Effect on diagnostic yield of repeated stool testing during outbreaks of Clostridium difficile-associated disease.

The effect on diagnostic yield of testing sequential stools was assessed during two hospital epidemics of Clostridium difficile. Using a rapid immunoassay, C. difficile-associated disease was diagnosed in 237 diarrhoeal patients, of whom 204 (86%) were diagnosed from the first faeces sample and 12 (5%) were diagnosed from follow-up samples obtained within 1 week.

Methicillin-resistant Staphylococcus aureus in Dutch soccer team.

An outbreak of community-acquired methicillin-resistant Staphylococcus aureus occurred among members and close contacts of a soccer team. Typing of the isolates showed the outbreak was caused by the well-known European ST80-IV strain. To our knowledge, this is the first report of an outbreak of this strain among members of a sports team.

[Clostridium difficile ribotype 027, toxinotype III in The Netherlands].

Recently, two Dutch hospitals reported outbreaks of Clostridium difficile ribotype 027, toxinotype III. This strain, which was seen earlier in the United States, Canada and the United Kingdom, produces large amounts of toxins due to a defect in the toxin-regulating gene and causes severe diarrhoea. Antibiotic use, especially use of fluoroquinolones, is a risk factor.

Treatment of chronic suppurative otitis media with ofloxacin in hydroxypropyl methylcellulose ear drops: a clinical/bacteriological study in a rural area of Malawi.

Chronic suppurative otitis media in young children is a major problem in Africa, with socio-economic consequences at a later age. Common treatment regimens with antibiotics are expensive and often not practically feasible. Therefore, a project was started to develop a low-cost and effective treatment in a rural area of Malawi by studying the clinical efficacy of an inexpensive application regimen of ofloxacin (0.

Variant esp gene as a marker of a distinct genetic lineage of vancomycin-resistant Enterococcus faecium spreading in hospitals.

In the USA, vancomycin-resistant Enterococcus faecium (VREF) is endemic in hospitals, despite lack of carriage among healthy individuals. In Europe, however, hospital outbreaks are rare, but VREF carriage among healthy individuals and livestock is common. We used amplified fragment-length polymorphism analysis to genotype 120 VREF isolates associated with hospital outbreaks and 45 non-epidemic isolates from the USA, Europe, and Australia.

[Vancomycin-resistant Enterococcus faecium outbreak in a nephrology ward].

In April 2000, an outbreak of vancomycin-resistant Enterococcus faecium (VRE) was discovered in an internal medicine/nephrology and dialysis ward of the Eemland Hospital, Amersfoort, the Netherlands. Although enterococci are considered relatively non-virulent, VRE are resistant to almost all commercially available antibiotics. Surveillance cultures were obtained from all patients at the ward, all patients visiting the dialysis ward and the environment of patients.

[Acute and chronic Q fever; epidemiology, symptoms, diagnosis and therapy of infection caused by Coxiella burnetii].

Q fever is a zoonosis caused by Coxiella burnetii, an obligate intracellular bacterium. Domestic ungulates and parturient cats are the primary reservoirs of infection. The animals excrete the bacterium in urine, faeces, milk and amniotic fluid.

[Q fever: not just in sheep].

Four patients, a woman aged 41 years and 3 men aged 12, 47 and 44 years, developed high fever after returning from a farm vacation in the Ardèche (France). They also suffered from severe headache, a painful tightness of the chest, abdominal pain or myalgia. Other symptoms were shivers, tiredness and a cough.

Meningococcal carriage in relation to an outbreak of invasive disease due to Neisseria meningitidis serogroup C in the Netherlands.

Background: a cross-sectional study on meningococcal carriage was performed in Putten, a small rural town in the Netherlands where an unusual high incidence of invasive meningococcal disease (IMD) due to Neisseria meningitidis C:2a:P1.5 occurred. The outbreak was controlled by mass vaccination of all inhabitants aged 2 to 20 years.

[Puerperal fever: an old enemy in aggressive form].

Two previously healthy women, aged 30 and 35 years, suffered pain in the lower abdomen, one before and the other after spontaneous delivery at 40 and 33 4/7 weeks of amenorrhoea, respectively, while a third woman, aged 33, at 36 weeks of amenorrhoea developed pain in the lower abdomen, fever, vomiting, and diarrhoea. All three women were found to have a uterine infection caused by streptococci of Lancefield group A (group A Streptococcus, GAS). In one woman, the diagnosis was made rapidly so that antibiotic treatment could be instituted in time; the other two developed sepsis and multiorgan failure, with a fatal issue in one of them.

IgA antibodies against Klebsiella and other Gram-negative bacteria in ankylosing spondylitis and acute anterior uveitis.

Mucosal infections, especially of the gastrointestinal tract, are thought to trigger the onset and/or reactivation of ankylosing spondylitis (AS). Previous investigations into the role of Klebsiella and other Gram-negative bacteria in AS patients show contrasting results. In the present study prevalence of IgA antibodies against Klebsiella, Yersinia, Salmonella, Shigella, and Campylobacter was examined in serum samples from 30 patients having HLA-B27 associated ankylosing spondylitis, 32 patients with HLA-B27 associated acute anterior uveitis (AAU), and 27 HLA-B27 positive patients having both AS and AAU.

No conclusive evidence of an epidemiological relation between Klebsiella and ankylosing spondylitis.

Fifty-six patients with ankylosing spondylitis and 87 healthy controls were screened for Klebsiella strains in their stools using a new highly sensitive culture medium. The presence of Klebsiella strains in the patient group was compared with activity of the disease. In a dynamic study changes in Klebsiella quantity over a period of 3 months were compared with changes in disease activity over the same period.

[Fulminant sepsis caused by Streptococcus suis].

A 26-year-old man, in daily contact with pigs was admitted to hospital with septic shock which appeared to be caused by Streptococcus suis type 2 infection. Despite immediate antibiotic therapy a multiple organ failure developed, with ARDS, cardiac failure, disseminated intravascular coagulation and acute renal failure. Streptococcus suis infection is a zoonosis.

Isolation of swine-like influenza A(H1N1) viruses from man in Switzerland and The Netherlands.

Swine influenza A (H1N1) viruses were isolated from two people in Switzerland and one in the Netherlands in early 1986. In haemagglutination-inhibition and neuraminidase-inhibition assays, the three viruses were closely related to one another and to the A/New Jersey/8/76 strain. The Swiss patients showed only mild symptoms, whereas the Dutch patient suffered from severe pneumonia.

Rabbit antisera to enterobacteriaceae isolated from HLA-B27 positive patients with ankylosing spondylitis (AS) are lytic for the mononuclear cells of AS patients.

Vaccines prepared from Gram-negative bacteria isolated from the stools of HLA-B27 positive AS patients were used to immunize rabbits. Three of the sera obtained were lytic in vitro for the mononuclear cells of HLA-B27 positive AS patients. One of these sera discriminated between AS patients and healthy HLA-B27 positive individuals.

IgG and IgA immune response against klebsiella in HLA-B27-associated anterior uveitis.

Enteric infections with Gram-negative bacteria are thought to play an important part in HLA-B27-associated disease such as Reiter's syndrome and reactive arthritis. But the role of bacterial infections in HLA-B27-positive ankylosing spondylitis (AS) and acute anterior uveitis (AU) is still controversial. A special interest has recently been devoted to the role of klebsiella infection in HLA-B27-associated disease.

New, simple medium for selective recovery of Klebsiella pneumoniae and Klebsiella oxytoca from human feces.

A culture medium was developed which selectively favored the growth of Klebsiella pneumoniae and Klebsiella oxytoca in Escherichia coli-rich fecal cultures, without the use of antibiotics. The discriminative capacity of this medium was based on the presence of only two carbon sources, citrate and inositol, which can be utilized by nearly all K. pneumoniae and K.