To test the validity of reports on detection of Helicobacter pylori in the mouth, samples were obtained simultaneously from the gastric mucosa and dental plaques for culture in 94 patients examined consecutively by endoscopy. Histological examinations and serological tests were also performed. Helicobacter pylori was not found in the mouth of any of the patients including 52 who had culture-positive gastric biopsies. Thus earlier results could not be confirmed, however, other techniques such as the polymerase chain reaction might give different results.
We report a nosocomial outbreak of Legionella pneumophila serogroup (sg) 1 infection at the general hospital, Värnamo, Sweden. From December 1990 to February 1991, 28 patients and 3 staff fell ill with pneumonia and 3 died. L. pneumophila sg 1 together with several other Legionellae were isolated from the hot water supply to 17 of 20 hospital wards, probably being spread by aerosolization via shower nozzles. Raising the hospital's hot water temperature from 45 degrees C to 65 degrees C, together with heat disinfection of the shower equipment, arrested the outbreak within a week. Keeping the hot water temperature > or = 60 degrees C without chlorination eliminated L. pneumophila from > 75% of the wards. During a period of 2 years after the outbreak we have diagnosed only 1 case of nosocomial legionellosis at the hospital despite an active surveillance program.
The results of Legionella urinary antigen testing were correlated to the interval between onset of disease and sampling of urine in 134 patients in connection with a large outbreak of Legionnaires' disease at a Swedish hospital. In 17 patients with the disease, 5/7 sampled during the first 5 days of illness proved negative in the urinary antigen test. The risk of obtaining negative results during the first days of the disease is emphasized.
The usefulness of determination of lactate concentration in cerebrospinal fluid (CSF) for differentiation between various types of meningitis was evaluated. Lactate concentration in the CSF was assayed by gas-liquid chromatography for 115 patients, 17 of whom had serous meningitis and 38 had bacterial meningitis. The mean lactate concentration in the CSF of patients with bacterial meningitis was significantly higher than in the CSF of patients with serous meningitis and in a control group. The mean concentration in patients with serous meningitis was significantly higher than in controls. The highest lactate level in serous meningitis overlapped with the lowest level in bacterial meningitis. Elevated lactate concentrations in CSF were found also in patients with noninfectious disorders of the central nervous system. Misleading results may therefore be obtained if the lactate concentration in CSF alone is used to distinguish between serous and bacterial meningitis. The study suggests, however, that measurements of lactate levels in CSF, when combined with clinical and conventional laboratory observations, can increase the reliability of rapid diagnosis of bacterial meningitis.
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