Terje Hoel

Oslo University Hospital, Kristiania (historical), Oslo County, Norway

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Publications (21)73.51 Total impact

  • Scandinavian Journal of Infectious Diseases 07/2009; 33(10):797-797. · 1.64 Impact Factor
  • Tidsskrift for den Norske laegeforening 10/2005; 125(18):2523.
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    ABSTRACT: To estimate the incidence of, identify risk factors for, and describe the clinical presentation of travel-associated African tick bite fever (ATBF), a rapidly emerging disease in travel medicine, we prospectively studied a cohort of 940 travelers to rural sub-Equatorial Africa. Diagnosis was based on suicide polymerase chain reaction and the detection of specific antibodies to Rickettia africae in serum samples by multiple-antigen microimmunofluorescence assay, Western blotting, and cross-adsorption assays. Thirty-eight travelers, 4.0% of the cohort and 26.6% of those reporting flulike symptoms, had ATBF diagnosed. More than 80% of the patients had fever, headache, and/or myalgia, whereas specific clinical features such as inoculation eschars, lymphadenitis, cutaneous rash, and aphthous stomatitis were seen in < or = 50% of patients. Game hunting, travel to southern Africa, and travel during November through April were found to be independent risk factors. Our study suggests that ATBF is not uncommon in travelers to rural sub-Saharan Africa and that many cases have a nonspecific presentation.
    Clinical Infectious Diseases 06/2003; 36(11):1411-7. · 9.42 Impact Factor
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    ABSTRACT: The association of Chlamydia pneumoniae with atherosclerosis is still controversial. Reports from different laboratories have varied widely and "gold standards" for the detection of C. pneumoniae are lacking. In the present study, aortic valves and peripheral blood mononuclear cells from 48 patients undergoing aortic valve replacement were examined for the presence of C. pneumoniae using a nested PCR. C. pneumoniae-specific DNA was not detected in any of the clinical samples. No PCR inhibition was observed by spiking the samples with target C. pneumoniae. A total of 31/46 patients (67%) were seropositive for C. pneumoniae IgG. These results do not support the association of C. pneumoniae with aortic valves and peripheral blood mononuclear cells in patients with atherosclerotic aortic heart valve disease.
    Scandinavian Journal of Infectious Diseases 02/2002; 34(9):660-3. · 1.64 Impact Factor
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    ABSTRACT: Rickettsia africae is the causative agent of African tick bite fever (ATBF), an acute febrile illness frequently accompanied by inoculation eschars, regional lymphadenitis, myalgia and severe headache. Recently, ATBF has been recognized as an emerging health problem for international travellers to rural sub-Saharan Africa. To estimate the incidence, risk factors for and proportion of symptomatic cases of travel-associated R. africae infection, we performed a seroepidemiological study of 152 first-time Norwegian travellers to rural areas in sub-Equatorial Africa. Seropositivity was based on the detection of specific antibodies to R. africae in microimmunofluorescence and/or Western blotting assays. Thirteen (8.6%) travellers were seropositive to R. africae. Eight (62%) seropositive travellers reported symptoms consistent with ATBF; of these, 2 had received antirickettsial therapy. Using multiple logistic regression, the following factors were found to be significantly associated with seropositivity: hunting as the purpose of travel [odds ratio (OR) 10.1; 95% confidence interval (CI) 1.5-69; p=0.019] and stay in rural areas of > 7 d (OR 6.0; 95% CI 1.5-24; p=0.012). This first seroepidemiological study on travel-associated R. africae infection suggests that the infection may be common in international travellers to rural sub-Saharan Africa but that most cases are asymptomatic or clinically mild and self-limited.
    Scandinavian Journal of Infectious Diseases 01/2002; 34(2):93-6. · 1.64 Impact Factor
  • Tidsskrift for Den norske legeforening 10/2000; 120(22):2695-7.
  • The Lancet 07/1998; 351(9119):1888. · 39.21 Impact Factor
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    ABSTRACT: An epidemic of hepatitis A virus (HAV) among intravenous drug abusers in Oslo involved 144 serologically confirmed cases. Another 26 patients (non-drug abusers), of whom 14 were derived from a single nosocomial outbreak, were associated with the epidemic. Sequencing of the VP1/P2A junction revealed that viruses associated with the epidemic were completely identical, whereas other HAV samples collected during the same period differed by up to 10%. HAV was detected in the serum of 48 of 100 patients by a nested PCR. Viremia was observed as early as 25 days before the onset of clinical hepatitis, and up to 30 days after. The large number of patients within the drug abuser group, and the few secondary cases, raised the question of whether the virus could be transmitted by the use of needles. To establish whether viral contamination of drugs did contribute appreciably to maintaining the epidemic, we examined heroin and amphetamine confiscated during the period, using immunomagnetic separation coupled to nested PCR, but failed to detect any virus. Antibodies against hepatitis B virus and hepatitis C virus were common among the HAV infected drug abusers (43% and 81%, respectively), suggesting widespread sharing of needles. This observation and the large number of patients with a demonstrable viremia suggest that needle sharing may contribute to the dissemination of HAV.
    Journal of Medical Virology 10/1997; 53(1):69-75. · 2.22 Impact Factor
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    ABSTRACT: Intravenous drug abuse is a well-known risk factor for acquiring hepatitis A infection. Among drug abusers most cases are sporadic, but epidemic outbreaks may occur occasionally. In this article we describe an epidemic outbreak including 144 serologically proved cases of hepatitis A among intravenous heroin and amphetamine abusers in Oslo. The outbreak lasted for 11 months. 59 (41%) of the patients were admitted to hospital. One of them died and seven developed severe but reversible acute hepatitis. We also registered 26 cases of hepatitis A among close contacts, 14 of whom were associated with a nosocomial outbreak that affected nurses, fellow patients and relatives. We do not know how the hepatitis A virus was introduced into the abuser population, but the further spread was probably dominated by a combination of faecal-oral transmission and parenteral transmission secondary to sharing needles. Although we were unable to detect hepatitis A virus in confiscated drug samples by means of polymerase chain reaction we cannot exclude that some abusers were infected by injection of contaminated amphetamine.
    Tidsskrift for Den norske legeforening 04/1997; 117(7):935-40.
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    ABSTRACT: Transfusion-associated transmission of Yersinia enterocolitica was first described in 1982. Since then more than 40 cases have been reported world-wide. The blood units are contaminated from apparently healthy donors who may, however, recently have had an episode of diarrhoea. Y enterocolitica is able to grow in packed red cells at refrigerator temperature. The mortality rate among recipients of contaminated blood is more than 50%. We describe a non-fatal case of a 80 year-old male who received one unit of packed red blood cells contaminated with Y enterocolitica (serogroup O:3, biotype 4). The blood had been collected 14 days before from a Norwegian donor with transient and slight abdominal discomfort. The microbe was isolated both from the patient's blood and from the donor blood bag. The patient was treated with ofloxacin and recovered without sequelae.
    Tidsskrift for Den norske legeforening 04/1995; 115(8):940-2.
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    ABSTRACT: To estimate the extent of meningococcal carriage in the Norwegian population and to investigate the relationship of several characteristics of the population to the carrier state, 1,500 individuals living in rural and small-town areas near Oslo were selected at random from the Norwegian National Population Registry. These persons were asked to complete a questionnaire and to volunteer for a bacteriological tonsillopharyngeal swab sampling. Sixty-three percent of the selected persons participated in the survey. Ninety-one (9.6%) of the volunteers harbored Neisseria meningitidis. The isolates were serogrouped, serotyped, tested for antibiotic resistance, and analyzed by multilocus enzyme electrophoresis. Eight (8.8%) of the 91 isolates represented clones of the two clone complexes that have been responsible for most of the systemic meningococal disease in Norway in the 1980s. Age between 15 and 24, male sex, and active and passive smoking were found to be independently associated with meningococcal carriage in logistic regression analyses. Working outside the home and having an occupation in transportation or industry also increased the risk for meningococcal carriage in individuals older than 17, when corrections for gender and smoking were made. Assuming that our sample is representative of the Norwegian population, we estimated that about 40,000 individuals in Norway are asymptomatic carriers of isolates with epidemic potential. Thus, carriage eradication among close contacts of persons with systemic disease is unlikely to have a significant impact on the overall epidemiological situation.
    Journal of Clinical Microbiology 03/1994; 32(2):323-30. · 4.23 Impact Factor
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    ABSTRACT: We describe a small epidemic of typhoid fever in a family who came originally from Pakistan. In 1992 six members (mother and five children) of a family of ten were admitted to our department with typhoid fever within a nine-day period. The index case was an 18 months old girl who had been hospitalized and treated elsewhere for typhoid fever. Two weeks after completing antibiotic treatment she was admitted to our hospital with a relapse. The source of her first infection is unknown. The rapid spread of typhoid fever in the family was most likely due to insufficient hygienic precautions and inadequate antibiotic treatment of the index case. Several coexisting factors such as poor housing conditions and cultural barriers may also have influenced the outcome. There is obviously a need for strict guidelines and proper coordination of treatment and follow-up of this and other similar contagious diseases.
    Tidsskrift for Den norske legeforening 11/1993; 113(24):3022-4.
  • T Hoel, R Espinoza
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    ABSTRACT: The Epidemic Section at the Oslo City Department of Health and Environment, is responsible for monitoring communicable diseases in Oslo. We have registered an increase in the number of severe cases of pneumococcal disease with bacteremia, sepsis and meningitis. Fifty-two cases of invasive pneumococcal disease occurred in Oslo in 1992. There are no available data on the HIV-status of these patients. Streptococcus pneumoniae is frequently found as part of the normal flora of the upper respiratory tract, and is an important pathogen for patients infected with HIV. We discuss indications for use of pneumococcal vaccine, and recommend earlier and more extensive use of this vaccine in HIV-infected persons in Norway.
    Tidsskrift for Den norske legeforening 07/1993; 113(16):2010-1.
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    ABSTRACT: Tularemia can present as an oto-rhino-laryngological disease. The clinical and radiological (CT) manifestations, diagnosis and treatment are discussed based on a case report where a patient with tonsillitis and enlarged cervical lymph nodes was admitted to the department of oto-rhino-laryngology of a hospital in Northern Norway. Francisella tularensis was isolated from the blood and there was a high titre of agglutinating serum antibodies to F. tularensis. The patient's contaminated drinking water well is the suspect source of infection.
    The Journal of Laryngology & Otology 03/1993; 107(2):127-9. · 0.70 Impact Factor
  • Terje Hoel, José B. Casals, Jan Eng
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    ABSTRACT: Thirty-one Norwegian clinical isolates of rapidly growing mycobacteria classified as Runyon's group IV, including 20 Mycobacterium fortuitum and 11 Mycobacterium chelonae strains, were found resistant to a majority of tuberculostatic agents. Minimal inhibitory concentration (MIC) was determined for twelve other antimicrobial agents: amikacin, tobramycin, streptomycin, cefoxitin, imipenem, norfloxacin, ciprofloxacin, doxycycline, erythromycin, fusidic acid, co-trimoxazole and capreomycin. The agar plate dilution method was employed and compared with the agar tablet diffusion method. Regression lines were established correlating MIC values and inhibition zones. The agar tablet diffusion method was found to be a simple and useful method for testing antimicrobial susceptibilities of M. fortuitum and M. chelonae, and a good correlation between MIC values and zone sizes with twelve antimicrobial agents was revealed. Correlation coefficients for most of these antimicrobial agents were around -0.90. M. chelonae was generally more resistant than M. fortuitum. Four antimicrobial agents, capreomycin, norfloxacin, ciprofloxacin and amikacin, showed differences between M. fortuitum and M. chelonae large enough to allow the zone diameter to be used diagnostically.
    Apmis 02/1993; 101(1):27-32. · 1.92 Impact Factor
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    ABSTRACT: Some recently introduced antimicrobial agents have only been incompletely evaluated for use in Francisella tularensis infections. The present study evaluated the susceptibility pattern of Scandinavian human, rodent, and hare F. tularensis isolates with respect to a selection of traditional as well as recently introduced antimicrobial agents. All strains were resistant to the following beta-lactams: penicillin, cephalexin, cefuroxime, ceftazidime, aztreonam, imipenem, and meropenem with minimal inhibitory concentrations > 32 mg/l. Against macrolides, a mixed susceptibility/resistance pattern appeared. All strains were susceptible to gentamicin, chloramphenicol, doxycycline, and four quinolones. Since the quinolones showed the lowest MIC values, and in addition give a good intracellular penetration, we conclude that future drugs to consider against tularemia should definitely include this group of antibiotics. The outpatient mode of antibiotic treatment is especially relevant as the Scandinavian variant of F. tularensis infection is nonlethal, usually pustuloglandular, and not septicemic. Therefore, oral drugs must be sought, and the quinolone group also satisfies this requirement.
    Apmis 01/1993; 101(1):33-6. · 1.92 Impact Factor
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    O Scheel, R Reiersen, T Hoel
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    ABSTRACT: A case of tularemia which occurred after close contact with a cat is presented. After unsuccessful amoxicillin treatment, a two-week course of doxycycline was given whereupon the patient responded well. However, the patient relapsed shortly after and was then given ciprofloxacin for two weeks. The patient then recovered completely. Clinical trials are needed in order to establish whether a quinolone could be the drug of choice for treatment of tularemia.
    European Journal of Clinical Microbiology 06/1992; 11(5):447-8. · 2.54 Impact Factor
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    ABSTRACT: Altogether 105 cases of tularemia were reported to the nationwide notification system for infectious diseases (MSIS) in Norway during the period 1975-90. The zoonosis appears every year in Northern Norway. The first epidemic outbreak was reported from Central Norway in 1984-85. During the nineteen eighties the disease has reappeared in Southern Norway. We review the clinical features and epidemiological patterns of tularemia in Norway. Preliminary investigations indicate that the future drug of choice for treatment of tularemia is one of the gyrase-inhibitors.
    Tidsskrift for Den norske legeforening 03/1992; 112(5):635-7.
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    ABSTRACT: Chlamydia pneumoniae infections may spread subclinically. The present investigation took place in a military setting. Sera drawn when the conscripts had entered their military service 2 months previously had been kept frozen and were available. In a camp with 500 people, 35 (7%) developed clinical symptoms of pneumonia. The infection was serologically verified with C. pneumoniae-specific micro-immunofluorescence technique. Of 40 healthy controls, 21 turned out to fulfil the serological criteria of infection, thus, representing subclinical cases. These 21 cases, when extrapolated to the whole camp, equalled a rate of 49% which, added to the 7% of pneumonic cases, gave a total infection rate of 56%. Pre-existing IgG antibodies were demonstrated in 10% of the pneumonic cases, 48% of the subclinical cases, and 89% of the non-infected, healthy controls. Without the access to pre-epidemic sera permitting us to establish 4-fold titre rises, the spread of subclinical C. pneumoniae infection would have been noted at 5%, and not 49% as here demonstrated.
    Scandinavian Journal of Infectious Diseases 02/1992; 24(4):431-6. · 1.64 Impact Factor
  • Terje Hoel, Jan Eng
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    ABSTRACT: One hundred and four clinical isolates of M. tuberculosis were susceptibility tested by the radiometric method (RAD) using the BACTEC system in parallel with a conventional modified proportion method (CON). In the latter, the strains were tested against four concentrations of drugs in Lowenstein-Jensen medium (isoniazid (INH), streptomycin (SM) and ethambutol (EMB)) OR 7H10 agar medium (rifampicin (RIF)) and reported as "sensitive", "intermediate" or "resistant" from the minimum inhibitory concentrations observed. The radiometric results were classified in the same three groups in accordance with the BACTEC methodology. The overall agreement between the results obtained by the two methods was 97.4% (INH 95.2%, EMB 96.2%, SM 98.1% and RIF 100%). In addition, the agreement between RAD and each of the drug concentration steps employed in CON was examined and the results discussed in relation to the established critical concentrations of the drugs. The BACTEC technique was found to be a rapid and convenient method for routine use.
    Apmis 12/1991; 99(11):977-80. · 1.92 Impact Factor