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Abstract Background Streptococcus pneumoniae and Haemophilus influenzae cause pneumonia and as Neisseria meningitidis they are important agents of meningitis. Although several PCR methods have been described for these bacteria the specificity is an underestimated problem. Here we present a quantitative multiplex real-time PCR (qmPCR) for detection of S. pneumoniae (9802 gene fragment), H. influenzae (omp P6 gene) and N. meningitidis (ctrA gene). The method was evaluated on bronchoalveolar lavage (BAL) samples from 156 adults with lower respiratory tract infection (LRTI) and 31 controls, and on 87 cerebrospinal fluid (CSF) samples from meningitis patients. Results The analytical sensitivity was not affected by using a combined mixture of reagents and a combined DNA standard (S. pneumoniae/H. influenzae/N. meningitidis) in single tubes. By blood- and BAL-culture and S. pneumoniae urinary antigen test, S. pneumoniae and H. influenzae were aetiological agents in 21 and 31 of the LTRI patients, respectively. These pathogens were identified by qmPCR in 52 and 72 of the cases, respectively, yielding sensitivities and specificities of 95% and 75% for S. pneumoniae, and 90% and 65% for H. influenzae, respectively. When using a cut-off of 105 genome copies/mL for clinical positivity the sensitivities and specificities were 90% and 80% for S. pneumoniae, and 81% and 85% for H. influenzae, respectively. Of 44 culture negative but qmPCR positive for H. influenzae, 41 were confirmed by fucK PCR as H. influenzae. Of the 103 patients who had taken antibiotics prior to sampling, S. pneumoniae and H. influenzae were identified by culture in 6% and 20% of the cases, respectively, and by the qmPCR in 36% and 53% of the cases, respectively. In 87 CSF samples S. pneumoniae and N. meningitidis were identified by culture and/or 16 S rRNA in 14 and 10 samples and by qmPCR in 14 and 10 samples, respectively, giving a sensitivity of 100% and a specificity of 100% for both bacteria. Conclusions The PCR provides increased sensitivity and the multiplex format facilitates diagnosis of S. pneumoniae, H. influenzae and N. meningitidis and the assay enable detection after antibiotic treatment has been installed. Quantification increases the specificity of the etiology for pneumonia.

To evaluate the effect of preventive measures 46 patients, all allergic to house-dust mites (Dermatophagoides spp.), were randomly allocated to a study and a control group. According to the patients' subjective recordings of symptom score and use of medicine, compared with the control group, the study group had improved. There was, however, no improvement when comparing the objective recordings of morning and evening peak flow and use of medicine, and it is concluded that the preventive measures in this programme are not very effective for patients allergic to house-dust mites. The reduction in indoor humidity in the study group was limited and, as a high indoor humidity is the cause of huge populations of house-dust mites in homes, it is emphasized that future programmes of preventive measures should focus more on damp problems, particularly those related to bad housing construction. [ABSTRACT FROM AUTHOR]

The concentration of house-dust mites (Dermatophagoides spp.) was investigated for four seasons in three locations in each of 50 Danish apartments. Simultaneously the absolute humidity was recorded and the previously known correlation between mite counts and indoor humidity was confirmed. It appeared. However, that apartments which had a low absolute indoor humidity in the winter period (due to low household load of water vapors) did not contain noticeable concentrations of house-dust mites kin the summer and autumn despite the fact that the indoor absolute humidity in these apartments could be high enough to allow for a high peak-population of mites. Because of this it is suggested that in a temperate climate avoidance measures against house-dust mites should be supplemented at least by a drying out period in the winter, Al when this process is convenient to perform because of the low outdoor absolute humidity. [ABSTRACT FROM AUTHOR]

From a study of 98 typical Danish city apartments it was found that pyroglyphid and tarsonemid mites dominated the housedust acarofauna. Both groups of miles show a remarkable similarity in their occurrence and dependence on the microclimate. Room air humidities above 7 g water/kg dry air involved the highest densities. Below this limit only background contamination appeared. At least 14 distinct forms of carsonemid mites were found, with Tarsonemus floricolus Can. & Fanz., 1876 as the dominating species. As tarsonemid mites were found regularly rather than occasionally, it is suggested that these mites may be responsible for at least a part of the cases of housedust allergy that cannot be ascribed to the content of Dermatophagoides mites in the housedust. [ABSTRACT FROM AUTHOR]

Objective: The effect of rehabilitation for chronic obstructive pulmonary disease has been well-documented in randomized controlled trials. Evidence-based guidelines support rehabilitation programmes for chronic obstructive pulmonary disease, but knowledge of their outcome in clinical practice is limited. The aim of this study was to assess the outcome of a clinical routine rehabilitation programme for chronic obstructive pulmonary disease implemented by a Danish regional hospital., Material and Methods: Changes in walk-distance (6-min walk-distance test; 6MWD), dyspnoea (Medical Research Council dyspnoea scale; MRC) and health-related quality of life (Short-Form 36; SF-36) were compared between and within completers and non-completers from baseline to the end of clinical routine rehabilitation, and at 6 and 12 months. The 8-week clinical routine rehabilitation comprised bi-weekly 90-min sessions of patient education and physical training., Results: The hospital treated 521 patients during the study period. Of these, 175 were invited to join the study, 148 participated at baseline, and 98 at the 12-month follow-up. Completers' 6MWD was sustained from baseline to the end of clinical routine rehabilitation, but had declined by 12 months. Dyspnoea and health-related quality of life did not change. Seventy-five percent of completers felt better or much better after rehabilitation., Conclusion: The failure of completers to achieve expected outcomes shows a need for a stronger implementation effort and continuous quality control. Successful implementation in clinical routine requires targeted recruitment and overall programme improvement in general, and a stronger focus on physical training and staff competences.