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Byline: Catharina F. M. Linssen (1), Jan A. Jacobs (1), Foekje F. Stelma (1), Walther N. K. A. Mook (2), Peter Terporten (1), Cornelis Vink (1), Marjolein Drent (3), Cathrien A. Bruggeman (1), Annick Smismans (1) Keywords: Viral pneumonia; Intensive care Abstract: Objective To evaluate the relationship between the HSV-1 and -2 loads in BAL fluid (BALF) and clinical outcome. Design Retrospective study. Setting The general intensive care unit of the University Hospital Maastricht. Patients Five hundred and twenty-one BALF samples from 462 patients were included. Patients were divided into three groups (1) patients admitted to the hospital 48 h before lavage (ICU) and (3) the remaining patients (non-ICU group). Interventions No additional interventions were conducted. Measurements and results HSV-1 and HSV-2 loads were determined by real-time polymerase chain reaction (PCR). HSV-1 DNA was detected in 4.3% (4/92) of samples in the community group, 15% (18/121) in the non-ICU group and in 32% (99/308) of the ICU group. In the age group 10.sup.5 genome equivalents (ge)/ml were associated with an increased 14-day in-hospital mortality compared to patients with a HSV-1 load a$?10.sup.5 ge/ml in BALF (41 vs. 20%, respectively, P = 0.001). HSV-1 pneumonia was histologically proven in two patients with a HSV-1 load exceeding 10.sup.5 ge/ml. Conclusions HSV-1 occurred more in critically ill patients and high loads in BALF were associated with an increased mortality. The higher mortality observed in patients with HSV-1 load >10.sup.5 ge/ml enforces its clinical relevance and necessitates to start randomized medical intervention studies. Author Affiliation: (1) Department of Medical Microbiology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands (2) Department of Intensive Care Medicine, University Hospital Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands (3) Department of Respiratory Medicine, University Hospital Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands Article History: Registration Date: 16/07/2008 Received Date: 11/10/2007 Accepted Date: 11/07/2008 Online Date: 05/08/2008 Article note: The abstract of this article was published in ESCV/SGM Conference, Birmingham, as an oral presentation.

OBJECTIVE. The aim of this study was to examine the contribution of a broad range of external influences to the gut microbiotic composition in early infancy. METHODS. Fecal samples from 1032 infants at 1 month of age, who were recruited from the KOALA Birth Cohort Study in the Netherlands, were subjected to quantitative real-time polymerase chain reaction assays for the enumeration of bifidobacteria, Escherichia coli, Clostridium difficile, Bacteroides fragilis group, lactobacilli, and total bacterial counts. Information on potential determinants of the gut microbiotic composition was collected with repeated questionnaires. The associations between these factors and the selected gut bacteria were analyzed with univariate and multivariate analyses. RESULTS. Infants born through cesarean section had lower numbers of bifidobacteria and Bacteroides, whereas they were more often colonized with C difficile, compared with vaginally born infants. Exclusively formula-fed infants were more often colonized with E coli, C difficile, Bacteroides, and lactobacilli, compared with breastfed infants. Hospitalization and prematurity were associated with higher prevalence and counts of C difficile. Antibiotic use by the infant was associated with decreased numbers of bifidobacteria and Bacteroides. Infants with older siblings had slightly higher numbers of bifidobacteria, compared with infants without siblings. CONCLUSIONS. The most important determinants of the gut microbiotic composition in infants were the mode of delivery, type of infant feeding, gestational age, infant hospitalization, and antibiotic use by the infant. Term infants who were born vaginally at home and were breastfed exclusively seemed to have the most "beneficial" gut microbiota (highest numbers of bifidobacteria and lowest numbers of C difficile and E coli). Key Words infant, intestinal microbiota, bacterial colonization, 16S ribosomal RNA, real-time polymerase chain reaction Abbreviations PCR--polymerase chain reaction CFU--colony-forming units OR--odds ratio CI--confidence interval, THE GUT MICROBIOTA plays an important role in human health by providing a barrier for colonization of pathogens, by exerting important metabolic functions (fermentation of nondigestible fibers, salvage of energy [...]

Abstract Background Chronic fatigue syndrome (CFS) is a clinical condition characterized by severe and disabling fatigue that is medically unexplained and lasts longer than 6 months. Although it is possible to effectively treat CFS, the nature of the underlying physiology remains unclear. Various studies have sought evidence for an underlying disturbance in immunity. The aim of this study was to compare the humoral and cellular immune responses upon influenza vaccination in CFS patients and healthy controls. Results Identical antibody titers were observed in CFS patients and healthy controls. Patients and controls demonstrated similar seroprotection rates against all three virus-strains of the influenza vaccine, both pre- and post-vaccination. Functional T cell reactivity was observed in both CFS patients and healthy controls. CFS patients showed a non-significant, numerically lower cellular proliferation at baseline compared to controls. Vaccination induced a significant increase in cellular proliferation in CFS patients, but not in healthy controls. Cytokine production and the number of regulatory T cells were comparable in patients and controls. Conclusions The humoral and cellular immune responses upon influenza vaccination were comparable in CFS patients and healthy controls. Putative aberrations in immune responses in CFS patients were not evident for immunity towards influenza. Standard seasonal influenza vaccination is thus justified and, when indicated, should be recommended for patients suffering from CFS.

OBJECTIVES. Antibiotic exposure in early life may be associated with atopic disease development either by interfering with bacterial commensal flora or by modifying the course of bacterial infections. We evaluated [...]

In the northern part of Western Europe, Echinococcus multilocularis is primarily detected in and spreading among foxes. The present case marks E. multilocularis as an emerging pathogen for humans, as it describes the first human case of probably locally acquired E. multilocularis in The Netherlands, with various interesting clinical aspects.