Sentinel based Laboratory Surveillance on bacterial pathogens, 1989-1995

Voor planning m.b.t. bestrijding van infectieziekten moeten overheid en betrokken instanties keuzen maken over de ontwikkeling en implementatie van beheersprogramma's en epidemiologisch en diagnostisch onderzoek. Surveillance is hiertoe een onmisbare ondersteuning. Door het LSI-project wordt landelijk laboratoriumsurveillance van bacteriele infecties via een netwerk van Streeklaboratoria voor de Volksgezondheid (STL) gerealiseerd. De streeklaboratoria omvatten naar schatting 55% van de Nederlandse populatie, verspreid over vrijwel alle provincies. Alle eerste isolaten bij de mens van Salmonella, Bordetella, Legionella, Shigella, Listeria, Yersinia, Streptococcus pyogenes (zowel invasief als oppervlakkig) en invasieve Haemophilus influenzae worden door middel van meldingsformulieren gerapporteerd. Middels een weekformulier wordt het totaal aantal onderzochte faecesmonsters per week geregistreerd. Ook een weekoptelling van de isolaten en een weektotaal van Campylobacter. Salmonella-, Bordetella-, en Streptococcus pyogenes-isolaten dienen opgestuurd te worden naar het Laboratorium voor Infectieziektenscreening en Diagnostiek (RIVM) voor serotypering en faagtypering. Haemophilus influenzae-stammen worden getypeerd door het Referentielaboratorium voor Bacteriele Meningitis. Naast inzicht in trends en voorkomen van enkele bacteriele infecties in Nederland, verschaft het LSI-project inzicht in technische en organisatorische aspecten van landelijke surveillance. In dit rapport wordt zeven jaar registratie beschreven: de periode 1989 tot en met 1995.To make rational decisions about priorities in the control of infectious diseases, a quantitative basis is necessary. Therefore, the Department of Infectious Diseases Epidemiology of the National Institute of Public Health and the Environment (RIVM) has started in 1987 a sentinel based laboratory surveillance on bacterial pathogens. Sixteen out of seventeen Dutch public health laboratories participate in the system. Each first isolate of Salmonella, Shigella, Bordetella, Yersinia, Listeria, Legionella, invasive Haemophilus influenzae and Streptoccus pyogenes must be reported by a form on which some basic information on the patient is collected. Weekly, the laboratories also report totals of reported pathogens including Campylobacter, and the total number of examined faeces samples, to check the completeness of reporting and to obtain information on the denominator. Salmonella, Bordetella and Streptococcus pyogenes isolates should be sent to the Laboratory of Bacteriology (RIVM) for serotyping and phage typing. Haemophilus influenza isolates should be sent to the Reference Laboratory on Bacterial Meningitis. Besides monitoring of bacterial infections in the Netherlands, this project gives a better view on the technical and management aspects of national surveillance. This report describes the results of 7 years registration, in the period 1989 until 1995.IG

Laboratorium Surveillance Infectieziekten - 1989-1995

Voor planning m.b.t. bestrijding van infectieziekten moeten overheid en betrokken instanties keuzen maken over de ontwikkeling en implementatie van beheersprogramma's en epidemiologisch en diagnostisch onderzoek. Surveillance is hiertoe een onmisbare ondersteuning. Door het LSI-project wordt landelijk laboratoriumsurveillance van bacteriele infecties via een netwerk van Streeklaboratoria voor de Volksgezondheid (STL) gerealiseerd. De streeklaboratoria omvatten naar schatting 55% van de Nederlandse populatie, verspreid over vrijwel alle provincies. Alle eerste isolaten bij de mens van Salmonella, Bordetella, Legionella, Shigella, Listeria, Yersinia, Streptococcus pyogenes (zowel invasief als oppervlakkig) en invasieve Haemophilus influenzae worden door middel van meldingsformulieren gerapporteerd. Middels een weekformulier wordt het totaal aantal onderzochte faecesmonsters per week geregistreerd. Ook een weekoptelling van de isolaten en een weektotaal van Campylobacter. Salmonella-, Bordetella-, en Streptococcus pyogenes-isolaten dienen opgestuurd te worden naar het Laboratorium voor Infectieziektenscreening en Diagnostiek (RIVM) voor serotypering en faagtypering. Haemophilus influenzae-stammen worden getypeerd door het Referentielaboratorium voor Bacteriele Meningitis. Naast inzicht in trends en voorkomen van enkele bacteriele infecties in Nederland, verschaft het LSI-project inzicht in technische en organisatorische aspecten van landelijke surveillance. In dit rapport wordt zeven jaar registratie beschreven: de periode 1989 tot en met 1995.<br

Liver function disturbances in Guillain-Barre syndrome:A prospective longitudinal study in 100 patients

In 100 consecutive patients with Guillain-Barre syndrome, we assessed liver function on admission and at fixed intervals after either intravenous immunoglobulin (IgIV) or plasma-exchange (PE) treatment. On admission, 38% showed a plasma alanine aminotransferase elevation, gamma glutamyl transferase elevation, or both of more than 1.5 times the upper limit of normal. Ten of these patients had serologic evidence of recent cytomegalovirus infection. The remaining 28 patients were negative for other known causes of liver damage, including infection with Epstein-Barr virus or hepatitis A, B, and C; alcohol abuse; hepatotoxic drugs; recent surgery; and concurrent liver disease. In a hospital control group of 100 consecutive patients with subarachnoid hemorrhage, only 5 had unexplained liver function disturbances on admission (p <0.0001). In the IgIV-treated group, the percentage of patients with elevated liver function tests increased from 35% before to 69% shortly after treatment at 2 weeks postadmission (p <0.005). In the PE-treated group, this percentage decreased somewhat from 41% to 36% (not significant). There was also a significant rise in median plasma activity of the various liver enzymes in the IgIV group. At 1 month, however, significant difference had disappeared. At 3 and 6 months, the percentage of patients with liver function disturbances reached a significantly lower level in both treatment groups compared with the time of admission. We concluded that many patients with Guillain-Barre syndrome had mild liver function disturbances without obvious cause. In addition, IgIV treatment was associated with mild transient liver function disturbances through an unknown mechanism

Liver function disturbances in Guillain-Barre syndrome: A prospective longitudinal study in 100 patients

In 100 consecutive patients with Guillain-Barre syndrome, we assessed liver function on admission and at fixed intervals after either intravenous immunoglobulin (IgIV) or plasma-exchange (PE) treatment. On admission, 38% showed a plasma alanine aminotransferase elevation, gamma glutamyl transferase elevation, or both of more than 1.5 times the upper limit of normal. Ten of these patients had serologic evidence of recent cytomegalovirus infection. The remaining 28 patients were negative for other known causes of liver damage, including infection with Epstein-Barr virus or hepatitis A, B, and C; alcohol abuse; hepatotoxic drugs; recent surgery; and concurrent liver disease. In a hospital control group of 100 consecutive patients with subarachnoid hemorrhage, only 5 had unexplained liver function disturbances on admission (p <0.0001). In the IgIV-treated group, the percentage of patients with elevated liver function tests increased from 35% before to 69% shortly after treatment at 2 weeks postadmission (p <0.005). In the PE-treated group, this percentage decreased somewhat from 41% to 36% (not significant). There was also a significant rise in median plasma activity of the various liver enzymes in the IgIV group. At 1 month, however, significant difference had disappeared. At 3 and 6 months, the percentage of patients with liver function disturbances reached a significantly lower level in both treatment groups compared with the time of admission. We concluded that many patients with Guillain-Barre syndrome had mild liver function disturbances without obvious cause. In addition, IgIV treatment was associated with mild transient liver function disturbances through an unknown mechanism