Waterborne outbreaks associated with contamination of drinking water by Campylobacter jejuni are rather common in the Nordic countries Sweden, Norway, and Finland, where in sparsely populated districts groundwater is commonly used without disinfection. Campylobacters, Escherichia coli, or other coliforms have rarely been detected in potential sources. We studied three waterborne outbreaks in Finland caused by C. jejuni and used sample volumes of 4,000 to 20,000 ml for analysis of campylobacters and sample volumes of 1 to 5,000 ml for analysis of coliforms and E. coli, depending on the sampling site. Multiple samples obtained from possible sources (water distribution systems and environmental water sources) and the use of large sample volumes (several liters) increased the chance of detecting the pathogen C. jejuni in water. Filtration of a large volume (1,000 to 2,000 ml) also increased the rate of detection of coliforms and E. coli. To confirm the association between drinking water contamination and illness, a combination of Penner serotyping and pulsed-field gel electrophoresis (digestion with SmaI and KpnI) was found to be useful. This combination reliably verified similarity or dissimilarity of C. jejuni isolates from patient samples, from drinking water, and from other environmental sources, thus confirming the likely reservoir of an outbreak.

Urine samples constitute a large proportion of samples tested in clinical microbiology laboratories. Culturing of the samples is fairly time-and labor-consuming, and most of the samples will yield no growth or insignificant growth. We analyzed the feasibility of the flow cytometry-based UF-500i instrument (Sysmex, Japan) to screen out urine samples with no growth or insignificant growth and reduce the number of samples to be cultured. A total of 1,094 urine specimens sent to our laboratory for culture during 4 months in the spring of 2009 in Lahti, Finland, were included in the study. After culture, all samples were analyzed with the Sysmex UF-500i for bacterial and leukocyte (white blood cell [WBC]) counts. Youden index and closest (0,1) methods were used to determine the cutoff values for bacterial and WBC counts in culture-positive and -negative groups. By flow cytometry, samples considered positive for UTI in culture had bacterial and WBC values that were significantly higher than those for samples considered negative. The flow cytometric screening worked best when both bacterial counts and WBC counts were used with age-and gender-specific cutoff values for all patient groups, excluding patients with urological disease or anomaly. By use of these cutoff values, 5/167 (3.0%) of culture-positive samples were missed by UF-500i and the percentage of samples that did not need to be cultured was 64.5%. Use of the UF-500i instrument is a reliable method for screening out a major part of the UTI-negative samples, significantly diminishing the amount of work required in the microbiology laboratory.Urinary tract infections (UTIs) are among the most common infections treated by community health care centers and hospitals (5,6,13,19,24). In Finland, urinary tract infections account for approximately 6% of all infectious disease diagnoses in primary care (20) and urine samples constitute a large proportion of the samples tested in clinical microbiology laboratories (13,18,24). The gold standard for UTI diagnosis is bacterial culture, which is based on bacterial counts and identification. Culturing of the samples is fairly time-and laborconsuming, and most of the samples yield no growth or insignificant growth (10,15,22,24). In order to improve the efficiency of handling of the urine samples, methods for screening out the culture-negative samples from the culture-positive samples have been developed. Chemical screening with strips for nitrite, pH, leukocytes, erythrocytes, albumin, and glucose is widely used (17,18,22,23), but a meta-analysis of the literature (4) has shown that the method is insensitive and is suitable as a rule-out test only when both nitrite and leukocyteesterase are negative. Cells, particles, and microorganisms in urine can be examined by microscopic-urine-sediment analysis, but this method is time-consuming, labor-intensive, and sensitive to interobserver variability (2,7,8,10,12,21).Pyuria with bacteria predicts bladder infection better than the presence of bacteria alone, and therefore, a screenin...

Prospective laboratory-based surveillance in 4 Finnish hospitals during 1999-2000 identified 1477 cases of nosocomial bloodstream infection (BSI), with an overall rate of 0.8 BSIs per 1000 patient-days. Of BSI cases, 33% were in patients with a hematological malignancy and 15% were in patients with a solid malignancy; 26% were in patients who had undergone surgery preceding infection. Twenty-six percent of BSIs were related to intensive care, and 61% occurred in patients with a central venous catheter. Sixty-five percent of the 1621 causative organisms were gram positive, 31% were gram negative, and 4% were fungi. The most common pathogens were coagulase-negative staphylococci (31%), Escherichia coli (11%), Staphylococcus aureus (11%), and enterococci (6%). Methicillin resistance was detected in 1% of S. aureus isolates and vancomycin resistance in 1% of enterococci. The 7-day case-fatality ratio was 9% and was highest for infections caused by Candida (21%) and enterococci (18%). The overall rate of nosocomial BSIs was similar to rates in England and the United States, but S. aureus, enterococci, and fungi were less common in our study, and the prevalence of antibiotic resistance was lower.

Four-layer antispecies radioimmunoassay (RIA) and enzyme immunoassay (EIA) procedures were developed for the detection of respiratory syncytial virus (RSV), parainfluenza type 2 virus, and adenovirus antigens in nasopharyngeal specimens from children hospitalized for acute respiratory disease. Polystyrene beads (RIA) or flat-bottomed polystyrene microtiter plates (EIA) were used as the solid phases, guinea pig anti-virus immunoglobulin were used as the captive antibodies, rabbit anti-virus immunoglobulin were used as the secondary antibodies, and '25I-labeled sheep anti-rabbit (RIA) or horseradish peroxidase-labeled

Children with acute otitis media were excluded because they are routinely treated with antibiotics. Children with tonsillitis were excluded because a separate study was being carried out of tonsillitis. There were 70 girls and 84 boys. Seventy eight (51%) children were less than 2 years old, 42 (27%) between 2 and 6 years, and 34 (22%) over 6 years old. The mean age was 3 years 4 months with a range of 2 months to 14 years.The outpatients received a questionnaire for follow up of the symptoms and signs of the disease. Re-examination was performed in 83 of 97 outpatients seven days after the first visit, and the questionnaire was returned. The follow up was conducted by telephone in another 13 patients, and one patient returned the questionnaire by mail. The inpatients were treated in the hospital until afebrile and were not routinely re-evaluated.Blood was taken for routine haematologic tests (total white blood cell counts (WBC) and differential counts, erythrocyte sedimentation rate (ESR), and CRP). Nasopharyngeal mucus aspirates for rapid diagnosis of virus was taken from 135 children.