| 1. |
- Askling, Johan, et al.
(författare)
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Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden
- 2005
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Ingår i: Arthritis and Rheumatism. - : Wiley. - 0004-3591 .- 1529-0131. ; 52:7, s. 1986-1992
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:Because treatment with tumor necrosis factor (TNF) antagonists may increase the risk of tuberculosis (TB), and because knowledge of the risk of TB in rheumatoid arthritis (RA) not treated with biologics is scarce and of uncertain generalizability to low-risk populations, this study sought to determine the risk of TB among Swedish patients with RA.METHODS:Using data from Swedish nationwide and population-based registers and data from an ongoing monitoring program of TNF antagonists, the relative risks of TB in patients with RA (versus the general population) and of TB associated with TNF antagonists (versus RA patients not treated with biologics) were determined by comparing the incidence of hospitalization for TB in 3 RA cohorts and 2 general population cohorts from 1999 to 2001. We also reviewed the characteristics of all reported cases of TB in RA patients treated with TNF antagonists in Sweden and calculated the incidence of TB per type of TNF antagonist between 1999 and 2004.RESULTS:During 1999-2001, RA patients who were not treated with TNF antagonists were at increased risk of TB versus the general population (relative risk 2.0, 95% confidence interval [95% CI] 1.2-3.4). RA patients treated with TNF antagonists had a 4-fold increased risk of TB (relative risk 4.0, 95% CI 1.3-12) versus RA patients not treated with TNF antagonists. The reported TB cases during 1999-2004 in RA patients exposed to TNF antagonists (9 infliximab, 4 etanercept, 2 both) were predominantly pulmonary. TB occurred up to 3 years following the start of treatment.CONCLUSION:Irrespective of whether TNF antagonists are administered, Swedish patients with RA are at increased risk of TB. During 1999-2001, TNF antagonists were associated with an increased risk of TB, up to 4-fold in magnitude. This increased risk may persist over time during treatment and is related to both infliximab and etanercept.
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| 2. |
- Darenberg, Jessica, et al.
(författare)
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Molecular and clinical characteristics of invasive group A streptococcal infection in Sweden
- 2007
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Ingår i: Clinical Infectious Diseases. - : Oxford University Press (OUP). - 1537-6591 .- 1058-4838. ; 45:4, s. 8-450
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Tidskriftsartikel (refereegranskat)abstract
- Background. The incidence and severity of invasive group A streptococcal infection demonstrate great variability over time, which at least, in part, seems to be related to group A streptococcal type distribution among the human population. Methods. An enhanced surveillance study of invasive group A streptococcal infection (746 isolates) was performed in Sweden from April 2002 through December 2004. Noninvasive isolates from either the throat or skin (773 isolates) were collected in parallel for comparison. Clinical and epidemiological data were obtained from 88% of patients with invasive disease and were related to isolate characteristics, including T type, emm sequence type, and the presence of 9 superantigen genes, as well as pulsed-field gel electrophoresis pattern comparisons of selected isolates. Results. The annual incidence was 3.0 cases per 100,000 population. Among the patients with invasive disease, 11% developed streptococcal toxic shock syndrome, and 9.5% developed necrotizing fasciitis. The overall case-fatality rate was 14.5%, and 39% of the patients with streptococcal toxic shock syndrome died (P < .001). The T3/13/B3264 cluster accounted for 33% of invasive and 25% of noninvasive isolates. Among this most prevalent type cluster, emm types 89 and 81 dominated. Combined results from pulsed-field gel electrophoresis, emm typing, and superantigen gene profiling identified subgroups within specific emm types that are significantly more prone to cause invasive disease than were other isolates of the same type. Conclusions. This study revealed a changing epidemiology of invasive group A streptococcal infection in Sweden, with emergence of new emm types that were previously not described. The results also suggest that some clones may be particularly prone to cause invasive disease.
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| 3. |
- Faxén, Ulrika Ljung, et al.
(författare)
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Multiresistent tuberkulos i Sverige kräver ökad vaksamhet
- 2009
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 106:30-31, s. 1895-1897
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Tidskriftsartikel (refereegranskat)abstract
- Multiresistent tbc diagnostiserades hos 52 patienter i Sverige 1991–2003. I maj 2007 levde 65 procent av dessa patienter, 19 procent var döda, och för 15 procent var hälsoläget okänt. Inom 24 månader från diagnos hade 21 procent fått recidiv och 12 procent dött. Multiresistent tbc var övervägande importerad. Sekundär smittspridning i Sverige konstaterades genom molekylärepidemiologisk typning hos minst ett fall utanför familjen. Trots den allvarliga prognosen överlevde majoriteten av patienterna med hjälp av medicinsk behandling. Siffror från 2007 och 2008 visar en flerfaldig ökning av antalet fall.
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| 4. |
- Garpenholt, Örjan, et al.
(författare)
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The impact of Haemophilus influenzae type b vaccination in Sweden
- 1996
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Ingår i: Scandinavian Journal of Infectious Diseases. - 0036-5548 .- 1651-1980. ; 28:2, s. 165-169
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Tidskriftsartikel (refereegranskat)abstract
- The number of patients with meningitis and bacteremia due to Haemophilus influenzae was studied in Sweden over the period 1987-1994. Conjugated H. influenzae type b vaccines were introduced in Sweden in 1992, and all children born after December 31, 1992, were offered vaccination free of charge. A rapid decline of H. influenzae meningitis and bacteraemia was observed in the autumn of 1993, when the expected peak incidence failed to appear. In the prevaccination period 1987-1991, the average annual incidence (cases/100,000) was 34.4 in children aged 0-4 years. In 1994, the annual incidence fell to 3.5. No significant decline was observed in older children or adults. There was a 92% reduction in the number of meningitis cases and an 83% reduction in cases of bacteraemia. A similar decline was noted in 2 regions which followed different strategies for the introduction of the vaccination programme.
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| 5. |
- Inghammar, Malin, et al.
(författare)
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COPD and the risk of tuberculosis--a population-based cohort study.
- 2010
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 5:4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Both chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) primarily affect the lungs and are major causes of morbidity and mortality worldwide. COPD and TB have common risk factors such as smoking, low socioeconomic status and dysregulation of host defence functions. COPD is a prevalent co-morbid condition, especially in elderly with TB but in contrast to other diseases known to increase the risk of TB, relatively little is known about the specific relationship and impact from COPD on TB-incidence and mortality. METHODS AND FINDINGS: All individuals > or = 40 years of age, discharged with a diagnosis of COPD from Swedish hospitals 1987-2003 were identified in the Swedish Inpatient Register (n = 115,867). Records were linked to the Swedish Tuberculosis Register 1989-2007 and the relative risk of active TB in patients with COPD compared to control subjects randomly selected from the general population (matched for sex, year of birth and county of residence) was estimated using Cox regression. The analyses were stratified by year of birth, sex and county of residence and adjusted for immigration status, socioeconomic status (SES) and inpatient co-morbidities previously known to increase the risk of TB. COPD patients had a three-fold increased hazard ratio (HR) of developing active TB (HR 3.0 (95% confidence interval 2.4 to 4.0)) that was mainly dependent on an increased risk of pulmonary TB. In addition, logistic regression estimates showed that COPD patients who developed active TB had a two-fold increased risk of death from all causes within first year after the TB diagnosis compared to the general population control subjects with TB (OR 2.2, 95% confidence interval 1.2 to 4.1). CONCLUSIONS: This population-based study comprised of a large number of COPD patients shows that these patients have an increased risk of developing active TB compared to the general population. The results raise concerns that the increasing global burden of COPD will increase the incidence of active TB. The underlying contributory factors need to be disentangled in further studies.
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| 6. |
- Karlsson, Carl-Axel, et al.
(författare)
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Tuberkulosutbrott på fritidshem: 14 barn smittade : Långtidsuppföljning sju år senare fann inga sena konsekvenser
- 2008
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 105:35, s. 2334-2337
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Tidskriftsartikel (refereegranskat)abstract
- Tuberkulos är i Sverige numera relativt sällsynt, men sjukdomen har på senare tid fått mycket uppmärksamhet i medierna. En anställd på ett fritidshem fick 1997 diagnos på tuberkulos efter ett års hosta. Av totalt 87 exponerade barn var 14 smittade, varav två med aktiv sjukdom. Ingen bland 25 anställda hade någon säkerställd aktuell smitta. En långtidsuppföljning gjordes sju år senare i Smittskyddsinstitutets centrala tuberkulosregister. Av de exponerade på fritidshemmet fanns inget nytt fall i registret utöver de redan kända. Långvarig och nära kontakt med smittsam tuberkulos medför stor risk att smittas. Övergång i aktiv sjukdom är vanligast under de två första åren efter exponering för tuberkulos.
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| 7. |
- Thegerström, Johanna, et al.
(författare)
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Clinical features and incidence of Mycobacterium avium infections in children
- 2008
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 40:6-7, s. 481-6
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Tidskriftsartikel (refereegranskat)abstract
- Mycobacterium avium is the most common pathogen in children presenting as non-tuberculous mycobacterial lymphadenitis. In Sweden non-tuberculous mycobacterial infection is a notifiable disease. The goal of our study was to determine the annual incidence of M. avium infection in Swedish children, 1998-2003, and describe clinical features related to age and treatment of children with M. avium lymphadenitis. To do this, we retrospectively analysed patient records of 162 children less than 7 y of age from the entire country with culture-verified M. avium disease. The incidence of M. avium infection in Sweden was lower in 2000-2003 than in 1998-1999. Young children (
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| 8. |
- Thegerström, Johanna, et al.
(författare)
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Mycobacterium avium lymphadenopathy among children, Sweden
- 2008
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Ingår i: Emerging Infectious Diseases. - : Centers for Disease Control and Prevention (CDC). - 1080-6040 .- 1080-6059. ; 14:4, s. 661-663
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Tidskriftsartikel (refereegranskat)abstract
- We studied Mycobacterium avium lymphadenopathy in 183 Swedish children (<7 years of age) from 1998 through 2003. Seasonal variation in the frequency of the disease, with a peak in October and a low point in April, suggests cyclic environmental factors. We also found a higher incidence of the disease in children who live close to water.
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