow and chicken. Immunoglobulins with and without HCMV IgG FcR-binding properties, like IgG from rabbit and mouse, can be of value in revealing the functional importance of the receptor. When the immunoglobulins were tested against herpes simplex virus type 1-induced FcR, both similarities and differences in immunoreactivity were seen relative to the HCMV FcR, which makes it unlikely that the binding sites for these two herpesvirus FcRs on the IgG molecule are identical.

35 episodes of septicemia in 33 patients occurred among 269 consecutive patients with granulocytopenia (granulocyte cell count less than or equal to 0.5 x 10(9)/l) during the 7-year period 1982-1988. 59% of isolated bacteria were Gram-positive (Staphylococcus aureus, Staph. epidermidis, Streptococcus species and Pneumococcus) and 41% Gram-negative (Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Enterobacter, Acinetobacter and Citrobacter). Compared to the 7-year period 1975-1981, there was a decrease in the relative number of patients with Gram-negative septicemia. Thus, a shift from a predominating Gram-negative etiology in the 1975-1981 period to a predominating Gram-positive etiology in the 1982-1988 period was noted. In both periods the mortality rate was high in patients with Gram-negative septicemia, especially in patients with a Ps, aeruginosa infection.

We report 2 cases of severe infections due to Pasteurella multocida, both occurring during pregnancy in previously healthy women. Both women had contact with animals (dog and cat) but neither of them had been bitten. Apart from a slight decrease in IgG levels, no immunological defects could be detected. Both women had received oral phenoxymethylpenicillin in the early phase of the disease, but still fell ill with severe infections. One woman had meningitis while the other suffered from cellulitis with deep abscess formation.

A consecutive series of patients with granulocytopenia was analysed with consideration of rate and spectrum of infectious complications. The records of 98 patients from 1975-81 were studied retrospectively. Fever was the most common symptom of infection. 78 patients had one or more infectious manifestations, and Staphylococcus aureus was the most common pathogen isolated. Septicemia occurred in 22 patients of which 17 were caused by gram-negative bacteria. Pseudomonas aeruginosa caused septicemia in 8 patients. The risk of septicemia increased with a decreasing cell count and with the degree and duration of fever. The mortality rate for the whole group was 24% and for the septicemic patients 41%.

Herpes simplex virus (HSV) infected cells express on their surface a receptor with affinity to the Fc portion of immunoglobulin G (IgG). The influence of the infected host cell on the specificity of the receptor was investigated with radiolabeled human IgG Fc fragment and four animal IgGs (rabbit, dog, cow, and rat) and eight human and animal (primate, rabbit, dog, cow, and rat) fibroblastoid and epithelioid cell lines. Human IgG Fc, rabbit IgG and cow IgG bound to all cell lines infected with HSV type 1 strain F (HSV-1 F), whereas dog IgG and rat IgG did not bind to any of these cells. The same binding pattern was seen when two additional HSV-1 strains infected rabbit epithelial (GMK AH1) cells. The results support the view that the specificity of the HSV Fc receptor is mainly under viral control and not primarily influenced by the species of the host cell.

Herpes simplex virus (HSV) induces a receptor on infected cells that is able to bind the Fc part of immunoglobulin G (IgG). We have examined some basic physicochemical and binding properties of the Fc receptor induced on HSV-1 infected green monkey kidney (GMK) cells in its interaction with rabbit IgG. Fixation of HSV-1 infected cells with glutaraldehyde, formaldehyde, acetone or ethanol did not inhibit the Fc binding ability. The binding specificity of the receptor was not affected by ethanol treatment and all subsequent binding studies were performed with cells treated with ethanol. The receptor was detected within 4 hours of infection and the binding increased until 16 hours post infection. The interaction between ligand and receptor was dependent on pH with a binding optimum around pH 8.0 and 8.5. EDTA, but not EGTA, inhibited receptor binding, suggesting participation of divalent cations in the receptor-ligand interaction. Inhibition of binding was also seen when cells were preincubated for 30 min at 56 degrees, 60 degrees and 100 degrees C in contrast with cells incubated at 37 degrees and 45 degrees C. The number of binding sites on ethanol-treated GMK cells 18 hours after infection was estimated to be around 4 x 10(6)/cell and the affinity constant at approximately 2 x 10(7) M-1.