Bacterial meningitis in one month-16 year old children at three Pediatric departments in Iceland during the period 1973-2000

Neðst á síðunni er að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: Bacterial meningitis is a serious disease most common in children. We report the epidemiology and outcome of bacterial meningitis in children between the age of one month to 16 years admitted to three Pediatric Departments in Iceland in 1973-2000 (28 years). Material and methods: Information was collected retrospectively from the medical records of admitted children diagnosed with bacterial meningitis. Results: 454 children were diagnosed; 255 boys and 199 girls; 77% were less than five years of age. Before 1989 the age specific incidence was 29/100.000/year and 12/100.000/year thereafter. The cerebral spinal fluid was culture positive in 74% but no organism was identified in 17%. The most common pathogens were N. meningitidis (44%), Hib (30%), and S. pneumoniae (7%). The incidence varied according to age. No child was diagnosed with Hib after launching of Hib vaccination in 1989. The mean age of the children increased significantly from less than two years prior to 1989 to less than three years thereafter and of children infected with N. meningitidis from around two year to three years. The mortality rate was 4,5%, none due to Hib. Fourteen percent suffered sensory-neural hearing impairment and no protective effects were seen of steroid therapy. Conclusions: The age specific incidence of bacterial meningitis of children in Iceland has decreased during the last decade, especially due to Hib vaccination. Further reduction can be expected by implementing general vaccination to N. meningitidis C and S. pneumoniae. Additionally, recognizing the symptoms of bacterial meningitis and starting proper therapy as soon as possible is crucial in order to minimize ominous outcome.Inngangur: Heilahimnubólga af völdum baktería er alvarlegur sjúkdómur og algengastur hjá börnum. Í þessari rannsókn er litið á faraldsfræði og fylgikvilla sjúkdómsins hjá eins mánaðar til 16 ára gömlum börnum sem lögðust inn á þrjár barnadeildir á Íslandi á árunum 1973-2000 (28 ár). Efniviður og aðferðir: Upplýsingar voru fengnar úr sjúkraskrám barna á Barnaspítala Hringsins og barnadeildum Landakotsspítala/Borgarspítala/ Sjúkrahúss Reykjavíkur og Fjórðungssjúkrahússins á Akureyri sem fengið höfðu greininguna heilahimnubólga af völdum baktería. Niðurstöður: Alls greindust 454 börn, 255 drengir og 199 stúlkur; 77% voru yngri en fimm ára. Aldursbundið nýgengi var 29/100.000/ár fram til ársins 1989 og 12/100.000/ár eftir það. Greining fékkst með ræktun úr mænuvökva hjá 74% en hjá 17% var sýkingavaldur óþekktur. Helstu sýkingavaldar voru Neisseria meningitidis (44%), Haemophilus influenzae af sermisgerð b (Hib) (30%) og Streptococcus pneumoniae (7%). Tíðni þeirra var mismunandi eftir aldri. Ekkert tilfelli Hib greindist eftir að bólusetning gegn bakteríunni hófst 1989. Algengustu hjúpgerðir N. meningitidis voru B (55%) og C (19%). Meðalaldur barnanna hækkaði marktækt úr tæpum tveimur árum fram til 1989 í tæplega þrjú ár eftir það, og barna með N. meningitidis úr rúmlega tveimur árum í rúmlega þrjú. Dánartíðnin var 4,5% en ekkert barn með Hib dó. Um þriðjungur barna fékk fylgikvilla sérstaklega eftir sýkingu af völdum S. pneumoniae. Fjórtán af hundraði fengu skyntaugarheyrnartap og voru sterar ekki verndandi. Ályktanir: Nýgengi heilahimnubólgu af völdum baktería hjá börnum á Íslandi hefur farið lækkandi síðustu ár, einkum vegna Hib bólusetningar. Líklegt er að bólusetning gegn N. meningitidis C og S. pneumoniae geti einnig fækkað enn frekar heilahimnubólgu hjá börnum. Auk þess eru skjót viðbrögð við einkennum heilahimnubólgu mikilvæg til að minnka líkur á fylgikvillu

The Helicobacter pylori Genome Project : insights into H. pylori population structure from analysis of a worldwide collection of complete genomes

Helicobacter pylori, a dominant member of the gastric microbiota, shares co-evolutionary history with humans. This has led to the development of genetically distinct H. pylori subpopulations associated with the geographic origin of the host and with differential gastric disease risk. Here, we provide insights into H. pylori population structure as a part of the Helicobacter pylori Genome Project (HpGP), a multi-disciplinary initiative aimed at elucidating H. pylori pathogenesis and identifying new therapeutic targets. We collected 1011 well-characterized clinical strains from 50 countries and generated high-quality genome sequences. We analysed core genome diversity and population structure of the HpGP dataset and 255 worldwide reference genomes to outline the ancestral contribution to Eurasian, African, and American populations. We found evidence of substantial contribution of population hpNorthAsia and subpopulation hspUral in Northern European H. pylori. The genomes of H. pylori isolated from northern and southern Indigenous Americans differed in that bacteria isolated in northern Indigenous communities were more similar to North Asian H. pylori while the southern had higher relatedness to hpEastAsia. Notably, we also found a highly clonal yet geographically dispersed North American subpopulation, which is negative for the cag pathogenicity island, and present in 7% of sequenced US genomes. We expect the HpGP dataset and the corresponding strains to become a major asset for H. pylori genomics

Athugun á lyfjanæmi campylobacter pylori

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)The in vitro susceptibility of 26 clinical isolates of Campylobacter pylori to cimethidine, bismuth, sucralfate and thirteen antibiotics was determined by agar dilution technique. All the Campylobacter pylori strains were recent isolates from Icelandic patients undergoing gastroscopy for either dyspepsia or epigastric pain. Penicillin, ampicillin, erythromycin and azithromycin were most active, MIC90 <0.25 /xg/ml. Cefoxitin, cefotaxime, ceftriaxone, gentamicin, tobramycin and chloramphenicol were also quite active, MIC90 <2 ^ig/ml. Cephradine and metronidazole had little activity, MIC90=8/ig/ml and 16/xg/ml respectively and trimethoprim-sulfamethoxazol was still less active, MIC90=128. Cimetidine and sucralfate showed no bactericidal activity. The results for bismuth were inconclusive.Kannað var næmi 26 stofna af Campylobacter pylori fyrir 16 lyfjum, cimetidíni, súkralfati, bismúti og 13 sýklalyfjum. Mæld voru hammörk (MIC - Minium Inhibitory Concentration) með raðþynningum í föstu æti. Bakteríustofnarnir voru einangraðir frá íslenskum sjúklingum, sem höfðu óþægindi frá meltingarfærum. Penisillín, ampisillín, erýtrómýsín og asitrómýsín reyndust virkust með 90% hammörk (MIC 90)<0.25 /íg/ml. Kefoxitín, kefótaxím, keftríaxón, gentamísín, tóbramýsín og klóramfeníkól höfðu einnig ágæta virkni með MIC 90<2 /íg/ml. Kefradín hafði litla virkni, MIC 90 var 8/xg/ml og sömuleiðis metrónídasól, MIC 90 var 16 //g/ml og Bactrim enn minni, með 128 /ig/ml. Ekki tókst að sýna fram á bakteríudrepandi áhrif címetidíns eða súkralfats. Niðurstöður fyrir bismút voru óljósar

Athugun á lyfjanæmi campylobacter pylori

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)The in vitro susceptibility of 26 clinical isolates of Campylobacter pylori to cimethidine, bismuth, sucralfate and thirteen antibiotics was determined by agar dilution technique. All the Campylobacter pylori strains were recent isolates from Icelandic patients undergoing gastroscopy for either dyspepsia or epigastric pain. Penicillin, ampicillin, erythromycin and azithromycin were most active, MIC90 <0.25 /xg/ml. Cefoxitin, cefotaxime, ceftriaxone, gentamicin, tobramycin and chloramphenicol were also quite active, MIC90 <2 ^ig/ml. Cephradine and metronidazole had little activity, MIC90=8/ig/ml and 16/xg/ml respectively and trimethoprim-sulfamethoxazol was still less active, MIC90=128. Cimetidine and sucralfate showed no bactericidal activity. The results for bismuth were inconclusive.Kannað var næmi 26 stofna af Campylobacter pylori fyrir 16 lyfjum, cimetidíni, súkralfati, bismúti og 13 sýklalyfjum. Mæld voru hammörk (MIC - Minium Inhibitory Concentration) með raðþynningum í föstu æti. Bakteríustofnarnir voru einangraðir frá íslenskum sjúklingum, sem höfðu óþægindi frá meltingarfærum. Penisillín, ampisillín, erýtrómýsín og asitrómýsín reyndust virkust með 90% hammörk (MIC 90)<0.25 /íg/ml. Kefoxitín, kefótaxím, keftríaxón, gentamísín, tóbramýsín og klóramfeníkól höfðu einnig ágæta virkni með MIC 90<2 /íg/ml. Kefradín hafði litla virkni, MIC 90 var 8/xg/ml og sömuleiðis metrónídasól, MIC 90 var 16 //g/ml og Bactrim enn minni, með 128 /ig/ml. Ekki tókst að sýna fram á bakteríudrepandi áhrif címetidíns eða súkralfats. Niðurstöður fyrir bismút voru óljósar

Útbreiðsla legionella spp. í umhverfi á Íslandi

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)An extensive, prospective study on pneumonia in the National University Hospital (Landspítalinn) (1) and Reykjavik City Hospital (Borgarspitalinn) (2) pointed to that Legionella spp. being a common cause of pneumonia in Iceland. These findings led to the current study on the distribution of Legionella spp. in the environment, especially in hospitals. Samples of water baths in laboratory units and from showerheads in many wards, were collected in three hospitals in Reykjavik: the University Hospital (98 samples), the Reykjavik City Hospital (27 samples) and Landakot (15 samples). Legionella pnenumophila serotype 1 was found in all the hospitals. In the University Hospital samples of water were also collected from staffquarters, from humidifiers for ventilation systems, from taps in all the wards, from the artificial kidney machines and finally from the cold water inlet for the hospital. This added up to a total of 145 samples and Legionella was found in one or more samples from all these places except the cold water inlet. All the strains found turned out to be L. pneumophila serotype 1. Nineteen water samples collected outside the hospitals did not contain Legionella.Á árunum 1983 og 1984 voru gerðar rannsóknir á orsökum lungnabólgu á Landspítala (1) og Borgarspítala (2) sem bentu til að umtalsverðan fjölda lungnasýkinganna mætti rekja til Legionella. Af þessu tilefni var ráðist í að kanna nánar útbreiðslu bakteríanna í umhverfi á Íslandi, einkum á stóru sjúkrahúsunum í Reykjavik. Rannsökuð voru vatnssýni úr hitaböðum á rannsóknardeildum, krönum og sturtuhausum á Landspítala, Borgarspítala og Landakotsspítala og fannst Legionella pneumophila serotypa 1, í einhverjum mæli á öllum sjúkrahúsunum. Samtals voru rannsökuð 285 sýni frá 208 stöðum á þessum sjúkrahúsum. Á Landspítala fannst L. pneumophila í 9 af 13 handlaugakrönum og 7 af 10 sturtuhausum í vistarverum starfsfólks. Þegar tekin voru sýni úr inntökum »jákvæðu« vaskanna fyrir heita vatnið annars vegar og kalda vatnið hins vegar ræktaðist Legionella úr öllum kaldavatnssýnunum, en heitavatnssýnin voru neikvæð. Af 10 rakagjöfum, sem athugaðir voru var einn jákvæður. Sama gilti um 15 af 22 handlaugakrönum á legudeildum og 6 af 8 gervinýrnavélum. Ekki tókst að rækta Legionella úr kaldavatnstanki sjúkrahússins. Allir stofnarnir reyndust vera L. pneumophila af serotypu 1. Legionella fannst ekki í neinu þeirra 19 vatnssýna, sem tekin voru utan sjúkrahúsanna, úr sturtuhausum í heimahúsum á höfuðborgarsvæðinu og úr Tjörninni

Bacterial meningitis in adults in Iceland, 1995-2010.

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageBacterial meningitis is a serious disease with a mortality rate of 15-20% in adults. We conducted a population-based study of bacterial meningitis in adults (≥ 16 y) in Iceland, 1995-2010.Cases were identified based on positive bacterial cultures from cerebrospinal fluid (CSF) and/or the ICD codes for bacterial meningitis. Medical charts were reviewed and outcomes were assessed using the national population registry. The study period was divided into 2 equal parts, 1995-2002 and 2003-2010, before and after implementation of routine childhood vaccination against serogroup C meningococci, respectively.In total, 111 episodes occurred in 110 individuals. The most common causative organisms were Neisseria meningitidis (41%) and Streptococcus pneumoniae (30%). Only 30% of the patients presented with the classical symptom triad of fever, neck stiffness, and an altered mental status. The overall incidence was 3.2/100,000 inhabitants/y, and dropped significantly between the first and second halves of the study (p = 0.03). This drop was due to a reduced incidence of N. meningitidis meningitis: 34 and 12 cases in the first and second periods, respectively (p = 0.006). The incidence of meningitis caused by S. pneumoniae remained unchanged. The case fatality rates were 18% and 13% in the first and second halves of the study, respectively (difference not significant).The incidence of bacterial meningitis has decreased since the implementation of meningococcal C vaccination in 2002. However, the case fatality rate has remained unchanged

Campylobacter-pylori in gastric mucosa : a prospective study of the prevalence of C.-pylori in the gastric mucosa of patients with symptoms of gastritis or ulcer.

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Gastric mucosal biopsies from 37 patients, who underwent gastroscopy in the gastrointestinal unit of the University Hospital in Iceland, were studied. Biopsies from three different areas of the stomach were obtained in each case. The results of bacterial culture on Skirrow's medium and histological study with HE- and Warthin-Starry staining methods were compared. C.-pylori was found in 75.5% of the specimens and in 86.5% the two different methods gave identical results. C.-pylori was found more commonly in the stomach of these icelandic patients than expected. There was a statistically significant correlation between the histological diagnosis of active chronic gastritis or gastric ulcer and the presence of C.-pylori in the mucosa. All the patients, who were found to have gastric ulcer, and 84.8% of the patients with chronic active gastritis had C.-pylori in the mucosa. These results support the contention that C.-pylori may be a causal agent in gastritis and gastric ulcer.Leitað var að Campylobacter-pylori í magaslímhúð hjá 37 sjúklingum sem voru magaspeglaðir á Landspítalanum. Tvær greiningaraðferðir voru bornar saman: sýklaræktun með sérstöku æti (Skirrow's medium) og vefjarannsókn með sérlitun (Warthin-Starry) fyrir C.-pylori. Sýkillinn fannst í 75,5% sýnanna og hjá 86,5% sjúklinganna bar aðferðunum saman. C.-pylori fannst oftar hjá þessum Íslensku sjúklingum en búast mátti við samkvæmt erlendum rannsóknum. Það fannst tölfræðilega marktækt samband milli virkrar bólgu (gastritis chronica activa) og C.-pylori í magaslímhúð. C.-pylori fannst í magaslímhúð hjá 28 af 33 sjúklingum (84,8%) með virka magabólgu, en einungis hjá einum af fjórum sjúklingum (25%) með hægfara magabólgu. Allir þeir þrettán sjúklingar, sem höfðu sár eða fleiður í magaslímhúð, reyndust einnig hafa C.-pylori. Niðurstöður rannsóknarinnar styðja þá kenningu að C.-pylori sé meðverkandi orsakaþáttur við virka bólgu og sár í maga

Campylobacter-pylori in gastric mucosa : a prospective study of the prevalence of C.-pylori in the gastric mucosa of patients with symptoms of gastritis or ulcer.

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Gastric mucosal biopsies from 37 patients, who underwent gastroscopy in the gastrointestinal unit of the University Hospital in Iceland, were studied. Biopsies from three different areas of the stomach were obtained in each case. The results of bacterial culture on Skirrow's medium and histological study with HE- and Warthin-Starry staining methods were compared. C.-pylori was found in 75.5% of the specimens and in 86.5% the two different methods gave identical results. C.-pylori was found more commonly in the stomach of these icelandic patients than expected. There was a statistically significant correlation between the histological diagnosis of active chronic gastritis or gastric ulcer and the presence of C.-pylori in the mucosa. All the patients, who were found to have gastric ulcer, and 84.8% of the patients with chronic active gastritis had C.-pylori in the mucosa. These results support the contention that C.-pylori may be a causal agent in gastritis and gastric ulcer.Leitað var að Campylobacter-pylori í magaslímhúð hjá 37 sjúklingum sem voru magaspeglaðir á Landspítalanum. Tvær greiningaraðferðir voru bornar saman: sýklaræktun með sérstöku æti (Skirrow's medium) og vefjarannsókn með sérlitun (Warthin-Starry) fyrir C.-pylori. Sýkillinn fannst í 75,5% sýnanna og hjá 86,5% sjúklinganna bar aðferðunum saman. C.-pylori fannst oftar hjá þessum Íslensku sjúklingum en búast mátti við samkvæmt erlendum rannsóknum. Það fannst tölfræðilega marktækt samband milli virkrar bólgu (gastritis chronica activa) og C.-pylori í magaslímhúð. C.-pylori fannst í magaslímhúð hjá 28 af 33 sjúklingum (84,8%) með virka magabólgu, en einungis hjá einum af fjórum sjúklingum (25%) með hægfara magabólgu. Allir þeir þrettán sjúklingar, sem höfðu sár eða fleiður í magaslímhúð, reyndust einnig hafa C.-pylori. Niðurstöður rannsóknarinnar styðja þá kenningu að C.-pylori sé meðverkandi orsakaþáttur við virka bólgu og sár í maga

Broiler Campylobacter Contamination and Human Campylobacteriosis in Iceland ▿ †

To examine whether there is a relationship between the degree of Campylobacter contamination observed in product lots of retail Icelandic broiler chicken carcasses and the incidence of human disease, 1,617 isolates from 327 individual product lots were genetically matched (using the flaA short variable region [SVR[) to 289 isolates from cases of human campylobacteriosis whose onset was within approximately 2 weeks from the date of processing. When there was genetic identity between broiler isolates and human isolates within the appropriate time frame, a retail product lot was classified as implicated in human disease. According to the results of this analysis, there were multiple clusters of human disease linked to the same process lot or lots. Implicated and nonimplicated retail product lots were compared for four lot descriptors: lot size, prevalence, mean contamination, and maximum contamination (as characterized by direct rinse plating). For retail product distributed fresh, Mann-Whitney U tests showed that implicated product lots had significantly (P = 0.0055) higher mean contamination than nonimplicated lots. The corresponding median values were 3.56 log CFU/carcass for implicated lots and 2.72 log CFU/carcass for nonimplicated lots. For frozen retail product, implicated lots were significantly (P = 0.0281) larger than nonimplicated lots. When the time frame was removed, retail product lots containing Campylobacter flaA SVR genotypes also seen in human disease had significantly higher mean and maximum contamination numbers than lots containing no genotypes seen in human disease for both fresh and frozen product. Our results suggest that cases of broiler-borne campylobacteriosis may occur in clusters and that the differences in mean contamination levels may provide a basis for regulatory action that is more specific than a presence-absence standard

Neisseria meningitidis sequence type and risk for death, Iceland

Invasive meningococcal infections are hyperendemic in Iceland, a relatively isolated country in the mid-Atlantic. We performed a nationwide study on all viable meningococcal strains (N = 362) from 1977 to 2004. We analyzed the association of patient's age and sex, meningococcal serogroups, and sequence types (STs) with outcomes. Overall, 59 different STs were identified, 19 of which were unique to Iceland. The most common STs were 32 (24.6%), 11 (19.9%), and 10 (10.2%). The unique ST-3492 ranked fourth (7.7%). The most common serogroups were B (56.4%), C (39.8%), and A (2.2%). Age (p &lt; 0.001) and infection with a unique ST (p = 0.011) were independently associated with increased death rates, whereas isolation of meningococci from cerebrospinal fluid only was associated with lower death rates (p = 0.046). This study shows evolutionary trends of meningococcal isolates in a relatively isolated community and highlights an association between unique STs and poor outcome