BACKGROUND Potential associations between current or previous C. trachomatis infections (general IgG and serovars) and spontaneous preterm birth (PTB) were examined and associations between C. trachomatis infections and previous fertility problems were explored. PATIENTS AND METHODS At week 17, Chlamydia antigen, Chlamydia IgG, Chlamydia complex B, C and GF levels were measured. Spontaneous preterm birth (< 37 completed weeks gestation) was the primary outcome, and secondary outcomes included infertility treatment, subfertility and ectopic pregnancies. Crude and adjusted relative risks (RR) and odds ratios (OR) were estimated by logistic regression. RESULTS C. trachomatis C-complex positivity was associated with spontaneous PTB [RR 2.6 (1.1-6.29)] and additionally with a prior history of subfertility [OR 4.4 [2.5-7.7]), infertility treatment [OR 7.2 (4.0-12.8)] and ectopic pregnancy [5.2 (2.2-12.4)]. CONCLUSION A previous infection with C. trachomatis C-complex was associated with an increased risk for spontaneous PTB and may potentially contribute to subfertility, infertility and ectopic pregnancy.

En 2004, en Copenhague, Dinamarca, durante un brote de hepatitis A que afecto especialmente a hombres que tenian relaciones sexuales con otros hombres (HRSH), se llevo a cabo un estudio de casos y controles para identificar los factores de riesgo de infeccion. Se consideraron casos a los HRSH de mas de 17 anos, que vivieran en Copenhague, infectados por el virus de la hepatitis A con IgM positiva diagnosticados entre Junio y Agosto de 2004 y que no hubieran tenido contacto con un caso de hepatitis A antes de la ocurrencia de la enfermedad. Los controles fueron seleccionados en el Festival del orgullo Gay de Copenhague. El estudio incluyo 18 casos y 64 controles. Dieciseis casos y 36 controles tenian parejas sexuales ocasionales (ORMH 5,6, IC 95% 1,2-26,9). Once casos y 14 controles habian tenido relaciones sexuales en saunas gays (ORMH 4,2, IC 95% 1,5-11,5). Parece que las relaciones en alojamientos privados fueron protectoras (ORMH 0,2, IC 95% 0,1-0,7). Las relaciones ocasionales incluyendo relaciones en saunas gays fueron un factor de riesgo importante para la distribucion del VHA en los HRSH en Copenhague. Los resultados concuerdan con los observados en otros brotes en Europa. Al disminuir la inmunidad general frente a la hepatitis A y aumentar el potencial epidemico, recomendamos una educacion sanitaria asi como la vacuna contra la hepatitis A para todos los hombres homosexuales que no tengan una pareja estable, particularmente si visitan saunas gays o algun otro sitio donde los cambios de pareja sean frecuentes. Para impedir la diseminacion de la hepatitis A en los varones homosexuales en Europa, seria necesario un consenso al nivel europeo sobre las medidas de prevencion y control.

En 2004, a Copenhague, au Danemark, lors d’une epidemie d’hepatite A qui a touche essentiellement les hommes ayant des relations sexuelles avec d’autres hommes (HSH), une etude cas-controle a ete conduite pour identifier les facteurs de risque d’infection. Un cas a ete defini comme un HSH de plus de 17 ans, resident a Copenhague, presentant une infection par le virus de l’hepatite A avec des IgM positifs diagnostiques entre juin et aout 2004, et n’ayant pas eu de contact avec un cas d’hepatite A parmi ses proches avant l’apparition de la maladie. Les controles ont ete selectionnes au Festival de la Gay Pride a Copenhague. L’etude a porte sur 18 cas et 64 controles. Seize cas et 36 controles avaient des partenaires sexuels occasionnels (ORMH 5,6, 95% CI 1,2-26,9). Onze cas et 14 controles avaient eu des relations sexuelles dans des saunas gays (ORMH 4,2, 95% CI 1,5-11,5). Il semble que les relations dans des domiciles prives aient ete protectrices (ORMH 0,2, 95% CI 0,1-0,7). Les relations occasionnelles incluant des relations dans des saunas gays etaient un important facteur de risque pour la dissemination du VHA chez les HSH a Copenhague. Les resultats concordent avec ceux observes lors d’autres epidemies en Europe. L’immunite generale vis-a-vis de l’hepatite A etant en baisse et le potentiel epidemique en hausse, nous recommandons une education sur ces problemes de sante, ainsi que la vaccination contre l’hepatite A pour tous les homosexuels masculins ne vivant pas en couple stable, en particulier s’ils frequentent des saunas gays ou d’autres lieux ou les changements de partenaires sont frequents. Endiguer la dissemination de l’hepatite A chez les homosexuels masculins en Europe pourrait passer par un consensus a l’echelle europeenne quant aux mesures de prevention et de controle a mettre en place.

During an outbreak of hepatitis A predominantly among men who have sex with men (MSM) in Copenhagen, Denmark, in 2004, we did a case-control study to determine risk factors for infection. A case was an MSM >17 years, living in Copenhagen, with IgM positive hepatitis A infection diagnosed between June and August 2004, and without a household contact with a hepatitis A case before onset of illness. Controls were selected at the Copenhagen Pride Festival. The study included 18 cases and 64 controls. Sixteen of 18 cases and 36/63 controls had sex with casual partners (ORMH 5.6, 95% CI 1.2-26.9). Eleven of 18 cases and 14/62 controls had sex in gay saunas (ORMH 4.2, 95% CI 1.5-11.5). Sex at private homes appeared to be protective (ORMH 0.2, 95% CI 0.1-0.7). Casual sex including sex in gay saunas was an important risk factor for the spread of HAV among MSM in Copenhagen. The results are in accordance with findings in other European outbreaks. As the general immunity to hepatitis A decreases and the outbreak potential increases, we recommend health education and hepatitis A vaccination to all MSM not living in monogamous relationships, especially if they visit gay saunas or other places with frequent partner change. To stop spread of hepatitis A among MSM in Europe, a European consensus on prevention and control measures may be required.

Among measles unvaccinated infants in Guinea-Bissau, we tested whether case infants with acute lower respiratory tract infection (ALRI), especially ALRI caused by respiratory syncytial virus (RSV), were more likely to be Bacille Calmette Guérin (BCG)-unvaccinated and to have no scar after BCG vaccination than were control infants without symptoms of ALRI. Three hundred and eighty-six case infants with ALRI were identified at a paediatric clinic (N=84), a health centre (N=82), and in a community morbidity surveillance system (N=220). Control infants were matched on sex, age, and district and were also measles unvaccinated. In ALRI case infants, the adjusted OR of being BCG unvaccinated was 2.87 (1.31–6.32), 1.72 (0.48–6.19) in boys and 4.45 (1.48–13.4) in girls. Among BCG vaccinated ALRI case infants, the adjusted OR of having no BCG scar was 1.54 (0.86–2.75), 0.93 (0.45–1.91) in boys and 2.70 (1.21–6.02) in girls. In ALRI case infants with RSV infection, similar trends were observed. BCG vaccination may have a non-targeted protective effect against ALRI, the effect being most marked in girls.

Em 2004, em Copenhague, na Dinamarca, durante um surto de hepatite A principalmente relacionado com homens que tem relacoes sexuais com outros homens, um estudo caso-controle foi feito para identificar os factores de risco de infeccao. Um caso foi definido como um HSH de mais de 17 anos, vivendo em Copenhaga, infectado pelo virus da hepatite A com IgM positivos diagnosticados entre junho e agosto de 2004 e que nao tiveram contacto com um caso de hepatite A entre os seus parentes antes da doenca aparecer. Os controles foram seleccionados no Festival da Gay Pride de Copenhague. O estudo incluiu 18 casos e 64 controles. Dezesseis casos e 36 controles tinham parceiros sexuais ocasionais (ORMH 5,6, 95% CI 1,2-26,9). Onze casos e 14 controles tinham tido relacoes sexuais nos saunas gays (ORMH 4,2, 95% CI 1,5-11,5). Parece que relacoes que tinham ocorrido em casas privadas fossem protectoras (ORMH 0,2, 95% CI 0,1-0,7). As relacoes occasionais incluindo relacoes em saunas gays eram um factor de risco importante para a disseminacao do VHA em HSH em Copenhague. Os resultados concordem com aqueles que foram observados em outros surtos na Europa. A immunidade geral frente a hepatite A tendo baixado e o potencial epidemico crescido, recomendamos uma educacao sobre estes assuntos de saude, como tambem a vacina contre a hepatite A para todos os homens homosexuais que nao vivem em casais estaveis, particularmente se visitarem saunas gays ou outros lugares aonde cambios de parceiro sao frequentes. Para parar a disseminacao da hepatite A nos homens homosexuais na Europa, um consenso ao nivel europeu- sobre as medidas de prevencao e controle poderia ser necessario.

Opposite gender transmission may increase the severity of certain infections. If infections transmitted from mother to son were more severe than from mother to daughter this might explain severe diseases among boys, particularly in small families with few individuals contributing to transmission. Among children from Guinea-Bissau, we tested whether mothers with recent respiratory syncytial virus exposure (positive IgM and IgA antibody responses) were more likely to have male than female children with respiratory syncytial virus antigen positive acute lower respiratory tract infection. Children with acute lower respiratory tract infection were identified at a paediatric clinic (n = 348), a health centre (n = 270), and in a community morbidity survey (n = 525), 14.2% (162/1143) having respiratory syncytial virus antigen. An equal number of boys and girls had acute lower respiratory tract infection, but boys were more likely to have respiratory syncytial virus detected (prevalence ratio = 1.36 (1.01-1.81)), this difference being particularly marked in the rainy season. With recent respiratory syncytial virus exposure of mother, boys were twice as likely to have respiratory syncytial virus detected (prevalence ratio = 2.04 (1.18-3.53)), the difference being marked in the rainy season. There was no gender difference in respiratory syncytial virus infection among children of RSV negative mothers. We conclude that mothers may transmit respiratory syncytial virus more easily or severely to sons.

Objective To evaluate the value of a urine sample for diagnosing Chlamydia trachomatis infection in an STD clinic in a prospective study of samples collected from 410 consecutive STD patients (167 female and 243 male).

OBJECTIVE:To compare detection of respiratory syncytial virus (RSV) for diagnostic purposes using nasopharyngeal aspirate (NPA) and nasal swabs (NS) in different clinical settings in a community study in Guinea-Bissau.METHOD:During 1996-98 paired specimens were obtained from 635 children under 5 years of age (median: 274 days; interquartile range: 144-453 days) with symptoms of lower respiratory infections (LRI). The specimens were analysed by an enzyme-linked immunosorbent assay for RSV antigen in Guinea-Bissau and re-analysed in Denmark using the same assay. The gold standard for RSV antigen detection was defined as any test being positive.RESULTS:RSV antigen was detected in 84 (13%) children, the prevalence being 19% (41/219) among infants aged < 6 months, 12% (22/184) in infants aged 6-11 months, and 9% (21/230) in older children. Sensitivity of antigen detection was higher in NPA (92% in analyses in Guinea-Bissau and 98% in Denmark) than in NS (63% in analyses in Guinea-Bissau, 71% in Denmark). Specificity of RSV antigen detection was equally high in NPA and NS (99-100%). Time since onset of symptoms was significantly shorter in RSV antigen positive than negative samples. Sensitivity did not depend on clinical setting or age of the child.CONCLUSION:Using NS samples was associated with a 27-31% reduction in sensitivity compared with NPA specimens. As NPAs are costly and considered a nuisance by the population, it might be cost-effective in larger epidemiological studies to lose 25-30% in sensitivity but be able to collect samples from a much larger population.

The susceptibility of Haemophilus influenzae to penicillin V and G, ampicillin and cefuroxime was investigated by MIC, disc and tablet diffusion methods, using chocolate agar as test medium, to determine the prevalence of ampicillin-resistant isolates and the optimal method for their detection. Eighty-six isolates were clinical isolates collected prospectively from July to September 1998 and 22 isolates were clinical isolates with decreased susceptibility to ampicillin previously referred to the reference laboratory. Eighty-seven isolates were ampicillin-susceptible and 16 were ampicillin-resistant. Thirteen produced beta-lactamases. Among the consecutive isolates 12.8% were resistant. With each of the Rosco Neo-sensitabs containing penicillin G, 2.5 microg ampicillin and 33 microg ampicillin, 3 very major errors occurred (resistant isolates misinterpreted as susceptible) and 5-13 major errors (susceptible isolates misinterpreted as resistant). The AB biodisk containing ampicillin (10 microg) was superior to the penicillin V and G discs, i.e. only 1 very major error occurred and major and minor errors were infrequent. The cefuroxime disc identified 4/8 beta-lactamase-negative ampicillin-resistant isolates. Thus, for susceptibility testing with chocolate agar as test medium, the use of an inoculum of 10(5) colony-forming units, 10 microg ampicillin discs and interpretative zone diameters of > or = 28 mm indicating susceptibility and < or = 25 mm indicating resistance was found to produce reliable identification of ampicillin-resistant isolates of H. influenzae.

Background. The objectives of this paper were. to assess the prevalence of different viral infections in relation to late abortions, stillbirths, and congenital malformations in sera from Russian pregnant women and recurrent aborters in order to establish basic knowledge for future pregnancy care.Methods. Patients were recruited at the Women's Clinic, Leningrad Regional Hospital during the period March-June 1995. One group of normally pregnant women (Group 1; n=182) and one group of recurrent aborters (Group 2; n=127) were evaluated, including demographic, medical, clinical, and serological data.Results and conclusions. The mean age of the two groups was 27.1 and 28.2 years, respectively. The mean number of deliveries was low (0.4 and 0.5, respectively). Thirty-one point six percent of Group 1 and 41.9% of Group 2 were daily smokers. The group of normally pregnant women had a significantly increased frequency of induced abortions compared to the recurrent aborters, while the recurrent aborters reported more genital infections. There was little difference in total antibodies to cytomegalovirus (CMV) (78.0% and 81.1%, respectively) or B19 IgG (75.3% and 66.9%, respectively) between the groups, while the normal pregnant women had a significantly higher prevalence of rubella antibodies (77.5% and 59.8%, respectively). Our results indicate that less women remain susceptible to primary CMV infection in pregnancy in Russia compared to western Europe and North America. The prevalence of B19 IgG was slightly lower than data from Sweden. Natural immunization against rubella virus was lower than in other, unvaccinated female populations. Vaccination strategies for rubella are now initiated in the Russian Federation. Results from this study are utilized in a federally supported, comprehensive pregnancy care project of North-West Russia.

In the B19 VP2 molecule an immunodominant heptapeptide epitope has been detected, recently for which IgG antibodies are synthesized exclusively in the acute phase of B19 infection. Using this acute-phase-specific epitope (KYVTGIN) a 2(nd)-generation epitope-type EIA was developed, which compares serum IgG activity for native VP2 capsids exhibiting conformational VP2 epitopes with IgG activity for the KYVTGIN epitope. In this study the diagnostic performance (clinical sensitivity and specificity) of the 1st and 2nd-generation epitope-type EIAs and of a peptide-based EIA utilising as antigen the KYVTGIN epitope alone was assessed in comparison with various high-quality IgM- and IgG- based B19 assays. Serum samples from 489 patients with B19-related symptoms and asymptomatic controls from three countries were studied. Among 323 patients with B19-IgG, 20% were diagnosed as acute infection, 73% had past immunity and 7% were not classified due to contradictory results among the different assays. The unclassified samples were explored for viral strain diversity by PCR and DNA sequencing but all sequences obtained were B19-like with variance of only a few per cent. The 2nd-generation epitope-type EIA had a diagnostic sensitivity of 98% and a diagnostic specificity of 94%. In combination with conventional approaches, the epitope-type assays increase greatly the accuracy of B19 serodiagnosis.

Objectives To estimate the incidence of human parvovirus B19 among pregnant women before and during an epidemic, to elucidate possible sociodemographic and medical risk factors during pregnancy and to estimate the association between parvovirus B19 infection and negative pregnancy outcome.Design Prospective study among pregnant women followed from their first antenatal visit before 24 full weeks of gestation until delivery.Setting Department of Obstetrics and Gynaecology, Odense University Hospital, Denmark, November 1992 to February 1994.Methods 3596 pregnant women were invited to participate. The women were examined at first antenatal visit in the period from November 1992 to February 1994 and at delivery. The last delivery was in August 1994 and samples were thus collected before and during a large parvovirus B19 epidemic in Denmark January to September 1994. A blood sample for parvovirus B19 serology was taken at enrolment and from the umbilical cord at delivery. Three questionnaires were completed during 2nd and 3rd trimesters and a registration form at delivery. In total, 3174 (87.6%) were enrolled and 79.5% completed the study.Results The prevalence of B19 IgG seropositivity at the first antenatal visit before 24 full weeks of gestation was 66%. The cumulative prevalence proportion of acute parvovirus B19 infection during pregnancy among IgG negative women was found to be 10.3% (IgM seropositivity and/or IgG sero‐conversion). The IgG seroconversion incidence increased significantly from 1.0% to 13.5% among 932 seronegative pregnant women before and during the epidemic, respectively (P < 0.001). Independent risk factors related to increased risk of B19 infection during pregnancy, adjusted for other sociodemographic and medical factors, were: children at home (adjusted OR 2.1, 95% CI 1.3–3.2); serious medical disease (adjusted OR 3.0, 95% CI 1.0–8.5); and a stressful job (adjusted OR 1.8, 95% CI 1.0–3.3). Parvovirus B19 IgM seropositivity was associated with events of late spontaneous abortions and stillbirths (crude OR 9.9; 95% CI 3.3–29.4).Conclusion Before and during an epidemic of acute B19 infection incidences were measured among pregnant women to be 1.0% and 13.5%, respectively. Three factors, significantly increasing the risk of acute B19, were identified as: having children at home; suffering from serious medical diseases; and having a stressful job. IgM positivity for parvovirus B19 was associated with negative outcome of pregnancy.

Respiratory syncytial virus (RSV) is probably the single major cause of lower respiratory infection (LRI) among infants worldwide. Its relative importance may be underestimated, as the diagnosis is based on antigen detection and antigen may only be detectable in the early phase of infection. We have therefore assessed the duration of secretory IgM and IgA antibody responses and whether assays for these antibodies can be used to improve the diagnosing of RSV-associated infections. During two RSV epidemics in Guinea-Bissau, 32 RSV antigen-positive children with LRI were followed with sequential nasopharyngeal suction on days 7, 14, 30, 60 and 120 in the first epidemic and every fortnight for 6 mo after the second epidemic to measure the duration of secretory IgM and IgA responses. Nearly all of the children had an IgM response during the first month after infection. The response ratio was highest on days 7 and 14, being 84% and 71%, respectively. After 30 d the IgM response decreased rapidly. Among 27 age- and sex-matched controls, only 1 child was positive for IgM. During the second epidemic, when the children were followed more intensively, half of the children were IgM-positive after the acute phase of infection. A secondary response may be more likely in children with low IgM responses in the acute phase (RR = 2.08 (95% confidence interval (CI) 0.92-4.70)). The IgA response was highest on days 28 and 42 after antigen detection, 72% having a detectable IgA response within the first 1.5 mo. Among 27 controls, only 2 were IgA-positive (7%). In the second epidemic with more intensive follow-up, 62% (8/13) of the IgA-positive children had a response that lasted 10 wk. Of the children with no persistent IgA response, half (5/10) had a subsequent IgA-positive response after the first 42 d. All of these children had a simultaneous IgM-positive response. When 29 of the children were tested after an epidemic when they were 1-3-y-old, >80% again had high IgM (24/29, 82%) and IgA (28/29, 94%) levels. Among samples collected over a 1-y period from infants with LRI in a community morbidity surveillance conducted at the local health centre and via paediatric outpatient consultation, 17% (110/659) were antigen-positive, 26% (171/659) IgM-positive and 38% (248/659) either antigen- or IgM-positive. IgM responses are short-lived among infants and may therefore be used as an indication of recent RSV infection among children with LRI. Using both antigen and IgM detection may significantly improve our detection of RSV infections.

Context Parvovirus B19 infection during pregnancy has been associated with fetal death. However, the incidence of and risk factors for infection in pregnant women have not been well studied.Objectives To estimate a pregnant woman's risk of infection with parvovirus B19 in epidemic and endemic situations and to study risk factors for infection.Design Population-based cohort study conducted between November 1992 and June 1994.Setting Three regions in Denmark.Participants A total of 30 946 pregnant women from a consecutive and population-based screening.Main Outcome Measures Specific IgG antibodies in serum samples obtained in the first trimester of pregnancy and from the newborn infant to assess past infection and seroconversion. Information on family structure, educational background, socioeconomic status, and pregnancy outcome was obtained from national registers.Results Based on 30 946 serum samples, 65.0% of pregnant women had evidence of past infection. Annual seroconversion rates among susceptible women during endemic and epidemic periods were 1.5% (95% confidence interval [CI], 0.2%-1.9%) and 13.0% (95% CI, 8.7%-23.1%), respectively. Baseline seropositivity was significantly correlated with increasing number of siblings, having a sibling of the same age, number of own children, and occupational exposure to children. Risk of acute infection increased with the number of children in the household as follows: 0 children odds ratio (OR), 1 (reference); 1 child OR, 3.17 (95% CI, 2.24-4.49); 2 children OR, 5.47 (95% CI, 3.55-8.45); 3 or more children OR, 7.54 (95% CI, 3.80-14.94). Having children aged 6 to 7 years resulted in the highest rate of seroconversion among mothers (6.8%; OR, 4.07; 95% CI, 1.89-8.73). Compared with other pregnant women, nursery school teachers had a 3-fold increased risk of acute infection (OR, 3.09; 95% CI, 1.62-5.89). Population-attributable risk of seroconversion was 55.4% for number of own children and 6.0% for occupational exposure.Conclusions The risk of infection is high for susceptible pregnant women during epidemics and associated with the level of contact with children. Nursery school teachers have the highest occupational risk, but most infections seem to be the result of exposure to the woman's own children.

Parvovirus B19 (B19), which causes erythema infectiosum, may cause hepatitis, 1 Yoto Y Kudoh T Haseyama K Suzuki N Chiba S Human parvovirus B19 infection associated with acute hepatitis. Lancet. 1996; 347: 868-869 Summary PubMed Scopus (121) Google Scholar transient disturbance of consciousness and hepatic dysfunction, 2 Yoto Y Kudoh T Asanuma H et al. Transient disturbance of consciousness and hepatic dysfunction associated with human parvovirus B19 infection. Lancet. 1994; 344: 624-625 Abstract PubMed Scopus (50) Google Scholar and fulminant non-A non-B liver failure just before or immediately after liver transplantation 3 Langnas AN Markin RS Cattral MS Naides SJ Parvovirus B19 as a possible causative agent of fulminant liver failure and associated aplastic anaemia. Hepatology. 1995; 22: 1661-1665 PubMed Google Scholar in children. Less common is acute hepatitis or hepatic disorder after B19 infection in adults. 4 Tsuda H Liver dysfunction caused by parvovirus B19. Am J Gastroenterol. 1993; 88: 1463 PubMed Google Scholar We report two cases of hepatic dysfunction from the same general practice (about 1200 regular patients) during a recent B19 epidemic in Denmark.

Parvovirus B19 (B19), also known as "erythema infectiosum", is a disease that occurs in smaller outbreaks during late winter and early summer; and in Denmark an epidemic occurs every three years. The symptoms vary from fever, fatigue and the characteristic maculopapoulous erythema to asymptomatic cases in 50% of the infected patients. Two-thirds of the Danish population have been infected. The virus has a broad spectrum of clinical manifestations ranging from erythema nodosum in children, arthralgia/arthritis (especially in adults), aplastic crisis in patients with haemolytic anaemia, chronic anaemia in immunocompromised patients, to hydrops foetalis following acute infection during pregnancy. In two adult females aged 41 and 35 years with persisting fatigue, malaise, transitory swelling and arthralgia we found elevated ALT and alkaline phosphatase (pt. 1), despite no serological evidence of hepatitis, cytomegalovirus (CMV), or Epstein-Barrvirus and no story of alcohol consumption or recent travelling outside Denmark. Ongoing B19 infection was diagnosed by ELISA and confirmed by B19 DNA PCR in case 2 and IgG avidity and epitope-type specificity in case 1, who was B19 DNA negative in three different samples. The concentrations of alkaline phosphatase and ALT returned to normal as the antibody response shifted from acute B19 infection to IgG positivity. In conclusion we suggest that a serological test and/or B19 DNA for B19 infection is a relevant test to undertake when screening patients for viral hepatitis especially during B19 epidemics and in exposed individuals.

In 1994 the first human parvovirus B19 (B19) epidemic to be documented in Denmark was recorded from February 2 to September 30. In total, 10,333 serum samples were tested for specific B19 IgM and IgG antibodies, using IDEIA Parvovirus B19 IgM and IgG kits. The prevalence of B19 IgM positivity was 11% for the whole period and 29% at the peak of the epidemic in week 14, declining from week 39 and onwards to 1-3%. The prevalence of B19 IgG (IgM-negative samples) was 60%, indicating an earlier infection, and the same for men and women. The gender distribution of tested patients was the same at the beginning of the epidemic as at the end of the epidemic and a year after its peak, i.e. 86% of samples were from women and only 14% from men. Age distribution for women was the same for the three periods (median age 34 years). For men the median age was 32 years, 39 years and 31 years, respectively. Only a few samples from children were tested. No change in test pattern was observed during the three periods. Approximately 75% of all samples tested were from women of childbearing age (18-45 years old), suggesting a fear of fetal complications in an actual or future pregnancy, rather than a serological verification of clinical symptoms. From the sparse clinical information that accompanied the serum sample we were not able to demonstrate that women were more likely than men to have a symptomatic B19 infection. With reservations we estimate that 14% of adverse pregnancy outcome is correlated with a B19 infection.

BACKGROUND:The development of antiviral therapy increases the need for rapid, sensitive and reliable methods or combination of methods for diagnosis and monitoring herpes simplex encephalitis, HSE.OBJECTIVES:Evaluation of diagnostic performance of three successively developed HSV PCR assays when combined with a new capture ELISA for HSV intrathecal antibody production (ITT).STUDY DESIGN:During a 3.6 year period a total of 4.206 CSF and serum samples from about 4.140 hospitalized patients with a tentative diagnosis of HSE were analyzed by a new ELISA for ITT. 1.962 CSF samples were examined also by PCR. Clinical signs and symptoms and additional tests were obtained on all ITT and/or PCR positive patients. In 1993 the PCR was a double PCR. In 1994 the PCR was a single PCR with internal inhibition control. Positive samples were confirmed by a different confirmative PCR to increase the specificity. From 1995 the PCR was as in 1994 but samples were no longer divided in the serology routine laboratory.RESULTS:A total of 33 HSE cases was found (incidence 1.8 HSE per million people). All patients were treated with aciclovir. Three patients died, 9 patients had primary infection, 2 patients had HSE previously, and 2 patients relapsed. Only 11 patients recovered satisfactory. Of all 37 positive ITT 7 were unlikely positive. False positive PCR was seen in 1993 and 1994, due to sample-to-sample contamination during division of samples, but was not seen since 1995 when this procedure was changed. The test results depended on the state of the disease. Thus, the sensitivity, specificity, PPV and NPV for ITT were highest when performed more than 1 week after debut of symptoms whereas these values were highest using PCR within the first week.CONCLUSION:Routine PCR diagnosis of HSE type 1 and 2 is a highly sensitive and specific method that should be performed together with serological ITT to cover the whole time span from debut of symptoms to several weeks after hospitalization.

OBJECTIVE: To evaluate the association between various microorganisms isolated from the genital tract in pregnant women with bacterial vaginosis.STUDY DESIGN: A cross-sectional population-based study among pregnant women addressed at their first antenatal visit before 24 full gestational weeks from the referring area of the Department of Obstetrics and Gynecology at Odense University Hospital, Denmark, from November 1992 to February 1994. The main outcome measures were prevalence of various microorganisms and statistical estimates of interactions (crude, adjusted, and relative odds ratios) between the microorganisms isolated from the lower genital tract in pregnant women with and without clinical diagnosis of bacterial vaginosis.RESULTS: Three thousand five hundred ninety-six (3596) pregnant women were asked to participate. Of the 3596 pregnant women 3174 (88.4%) agreed to participate before 24 full gestational weeks. After controlling for the presence of other microorganisms, strong associations between Gardnerella vaginalis, anaerobic bacteria, Mycoplasma hominis, and present bacterial vaginosis were found. Similarly Lactobacillus spp. were found to be associated with the absence of bacterial vaginosis. The combination of G. vaginalis and anaerobic bacteria and/or M. hominis was found in 59.6% of the cases with bacterial vaginosis and in 3.9% of the cases without bacterial vaginosis (odds ratio 36.4, 95% confidence interval 27.8 to 47.8). The crude odds ratio was found to be as high as 74.8 (95% confidence interval 32.3 to 174.1) when the combination of G. vaginalis, M. hominis, anaerobic bacteria, and no Lactobacillus spp. was associated with bacterial vaginosis,CONCLUSION: There is a microbial foundation for bacterial vaginosis, and it is possibly due to an intermicrobial interaction in which the microorganisms G. vaginalis, anaerobic bacteria, and M. hominis are dominating, indicating that these constitute the pathologic core of bacterial vaginosis.