| 1. |
- Säll, Olof, 1980-, et al.
(författare)
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Atypical presentation of Neisseria meningitidis serogroup W disease is associated with the introduction of the 2013 strain
- 2021
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Ingår i: Epidemiology and Infection. - : Cambridge University Press. - 0950-2688 .- 1469-4409. ; 149
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Tidskriftsartikel (refereegranskat)abstract
- Since 2015, the incidence of invasive meningococcal disease (IMD) caused by serogroup W (MenW) has increased in Sweden, due to the introduction of the 2013 strain belonging to clonal complex 11. The aim of this study was to describe the clinical presentation of MenW infections, in particular the 2013 strain, including genetic associations. Medical records of confirmed MenW IMD cases in Sweden during the years 1995-2019 (n = 113) were retrospectively reviewed and the clinical data analysed according to strain. Of all MenW patients, bacteraemia without the focus of infection was seen in 44%, bacteraemic pneumonia in 26%, meningitis in 13% and epiglottitis in 8%, gastrointestinal symptoms in 48% and 4% presented with petechiae. Phylogenetic analysis was used for possible links between genetic relationship and clinical picture. The 2013 strain infections, particularly in one cluster, were associated with more severe disease compared with other MenW infections. The patients with 2013 strain infections (n = 68) were older (52 years vs. 25 years for other strains), presented more often with diarrhoea as an atypical presentation (P = 0.045) and were more frequently admitted for intensive care (P = 0.032). There is a risk that the atypical clinical presentation of MenW infections, with predominantly gastrointestinal or respiratory symptoms rather than neck stiffness or petechiae, may lead to delay in life-saving treatment.
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| 2. |
- Björklund, Verna, et al.
(författare)
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Early-onset group B streptococcal infections in five Nordic countries with different prevention policies, 1995 to 2019
- 2024
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Ingår i: Eurosurveillance. - : European Centre for Disease Control and Prevention (ECDC). - 1025-496X .- 1560-7917. ; 29:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Neonatal early-onset disease caused by group B Streptococcus (GBS) is a leading cause of infant morbidity. Intrapartum antibiotic prophylaxis (IAP) is effective in preventing early-onset GBS disease, but there is no agreement on the optimal strategy for identifying the pregnant women requiring this treatment, and both risk-based prophylaxis (RBP) and GBS screening-based prophylaxis (SBP) are used.Aim: The aim of this study was to evaluate the effect of SBP as a public health intervention on the epidemiology of early-onset GBS infections.Methods: In 2012, Finland started the universal SBP, while Denmark, Iceland, Norway and Sweden continued with RBP. We conducted an interrupted time series analysis taking 2012 as the intervention point to evaluate the impact of this intervention. The incidences of early- and late-onset GBS infections during Period I (1995-2011) and Period II (2012-2019) were collected from each national register, covering 6,605,564 live births.Results: In Finland, a reduction of 58% in the incidence of early-onset GBS disease, corresponding to an incidence rate ratio (IRR) of 0.42 (95% CI: 0.34-0.52), was observed after 2012. At the same time, the pooled IRR of other Nordic countries was 0.89 (95% CI: 0.80-1.0), specifically 0.89 (95% CI: 0.70-1.5) in Denmark, 0.34 (95% CI: 0.15-0.81) in Iceland, 0.72 (95% CI: 0.59-0.88) in Norway and 0.97 (95% CI: 0.85-1.1) in Sweden.Conclusions: In this ecological study of five Nordic countries, early-onset GBS infections were approximately halved following introduction of the SBP approach as compared with RBP.
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| 3. |
- Hertting, Olof
(författare)
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Urinary tract infection : pathogenesis and complications
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Urinary tract infections (UTI) are one of the most common infections in women and children worldwide. If not diagnosed and treated appropriately, it may lead to severe illness and long-term complications. The economic impact caused by UTI on society is significant. In addition, bacterial resistance to common antibiotics is spreading at a high rate. Recent years, the understanding of the host-pathogen interaction and activation of the immune response in the urinary tract has increased considerably. However, there is still a lack of understanding how these basic molecular events can be translated into clinical practise. In this thesis, the complex interaction between the uropathogenic E. coli and the urinary bladder and the kidney epithelium is described in the context of novel findings about virulence factors, immune response and complications following UTI. In the first study, we investigated the chemokine profile in the kidneys of mice with pyelonephritis and the impact of IL-1β by using an IL-1β knockout mouse and renal cell lines. We could show a robust induction of IL-8/MIP-2 and of the chemokines MCP-1 and RANTES, not previously associated with bacterial infection. In the second study, we described a new set of molecules involved in UTI pathogenicity, the metalloproteinase MMP-9 and its natural inhibitor TIMP-1. They increased in experimental pyelonephritis in mice and were found to be expressed by immune cells and resident renal cells. In children with pyelonephritis, we could link TIMP-1 to an increased risk of renal scarring. In the third study, we investigated the virulence factor cytotoxic necrotizing factor (CNF1), commonly found in uropathogenic E. coli. Increased inflammatory reaction could be attributed to CNF1 in vitro; however, urine from patients with UTI caused by CNF1 positive or negative E. coli showed no difference in inflammatory response. Thus, the difference seen in vitro is probably of minor importance in vivo in comparison to other virulence factors of the uropathogenic E. coli. In the last paper, we demonstrated that women supplemented with vitamin D had a stronger response of the antimicrobial peptide cathelicidin when biopsies from the urinary bladder were infected ex vivo. We also showed that normal urinary bladder cells were able to activate 25 hydroxyvitamin D3 to its functional form 1,25 dihydroxyvitamin D3, indicating a role for locally produced vitamin D in the urinary bladder. In addition, bladder cells increased their cathelicidin stores after vitamin D treatment and exerted antibacterial properties against uropathogenic E. coli. In conclusion, this thesis presents new findings about host-microbe interaction in the urinary tract, the immune response and post-infectious complications of UTI. MMP-9, TIMP-1 and the chemokines IL-8/MIP-2, MCP-1 and RANTES were produced in the kidneys during pyelonephritis. IL-1β and TIMP-1 affected the severity of infection and renal scarring. The E. coli toxin CNF1 influenced the immune response only in vitro, but did not seem to influence inflammation in vivo. Finally, treatment with vitamin D increased the antibacterial properties of the uroepithelium by induction of the antimicrobial peptide cathelicidin.
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| 4. |
- Hertting, Olof, et al.
(författare)
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Vitamin D-deficient mice have more invasive urinary tract infection
- 2017
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Ingår i: PLOS ONE. - : Public Library Science. - 1932-6203. ; 12:7
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Tidskriftsartikel (refereegranskat)abstract
- Vitamin D deficiency is a common health problem with consequences not limited to bone and calcium hemostasis. Low levels have also been linked to tuberculosis and other respiratory infections as well as autoimmune diseases. We have previously shown that supplementation with vitamin D can induce the antimicrobial peptide cathelicidin during ex vivo infection of human urinary bladder. In rodents, however, cathelicidin expression is not linked to vitamin D and therefore this vitamin D-related effect fighting bacterial invasion is not relevant. To determine if vitamin D had further protective mechanisms during urinary tract infections, we therefore used a mouse model. In vitamin D-deficient mice, we detected more intracellular bacterial communities in the urinary bladder, higher degree of bacterial spread to the upper urinary tract and a skewed cytokine response. Furthermore, we show that the vitamin D receptor was upregulated in the urinary bladder and translocated into the cell nucleus after E. coli infection. This study supports a more general role for vitamin D as a local immune response mediator in the urinary tract.
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| 5. |
- Wekell, Per, et al.
(författare)
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An overview of how on-call consultant paediatricians can recognise and manage severe primary immunodeficiencies.
- 2019
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Ingår i: Acta paediatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 108:12, s. 2175-2185
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Tidskriftsartikel (refereegranskat)abstract
- Severe primary paediatric immunodeficiency syndromes are rare and potentially fatal unless suspected, diagnosed and treated early. We provide clinical guidance and support for on-call consultant paediatricians working in secondary level hospitals on how to recognise and manage children with these conditions. Our paper addresses four conditions that risk the most severe outcomes if they are not adequately cared for during on-call periods, such as weekends: severe combined immunodeficiency, haemophagocytic lymphohistiocytosis, severe congenital neutropaenia and chronic granulomatous disease. CONCLUSION: On-call paediatricians are provided with advice on handling the most severe primary immunodeficiencies.
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| 6. |
- Wekell, Per, et al.
(författare)
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Fifteen-minute consultation: Recognising primary immune deficiencies in children
- 2019
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Ingår i: Archives of Disease in Childhood: Education and Practice Edition. - : BMJ. - 1743-0585 .- 1743-0593. ; 104, s. 235-243
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Tidskriftsartikel (refereegranskat)abstract
- © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. Children with primary immunodeficiency syndromes present with broad variation of clinical features and the consequences are often severe if not promptly recognised. Here, support is provided for the general paediatrician to recognise primary immunodeficiencies among the many children they meet in their clinical practice.
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