| 1. |
- Alaridah, Nader, et al.
(författare)
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Transmission dynamics study of tuberculosis isolates with whole genome sequencing in southern Sweden
- 2019
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Ingår i: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Epidemiological contact tracing complemented with genotyping of clinical Mycobacterium tuberculosis isolates is important for understanding disease transmission. In Sweden, tuberculosis (TB) is mostly reported in migrant and homeless where epidemiologic contact tracing could pose a problem. This study compared epidemiologic linking with genotyping in a low burden country. Mycobacterium tuberculosis isolates (n = 93) collected at Scania University Hospital in Southern Sweden were analysed with the standard genotyping method mycobacterial interspersed repetitive units-variable number tandem repeats (MIRU-VNTR) and the results were compared with whole genome sequencing (WGS). Using a maximum of twelve single nucleotide polymorphisms (SNPs) as the upper threshold of genomic relatedness noted among hosts, we identified 18 clusters with WGS comprising 52 patients with overall pairwise genetic maximum distances ranging from zero to nine SNPs. MIRU-VNTR and WGS clustered the same isolates, although the distribution differed depending on MIRU-VNTR limitations. Both genotyping techniques identified clusters where epidemiologic linking was insufficient, although WGS had higher correlation with epidemiologic data. To summarize, WGS provided better resolution of transmission than MIRU-VNTR in a setting with low TB incidence. WGS predicted epidemiologic links better which could consolidate and correct the epidemiologically linked cases, avoiding thus false clustering.
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| 2. |
- Almroth, Gabriel, 1953-, et al.
(författare)
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Perspectives on hepatitis B infections and the efficacy of vaccination (hepatitis B and pneumococci) in dialysis patients.
- 2003
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Ingår i: Upsala journal of medical sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 108:1, s. 61-74
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Tidskriftsartikel (refereegranskat)abstract
- Hepatitis B is a well known problem in dialysis units. We therefore examined the historical frequency of hepatitis B carriers in our unit, our vaccination program to hepatitis B virus (HBV), the response to hepatitis B vaccine, the IgG subclass response of anti-HBs and the response and IgG subclass response to pneumococcal vaccination (another vaccine) in dialysis patients. From 1970 and onwards 23 HBV carriers were found, but no new cases of hepatitis B occurred during the study period, i.e. from 1980 and onwards. Only one of the carriers was alive by the end of 2001. In four patients liver disease (in one of them liver cirrhosis) may have been a concomitant cause of death. The antibody response to hepatitis B vaccine was significantly lower in patients than in staff. In four patients a fourth injection was cancelled due to transplantation and bad health, while such data were lacking in 8 cases. In anti-HBs positive patients and controls a significant difference in the response of healthy adults was observed in anti-HBs IgG1 (p < 0.001) vs all other IgG subclasses. Dialysis patients had low levels, or negative findings, in all cases, with IgG1 as the highest proportion found (3/11 patients). An antibody response to pneumococcal vaccination was registered in 25 out of 29 dialysis patients (in all 86%). The IgG-subclass vaccination response to pneumococci in 28 dialysis patients was mainly IgG2 and IgG1 but also occurred in IgG3 and IgG4. Prevaccination antibody levels of the controls were higher in IgG1 and IgG2 (p < 0.01) (n = 21) than in dialysis patients (n = 28). Hepatitis B is nowadays a rare, but still dangerous disease in nephrology units. Dialysis patients have a reduced response to hepatitis B vaccine and vaccination schedules should be started early as some patients otherwise may not receive a fourth injection. The adequate antibody response to pneumococcal vaccination mainly due to IgG2 and IgG1 antibodies indicates that the antigen involved is important in vaccination responses in dialysis patients.
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| 3. |
- Katouli, M, et al.
(författare)
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Virulence characteristics of Escherichia coli strains causing acute cystitis in young adults in Iran.
- 2005
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Ingår i: The Journal of infection. - : Elsevier BV. - 0163-4453. ; 50:4, s. 312-21
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Tidskriftsartikel (refereegranskat)abstract
- Escherichia coli strains that cause cystitis posses virulence properties that facilitate their colonisation and persistence in the bladder. In Iran, despite the high number of the urinary tract infections, very few studies has been done to determine the role of these virulence properties in the pathogenesis of E. coli cyctitis.
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| 4. |
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| 5. |
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| 6. |
- Resman, F., et al.
(författare)
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Increase of beta-Lactam-Resistant Invasive Haemophilus influenzae in Sweden, 1997 to 2010
- 2012
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Ingår i: Antimicrobial Agents and Chemotherapy. - : American Society for Microbiology. - 0066-4804 .- 1098-6596. ; 56:8, s. 4408-4415
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Tidskriftsartikel (refereegranskat)abstract
- The proportions of Haemophilus influenzae resistant to ampicillin and other beta-lactam antibiotics have been low in Sweden compared to other countries in the Western world. However, a near-doubled proportion of nasopharyngeal Swedish H. influenzae isolates with resistance to beta-lactams has been observed in the last decade. In the present study, the epidemiology and mechanisms of antimicrobial resistance of H. influenzae isolates from blood and cerebrospinal fluid in southern Sweden from 1997 to 2010 (n = 465) were studied. Antimicrobial susceptibility testing was performed using disk diffusion, and isolates with resistance to any tested beta-lactam were further analyzed in detail. We identified a significantly increased (P = 0.03) proportion of beta-lactam-resistant invasive H. influenzae during the study period, which was mainly attributed to a significant recent increase of beta-lactamase-negative beta-lactam-resistant isolates (P = 0.04). Furthermore, invasive beta-lactamase-negative beta-lactam-resistant H. influenzae isolates from 2007 and onwards were found in higher proportions than the corresponding proportions of nasopharyngeal isolates in a national survey. Multiple-locus sequence typing (MIST) of this group of isolates did not completely separate isolates with different resistance phenotypes. However, one cluster of beta-lactamase-negative ampicillin-resistant (BLNAR) isolates was identified, and it included isolates from all geographical areas. A truncated variant of a beta-lactamase gene with a promoter deletion, bla(TEM-1)-P Delta dominated among the beta-lactamase-positive H. influenzae isolates. Our results show that the proportions of beta-lactam-resistant invasive H. influenzae have increased in Sweden in the last decade.
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| 7. |
- Resman, Fredrik, et al.
(författare)
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Invasive disease caused by Haemophilus influenzae in Sweden 1997-2009; evidence of increasing incidence and clinical burden of non-type b strains
- 2011
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Ingår i: Clinical Microbiology and Infection. - : Elsevier BV. - 1469-0691 .- 1198-743X. ; 17:11, s. 1638-1645
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Tidskriftsartikel (refereegranskat)abstract
- Introduction of a conjugated vaccine against encapsulated Haemophilus influenzae type b (Hib) has led to a dramatic reduction of invasive Hib disease. However, an increasing incidence of invasive disease by H. influenzae non-type b has recently been reported. Non-type b strains have been suggested to be opportunists in an invasive context, but information on clinical consequences and related medical conditions is scarce. In this retrospective study, all H. influenzae isolates (n = 410) from blood and cerebrospinal fluid in three metropolitan Swedish regions between 1997 and 2009 from a population of approximately 3 million individuals were identified. All available isolates were serotyped by PCR (n = 250). We observed a statistically significant increase in the incidence of invasive H. influenzae disease, ascribed to non-typeable H. influenzae (NTHi) and encapsulated strains type f (Hif) in mainly individuals >60 years of age. The medical reports from a subset of 136 cases of invasive Haemophilus disease revealed that 48% of invasive NTHi cases and 59% of invasive Hif cases, respectively, met the criteria of severe sepsis or septic shock according to the ACCP/SCCM classification of sepsis grading. One-fifth of invasive NTHi cases and more than one-third of invasive Hif cases were admitted to intensive care units. Only 37% of patients with invasive non-type b disease had evidence of immunocompromise, of which conditions related to impaired humoral immunity was the most common. The clinical burden of invasive non-type b H. influenzae disease, measured as days of hospitalization/100 000 individuals at risk and year, increased significantly throughout the study period.
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| 8. |
- Rönner, Anna-Clara, 1971, et al.
(författare)
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Genetic profiling of Campylobacter jejuni strains from humans infected in Sweden or in Thailand, and from healthy Swedish chickens, studied by pulsed-field gel electrophoresis (PFGE).
- 2005
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Ingår i: Scandinavian journal of infectious diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 37:8, s. 579-584
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Tidskriftsartikel (refereegranskat)abstract
- The major objective of the study was to explore the genomic diversity between Campylobacter jejuni (C.jejuni) from different sources as a tool for epidemiological considerations. Subtyping was performed using pulsed-field gel electrophoresis (PFGE) and the enzyme used for cleavage was SmaI. Isolates originated from humans infected in Sweden (n=49) and Thailand (n=32) and from healthy Swedish chickens (n=51). Eight PFGE groups were formed in a dendrogram and 48% of the isolates belonged to 1 of these groups. In 2 PFGE groups, strains from humans infected in both Sweden and Thailand were represented. Four of the PFGE groups comprised high frequencies of strains from domestic human infection, as well as from healthy chickens. The PFGE pattern was also compared with the antibiotic resistance pattern in all the above-mentioned isolates. In conclusion, C.jejuni was a diverse group based on PFGE genotyping; about 24% of the clones from Swedish patients and healthy Swedish chickens were similar; and there was no correlation between the antibiotic resistance pattern and the PFGE profiling among the studied strains. Our findings are also in accordance with our hypothesis that there may be similarities between Swedish and Thai strains, which might support a theory of globally occurring C.jejuni.
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| 9. |
- Rönner, Anna-Clara, 1971, et al.
(författare)
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Species identification by genotyping and determination of antibiotic resistance in Campylobacter jejuni and Campylobacter coli from humans and chickens in Sweden.
- 2004
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Ingår i: International journal of food microbiology. - : Elsevier BV. - 0168-1605 .- 1879-3460. ; 96:2, s. 173-9
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Tidskriftsartikel (refereegranskat)abstract
- Campylobacter is today the most common cause of human bacterial enteritis in Sweden, as well as in most other industrialized countries. Common sources of infection are undercooked chicken meat, unpasteurized milk and contaminated drinking water. One aim with our present study was to identify the species Campylobacter jejuni and Campylobacter coli strains from humans and chickens using a polymerase chain reaction/restriction enzyme analysis (PCR/REA) method, as well as traditional hippurate hydrolysis test. Another aim was to investigate the antibiotic resistance pattern of the human domestic C. jejuni/C. coli isolates from infected patients and isolates from healthy Swedish chicken, as well as isolates from humans infected abroad. If discrimination between C. jejuni and C. coli was based on testing for hippurate hydrolysis, 95% of the human domestic strains and 88% of the chicken strains were identified as C. jejuni. Based on genotyping by PCR/REA, 100% of the human domestic strains and 98% of the chicken strains were attributed to C. jejuni. The E-test and disc diffusion methods were used for phenotypic antibiotic resistance studies. The two methods gave similar results. Most Swedish C. jejuni/C. coli isolates both from humans and chickens were sensitive to doxycycline and erythromycin, which are antibiotics used to treat human infection. Only 7% of the human domestic strains and 2% of the chicken strains were resistant to the quinolones tested. As a comparison, more than 94% of strains isolated from travelers to Asia and southern Europe showed antibiotic resistance to one or more drugs.
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| 10. |
- Rönner, Anna-Clara, 1971, et al.
(författare)
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The hygienic effectiveness of 2 different skin cleansing procedures.
- 2010
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Ingår i: Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society / WOCN. - 1528-3976. ; 37:3, s. 260-4
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Tidskriftsartikel (refereegranskat)abstract
- This study was designed to assess the ability of 2 skin cleaning procedures to remove transient microbial flora from the skin.
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| 11. |
- Sandström, Göran, et al.
(författare)
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Helicobacter pylori Antibodies and Iron Deficiency in Female Adolescents.
- 2014
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Ingår i: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 9:11
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Tidskriftsartikel (refereegranskat)abstract
- Iron deficiency (ID) is a common clinical problem worldwide, affecting primarily females. Helicobacter pylori (HP) infection has been shown to be associated with ID. The objective of this study was to define the prevalence of HP antibodies in female adolescents, and to find out if there was a correlation between HP infection and ID. The secondary aim was to study if regularly performed sporting activity, have any association to HP infection, in itself.
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| 12. |
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| 13. |
- Söderström, A, et al.
(författare)
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A large Escherichia coli O157 outbreak in Sweden associated with locally produced lettuce.
- 2008
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Ingår i: Foodborne pathogens and disease. - : Mary Ann Liebert Inc. - 1556-7125 .- 1535-3141. ; 5:3, s. 339-49
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Tidskriftsartikel (refereegranskat)abstract
- In 2005 a large outbreak of verotoxin-producing Escherichia coli (VTEC) occurred in Sweden. Cases were interviewed and cohort and case-control studies were conducted. Microbiological investigations were performed using polymerase chain reaction (PCR) to detect the Shiga-like toxin (Stx) genes followed by cultivation and pulsed-field gel electrophoresis. A total of 135 cases were recorded, including 11 cases of hemolytic uremic syndrome. The epidemiological investigations implicated lettuce as the most likely source of the outbreak, with an OR of 13.0 (CI 2.94-57.5) in the case-control study. The lettuce was irrigated by water from a small stream, and water samples were positive for Stx 2 by PCR. The identical VTEC O157 Stx 2 positive strain was isolated from the cases and in cattle at a farm upstream from the irrigation point. An active surveillance and reporting system was crucial and cooperation between all involved parties was essential for quickly identifying the cause of this outbreak. Handling of fresh greens from farm to table must be improved to minimize the risk of contamination.
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| 14. |
- Welinder-Olsson, Christina, 1959, et al.
(författare)
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EHEC outbreak among staff at a children's hospital--use of PCR for verocytotoxin detection and PFGE for epidemiological investigation.
- 2004
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Ingår i: Epidemiology and infection. - 0950-2688. ; 132:1, s. 43-9
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Tidskriftsartikel (refereegranskat)abstract
- This is the first report of a major foodborne outbreak of enterohaemorrhagic Escherichia coli (EHEC) in Sweden. It occurred among the nursing staff at a children's hospital with approximately 1600 employees. Contaminated lettuce was the most likely source of infection. Nine persons were culture-positive for Escherichia coli (E. coli) O157 and verocytotoxin-positive by PCR and a further two were verocytotoxin-positive by PCR only. All 11 EHEC-positive individuals had attended a party for approximately 250 staff members, which was held at the hospital. In a questionnaire 37 persons stated that they had symptoms consistent with EHEC infection during the weeks after the party. There was no evidence of secondary transmission from staff to patients. The value of PCR as a sensitive and fast method for diagnosis is discussed in this paper. Pulsed-field gel electrophoresis (PFGE) was used to ascertain that staff members were infected by the same clone, and that two patients with E. coli O157 infection were not.
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| 15. |
- Welinder-Olsson, Christina, 1959, et al.
(författare)
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Enterohemorrhagic Escherichia coli (EHEC).
- 2005
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Ingår i: Scandinavian journal of infectious diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 37:6-7, s. 405-16
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Tidskriftsartikel (refereegranskat)abstract
- Enterohaemorrhagic Escherichia coli has since the last 2 decades been known to cause severe and bloody diarrhoea as well as haemorrhagic colitis (HC) and haemorrhagic uraemic syndrome (HUS) especially among children. The importance of screening for EHEC among children and older patients with severe symptoms is apparent. Production of the verocytotoxins VT1 and VT2 are the main features of EHEC, and the VT types and mode of action during human infection is described. There are, however, other features adding to the pathogenicity. In this review we deal with the importance of properties such as fimbriae and adhesins as well as systems to meet the bacterial need for iron during infection. These factors are probably important for the establishment of EHEC in the gut and add to the bacterial virulence. It has now become evident that VT producing E. coli, irrespective of serogroup, might be human pathogens. We conclude that knowledge of the different possible virulence factors adds to the possibility of separating more virulent from less virulent isolates.
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| 16. |
- Welinder-Olsson, Christina, 1959, et al.
(författare)
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Genetic profiling of enterohemorrhagic Escherichia coli strains in relation to clonality and clinical signs of infection.
- 2002
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Ingår i: Journal of clinical microbiology. - 0095-1137. ; 40:3, s. 959-64
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Tidskriftsartikel (refereegranskat)abstract
- Sixty-seven human strains of enterohemorrhagic Escherichia coli (EHEC) (from patients with more or less severe symptoms) were serogrouped and arranged according to pulsed-field gel electrophoresis (PFGE) patterns. We used PCR to investigate the strains according to known or putative virulence factors, and associations with disease were studied. All EHEC strains with the same PFGE pattern belonged to the same serogroup. On the contrary, two serogroups (O157 and O8) included strains with different PFGE patterns. We found several different combinations of chromosomal and plasmid-borne determinants, encoding the putative virulence factors, among the strains. As judged from clinical symptoms, there was no marked difference in pathogenicity among the strains and their combinations of virulence traits. All strains of O157 had the genes coding for verocytotoxin (VT) 2, intimin (eaeA), E. coli hemolysin (E-hly), and secreted serine protease (espP). Among EHEC non-O157 strains, the genes coding for VT1 and VT2 were equally dispersed. EaeA positivity was just as common among VT1- as VT2-positive strains. Among the plasmid-borne determinants, E-hly and espP were the most common and E-hly might be a pathogenicity marker among EHEC non-O157 strains. The conclusion is that PFGE is a very useful tool in epidemiological studies. The EHEC plasmids are heterogeneous in their gene composition, with the four plasmid-borne determinants found in many combinations. There was no reliable correlation between chromosomal and plasmid-borne virulence factors and human disease.
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| 17. |
- Welinder-Olsson, Christina, 1959, et al.
(författare)
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Improved microbiological techniques using the polymerase chain reaction and pulsed-field gel electrophoresis for diagnosis and follow-up of enterohaemorrhagic Escherichia coli infection.
- 2000
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Ingår i: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. - 0934-9723. ; 19:11, s. 843-51
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Tidskriftsartikel (refereegranskat)abstract
- The aims of the present investigation were to evaluate the microbiological diagnostic procedures, especially polymerase chain reaction (PCR) versus culture and seroagglutination, in relation to the clinical features of enterohaemorrhagic Escherichia coli (EHEC) infection and to study the status of EHEC in the western part of Sweden. During 1997 and 1998, stool specimens from 3,948 patients were analysed by PCR for the presence of EHEC with verotoxin (VT)1- and/or VT2-producing DNA sequences. The stool specimens were also cultured for Escherichia coli O157:H7, Salmonella, Campylobacter, Shigella and Yersinia. Fifty-five patients were positive by PCR. Thirty-nine patients were positive for EHEC by PCR and culture. Of these, 29 were infected with EHEC serogroup O157:H7 strains. All EHEC isolates were analysed by pulsed-field gel electrophoresis (PFGE); 17 different clones were identified. Studies on the duration of the presence of EHEC in the gut showed that EHEC often disappears rather quickly, i.e. within 2 weeks. In one patient, however, EHEC remained for several months. In conclusion, PCR, rather than culture and agglutination, should be the method of choice for microbiological diagnosis of EHEC infection. PCR is more sensitive than culture for detecting EHEC in the gut.
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| 18. |
- Welinder-Olsson, Christina, 1959, et al.
(författare)
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Virulence genes in verocytotoxigenic Escherichia coli strains isolated from humans and cattle.
- 2005
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Ingår i: APMIS : acta pathologica, microbiologica, et immunologica Scandinavica. - : Wiley. - 0903-4641. ; 113:9, s. 577-85
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Tidskriftsartikel (refereegranskat)abstract
- Verocytotoxigenic Escherichia coli (VTEC) causing diarrhoea, haemorrhagic colitis and haemolytic-uremic syndrome usually have additional traits such as the adhesin intimin and a large plasmid that seems to increase virulence. There are, however, isolates of VTEC causing serious symptoms that do not harbour these traits. In the present study we have used PCR with primers detecting adhesin genes other than eaeA, namely fimA, papC, sfaD/sfaE and daaE. We have also used PCR to detect the genes hlyA and iutA that besides the plasmid-borne gene E-hly possibly support the bacterial access to iron. The aim of the study was to identify and compare the presence of virulence genes in VTEC isolates of human and cattle origin. The main finding was that the absence of E-hly might be compensated for by the gene iutA coding for aerobactin or hlyA coding for alpha-haemolysin as 94% of the human VTEC isolates had at least one of these genes. Interestingly, only 45% of VTEC isolated from cattle had any of these genes. We propose that this might be the reason for the relatively low incidence of symptomatic VTEC infections among humans in relation to the high number of VTEC among cattle.
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