| 1. |
- Ahrné, Siv, et al.
(författare)
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Lactobacilli in the intestinal microbiota of Swedish infants
- 2005
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Ingår i: Microbes and Infection. - : Elsevier BV. - 1286-4579 .- 1769-714X. ; 7:11-12, s. 1256-62
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Tidskriftsartikel (refereegranskat)abstract
- Lactobacillus colonisation was examined in 112 Swedish infants. Faecal samples obtained at 1, 2, 4 and 8 weeks and at 6, 12 and 18 months of age were cultivated quantitatively on Rogosa agar. Lactobacilli were speciated by PCR and typed to the strain level by randomly amplified polymorphic DNA (RAPD). Lactobacilli reached a peak at 6 months when 45% of the infants were colonised. L. rhamnosus and L. gasseri were the most common species in this period. Colonisation by lactobacilli in general (P < 0.01) and L. rhamnosus in particular (P < 0.05) was more common in breast-fed than in weaned infants at 6 months of age. Lactobacillus isolation reached a nadir of 17% by 12 months (P < 0.0001), but increased to 31% by 18 months of age P < 0.05). The food-related species L. paracasei, L. plantarum, L. acidophilus and L. delbrueckii dominated in this second phase. A single strain persisted for at least 3 weeks in 17% of the infants during the first 6 months, most commonly L. rhamnosus. Lactobacillus population counts in colonised infants increased from 10(6.4) cfu/g at 1 week to 10(8.8) cfu/g at 6 months, and then dropped to 10(5.4) cfu/g faeces at 12 months of age. Lactobacillus colonisation was not significantly related to delivery mode, or to presence of siblings or pets in the household. Our results suggest that certain Lactobacillus species, especially L. rhamnosus, thrive in the intestinal flora of breast-fed infants. After weaning they are replaced by other Lactobacillus species of types found in food.
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| 2. |
- Beck-Friis, Josefine, et al.
(författare)
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Increased risk of hepatotoxicity and temporary drug withdrawal during treatment of active tuberculosis in pregnant women.
- 2020
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Ingår i: International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. - : Elsevier BV. - 1878-3511. ; 98, s. 138-143
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Tidskriftsartikel (refereegranskat)abstract
- Few studies have focused on the treatment of tuberculosis (TB) during pregnancy. This study aimed to evaluate the risk of adverse events, particularly liver toxicity, in pregnant women during treatment for active TB.We conducted a retrospective study on pregnant and age-matched non-pregnant women receiving treatment for active TB at four hospitals in Western Sweden between 1992 and 2017.A total of 135 women were included, 40 pregnant and 95 non-pregnant. The frequency of severe hepatotoxicity was 40% in pregnant women and 6% among non-pregnant women (p < 0.001) (odds ratio 9.9; 95% confidence interval 3.5-28.0). Temporary drug withdrawal due to elevated transaminase levels was more frequent for pregnant than non-pregnant women (40% vs 9.5%; p < 0.001) (odds ratio 6.4; 95% confidence interval 2.5-16.2). There was one fatal case of hepatotoxicity in a pregnant woman.Severe hepatotoxicity was significantly more frequent in pregnant women compared to non-pregnant women. Careful monitoring of liver transaminases while receiving TB treatment during pregnancy is mandatory, as well as ensuring adequate measures with adjustment of drug regimen and temporary drug withdrawals when a rise in liver enzymes is noted.
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| 3. |
- Carlsson, Camilla, 1993, et al.
(författare)
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A protocol for a systematic review and meta-analysis of tuberculosis care around the time of pregnancy
- 2024
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Ingår i: Wellcome Open Research. - 2398-502X. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Tuberculosis is estimated to cause 1.5 million deaths annually and is most common during the reproductive years. Despite that fact, we found that tuberculosis screening, prevention or care recommendations for people around the time of pregnancy were absent from some national policy recommendations and varied in others. Objectives: To address the apparent gaps and inconsistencies in policy, we aim to design a systematic review and meta-analysis of the original research evidence informing tuberculosis care around the time of pregnancy. Methods: With assistance from librarians at the Biomedical library of the University of Gothenburg, Pubmed, CINAHL and Scopus databases will be searched. Search terms will aim to identify studies generating original research evidence informing care for tuberculosis around the time of pregnancy. Evidence may include: the outcome of TB and/or of pregnancy; the cost-effectiveness or acceptability of any intervention; the sensitivity and specificity of any assessment, selection, diagnostic or test criterion. The output from these literature searches will be screened by two independent reviewers to select the eligible studies for inclusion. Discrepancies will be resolved with a third reviewer. Firstly, publications that provide contextual data will be tabulated, summarising their main contributions. Secondly, studies that provide evidence directly guiding patient care will be our focus and will be considered to be key. The key studies will be subject to quality assessment, data extraction and when possible, meta-analysis. Conclusions: This systematic review and meta-analysis aims to guide policy, practice and future research priorities concerning tuberculosis care around the time of pregnancy.
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| 4. |
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| 5. |
- Evans, D., et al.
(författare)
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Social and behavioral factors associated with failing second-line ART - results from a cohort study at the Themba Lethu Clinic, Johannesburg, South Africa
- 2018
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Ingår i: Aids Care-Psychological and Socio-Medical Aspects of Aids/Hiv. - : Informa UK Limited. - 0954-0121. ; 30:7, s. 863-870
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Tidskriftsartikel (refereegranskat)abstract
- Poor adherence is a main challenge to successful second-line ART in South Africa. Studies have shown that patients can re-suppress their viral load following intensive adherence counselling. We identify factors associated with failure to re-suppress on second-line ART.The study was a retrospective cohort study which included HIV-positive adults who experienced an elevated viral load 400copies/ml on second-line ART between January 2013-July 2014, had completed an adherence counselling questionnaire and had a repeat viral load result recorded within 6 months of intensive adherence counselling. Log-binomial regression was used to evaluate the association between patient characteristics and social, behavioral or occupational factors and failure to suppress viral load (400copies/ml).A total of 128 patients were included in the analysis, and of these 39% (n=50) failed to re-suppress their viral load. Compared to those who suppressed, far more patients who failed to suppress reported living with family (44.2% vs. 23.7%), missing a dose in the past week (53.3% vs. 30.0%), using traditional/herbal medications (63.2% vs. 34.3%) or had symptoms suggestive of depression (57.7% vs. 34.3%).These patient-related factors could be targeted for interventions to reduce the risk for treatment failure and prevent switching to expensive third-line ART.
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| 6. |
- Johnston, B. C., et al.
(författare)
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Microbial Preparations (Probiotics) for the Prevention of Clostridium difficile Infection in Adults and Children: An Individual Patient Data Meta-analysis of 6,851 Participants
- 2018
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Ingår i: Infection Control and Hospital Epidemiology. - : Cambridge University Press (CUP). - 0899-823X .- 1559-6834. ; 39:7, s. 771-781
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE. To determine whether probiotic prophylaxes reduce the odds of Clostridium difficile infection (CDI) in adults and children. DESIGN. Individual participant data (IPD) meta-analysis of randomized controlled trials (RCTs), adjusting for risk factors. METHODS. We searched 6 databases and 11 grey literature sources from inception to April 2016. We identified 32 RCTs (n=8,713); among them, 18 RCTs provided IPD (n=6,851 participants) comparing probiotic prophylaxis to placebo or no treatment (standard care). One reviewer prepared the IPD, and 2 reviewers extracted data, rated study quality, and graded evidence quality. RESULTS. Probiotics reduced CDI odds in the unadjusted model (n=6,645; odds ratio [OR] 0.37; 95% confidence interval [CI], 0.25-0.55) and the adjusted model (n=5,074; OR, 0.35; 95% CI, 0.23-0.55). Using 2 or more antibiotics increased the odds of CDI (OR, 2.20; 95% CI, 1.11-4.37), whereas age, sex, hospitalization status, and high-risk antibiotic exposure did not. Adjusted subgroup analyses suggested that, compared to no probiotics, multispecies probiotics were more beneficial than single-species probiotics, as was using probiotics in clinical settings where the CDI risk is 5%. Of 18 studies, 14 reported adverse events. In 11 of these 14 studies, the adverse events were retained in the adjusted model. Odds for serious adverse events were similar for both groups in the unadjusted analyses (n=4,990; OR, 1.06; 95% CI, 0.89-1.26) and adjusted analyses (n=4,718; OR, 1.06; 95% CI, 0.89-1.28). Missing outcome data for CDI ranged from 0% to 25.8%. Our analyses were robust to a sensitivity analysis for missingness. CONCLUSIONS. Moderate quality (ie, certainty) evidence suggests that probiotic prophylaxis may be a useful and safe CDI prevention strategy, particularly among participants taking 2 or more antibiotics and in hospital settings where the risk of CDI is >= 5%.
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| 7. |
- Jönsson, Bodil, 1959, et al.
(författare)
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Evaluation of the Cobas TaqMan MTB test for detection of Mycobacterium tuberculosis complex.
- 2015
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Ingår i: Infectious diseases (London, England). - : Informa UK Limited. - 2374-4243 .- 2374-4235. ; 47:4, s. 231-6
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Tidskriftsartikel (refereegranskat)abstract
- The Cobas TaqMan MTB assay is used for rapid detection of the Mycobacterium tuberculosis complex (MTC) in clinical samples. It is only validated for respiratory samples, but is often requested by physicians for non-respiratory specimens. The aim of this study was therefore to evaluate the performance of this assay in clinical praxis in a country with low prevalence of tuberculosis (TB).
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| 8. |
- Jönsson, Bodil, 1959, et al.
(författare)
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TB can be detected with PCR – but only in smearpositive respiratory samples : Tbc kan påvisas med PCR – men bara i direktpositiva luftvägsprov
- 2018
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Ingår i: Lakartidningen. - 0023-7205. ; 115:1-2
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Forskningsöversikt (refereegranskat)abstract
- Unnecessary and inappropriate clinical requests represent a great waste of time and money and may also result in false diagnoses. PCR techniques, such as Cobas TaqMan MTB, are used for rapid detection of tuberculosis (TB). These assays are only validated for respiratory specimens, but they are commonly requested also for non-respiratory specimens. These assays perform well in smear-positive respiratory samples, while the sensitivities are quite unsatisfactory for both respiratory and non-respiratory smearnegatives samples. The specificity is high and it is possible to rapidly distinguish between TB and infections caused by environmental mycobacteria. The analyses demonstrate, furthermore, that PCR assays cannot be used to evaluate treatment, detect relapses or exclude TB. Nor can these assays be used to evaluate contagiousness or to screen for TB. © 2017, Swedish Medical Association. All rights reserved.
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| 9. |
- Lönnermark, Elisabeth, 1965, et al.
(författare)
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Effects of Probiotic Intake and Gender on Nontyphoid Salmonella Infection
- 2015
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Ingår i: Journal of Clinical Gastroenterology. - 0192-0790 .- 1539-2031. ; 49:2, s. 116-123
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Tidskriftsartikel (refereegranskat)abstract
- The goal of the study was to examine if intake of Lactobacillus plantarum can accelerate clearance of nontyphoid Salmonella and reduce infection-related symptoms.
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| 10. |
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| 11. |
- Lönnermark, Elisabeth, 1965
(författare)
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Lactobacilli in the normal microbiota and probiotic effects of Lactobacillus plantarum
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Lactobacilli colonise most adult individuals and are also frequently used as probiotics, i.e. bacteria which possibly have health promoting effects when ingested. In this thesis, the intestinal Lactobacillus microbiota was studied in longitudinally followed infants. The oral and intestinal Lactobacillus microbiota of adults with and without IgA deficiency was examined to investigate the influence of secretory-IgA (S-IgA) on mucosal lactobacilli. Probiotic effects of the strain L. plantarum 299v were studied in antibiotic-treated patients and in patients with salmonellosis. In infants, colonisation by lactobacilli increased until six months of age, when 45 % were colonised, most often by L. rhamnosus or L. gasseri. Colonisation dropped and reached its lowest point by one year, to increase again by 18 months. By that time, L. paracasei and other food-related Lactobacillus species were most common. Only 30% of the infants harboured the same strain on at least two sampling occasions, indicating that stable colonisation by lactobacilli is quite uncommon in infants. Colonisation by L. rhamnosus was more common in breastfed than in weaned infants at six months, suggesting that breastfeeding favours this species. Lactobacillus colonisation was not significantly related to delivery mode, or to contact with siblings or pets. The influence of S-IgA on the oral and faecal Lactobacillus microbiota was studied by comparing IgA-deficient and healthy adult individuals. Expression of mannose-specific (MS) adhesins by lactobacilli was studied since such adhesins could possibly interact with mannose-containing polysaccharide chains of S-IgA. Lactobacilli were isolated from the oral cavity and faeces of the majority of both IgA-deficient and healthy individuals. L. paracasei and L. gasseri dominated in oral samples, and L. paracasei was the most common species in faecal samples from both groups. The only significant difference in species distribution was a lower colonisation by L. fermentum in the oral cavity of IgA-deficient individuals. Thus, the presence of S-IgA seems to have little influence on the Lactobacillus species distribution. The expression of MS adhesins was more common in oral than in faecal lactobacilli, indicating that these adhesins may be of advantage for oral colonisation. Faecal isolates from IgA-deficient individuals more often expressed MS adhesins than faecal isolates from controls. Possibly, expression of MS adhesins is less advantageous for lactobacilli in the presence of S-IgA in the gut. In two double-blind placebo-controlled studies we explored if intake of L. plantarum 299v could counteract gastrointestinal side-effects during treatment with antibiotics, and reduce time to clearance and symptoms of Salmonella in patients with non-typhoid salmonellosis, respectively. Intake of L. plantarum reduced the risk of experiencing loose stools or nausea in antibiotic-treated patients. The risk of diarrhoea, i.e. at least three loose stools a day for at least two days, was not reduced, and there was no effect on colonisation by toxin-producing C. difficile. In patients with salmonellosis, intake of L. plantarum 299v did not reduce time to clearance of Salmonella, or time to resolution of diarrhoea and other symptoms. After clearance of Salmonella, patients receiving L. plantarum less frequently had hard stools, but tended to have more loose stools than patients on placebo. The differences regarding effects of L. plantarum 299v in the two studies could relate to e.g. differences between the studies regarding doses and formulas of the probiotic strain. Gender seemed to influence the course of salmonellosis. Women tended to clear Salmonella more quickly than men, but had diarrhoea for a longer period. After Salmonella clearance, women had more loose stools, nausea and flatulence than men. Also, effects of L. plantarum after clearance of Salmonella were influenced by gender. Women receiving L. plantarum had more abdominal pain than those on placebo, whereas men in the L. plantarum group had less hard stools, but more diarrhoea than men on placebo. The gender-related differences regarding salmonellosis and probiotic effects need to be further explored.
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| 12. |
- Lönnermark, Elisabeth, 1965, et al.
(författare)
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Oral and faecal lactobacilli and their expression of mannose-specific adhesins in individuals with and without IgA deficiency
- 2012
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Ingår i: International Journal of Medical Microbiology. - : Elsevier BV. - 1618-0607 .- 1438-4221. ; 302:1, s. 53-60
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Tidskriftsartikel (refereegranskat)abstract
- Lactobacilli are present in the intestine and oral cavity of most adults. Secretory IgA in mucosal secretions may provide carbohydrate receptors for bacterial adhesins. Here, oral and faecal samples from 33 IgA-deficient individuals and 34 controls were cultured for lactobacilli, which were identified using species-specific PCR or partial 165 rDNA sequencing and tested for expression of mannose-specific adhesins. Lactobacilli were found in the oral cavity of 76% of IgA-deficient and 85% of control individuals. Lactobacillus paracasei and Lactobacillus gasseri dominated in both groups. Lactobacillus fermentum was less common in IgA-deficient individuals than in controls (p = 0.0055) and Lactobacillus salivarius was less common in symptomatic than in healthy IgA-deficient individuals (p = 0.0051). Faecal samples yielded lactobacilli in most individuals. L. paracasei was most frequent, followed by L. gasseri and Lactobacillus plantarum. Mannose-specific adhesins were expressed more frequently by oral than by faecal isolates (p = 0.032) and oral isolates adhered in higher numbers than faecal isolates (46 vs. 14 bacteria/cell, p = 0.0038). Faecal isolates from IgA-deficient individuals more frequently expressed mannose-specific adhesins than faecal isolates from controls (p = 0.039). Mannose-specific adhesins may be a colonisation factor in the oral cavity, and the presence of secretory IgA may modify adhesin expression. However, secretory IgA seems to have little influence on Lactobacillus species distribution. (C) 2011 Elsevier GmbH. All rights reserved.
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| 13. |
- Rabe, Hardis, et al.
(författare)
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In vitro stimulation with nontuberculous mycobacteria induced a stronger cytokine response in leukocytes isolated from individuals with latent tuberculosis compared to those isolated from active tuberculosis or cystic fibrosis patients
- 2024
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Ingår i: TUBERCULOSIS. - : Churchill Livingstone. - 1472-9792 .- 1873-281X. ; 147
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Tidskriftsartikel (refereegranskat)abstract
- Mycobacterium tuberculosis and opportunistic environmental non -tuberculous mycobacteria (NTM) can cause severe infection. Why latent tuberculosis infection advances to active disease, and why some individuals with cystic fibrosis (CF) develop pulmonary infections with NTM is still poorly understood. The aim of this study was to investigate the effector function of peripheral blood mononuclear cells (PBMC) from individuals with active or latent tuberculosis, individuals with CF with or without pulmonary NTM-infection and healthy controls, by measuring cytokine response to in vitro stimulation with different species of NTMs. The cytokine concentrations of IL -17A, IL -22, IL -23, IL -10, IL12p70 and IFN- gamma were measured in PBMC-culture supernatants after stimulation with NTMs. PBMCs from individuals with latent tuberculosis infection showed strong IL -17A, IL -22, and IFN- gamma responses compared to individuals with active tuberculosis or CF. IL -10 production was low in both tuberculosis groups compared to the CF groups and controls. This study suggests that IL -17A and IL -22 might be important to keep tuberculosis in a latent phase and that individuals with CF with an ongoing NTM infection seem to have a low cytokine response.
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| 14. |
- Westerlund, Emma E., et al.
(författare)
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Tuberculosis-related knowledge is associated with patient outcomes in shantytown residents; Results from a cohort study, Peru
- 2015
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Ingår i: Journal of Infection. - : W.B. Saunders Ltd. - 0163-4453. ; 71:3, s. 347-357
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Tuberculosis is frequent among poor and marginalized people whose limited tuberculosis-related knowledge may impair healthcare access. We characterised tuberculosis-related knowledge and associations with delayed treatment and treatment outcome. Methods: Tuberculosis patients (n = 943), people being tested for suspected tuberculosis (n = 2020), and randomly selected healthy controls (n = 476) in 16 periurban shantytowns were interviewed characterizing: socio-demographic factors; tuberculosis risk-factors; and patients' treatment delay. Principle component analysis was used to generate a tuberculosisrelated knowledge score. Patients were followed-up for median 7.7 years. Factors associated with tuberculosis treatment delay, treatment outcome and tuberculosis recurrence were assessed using linear, logistic and Cox regression. Results: Tuberculosis-related knowledge was poor, especially in older people who had not completed schooling and had never been diagnosed with tuberculosis. Tuberculosis treatment delay was median 60 days and was more delayed for patients who were poorer, older, had more severe tuberculosis and in only unadjusted analysis with incomplete schooling and low tuberculosis-related knowledge (all p ≤ 0.03). Lower than median tuberculosis-related knowledge was associated with tuberculosis recurrence (unadjusted hazard ratio = 2.1, p = 0.008), and this association was independent of co-morbidities, disease severity and demographic factors (multiple regression adjusted hazard ratio = 2.6, p = 0.008). Conclusions: Low tuberculosis-related knowledge independently predicted tuberculosis recurrence. Thus health education may improve tuberculosis prognosis. © 2015 The British Infection Association.
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