| 1. |
- Wennerås, Christine, 1963, et al.
(författare)
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Distinct Inflammatory Mediator Patterns Characterize Infectious and Sterile Systemic Inflammation in Febrile Neutropenic Hematology Patients
- 2014
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 9:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Invasive infections and sterile tissue damage can both give rise to systemic inflammation with fever and production of inflammatory mediators. This makes it difficult to diagnose infections in patients who are already inflamed, e.g. due to cell and tissue damage. For example, fever in patients with hematological malignancies may depend on infection, lysis of malignant cells, and/or chemotherapy-induced mucosal damage. We hypothesized that it would be possible to distinguish patterns of inflammatory mediators characterizing infectious and non-infectious causes of inflammation, respectively. Analysis of a broad range of parameters using a multivariate method of pattern recognition was done for this purpose. Methods: In this prospective study, febrile (>38 degrees C) neutropenic patients (n = 42) with hematologic malignancies were classified as having or not having a microbiologically defined infection by an infectious disease specialist. In parallel, blood was analyzed for 116 biomarkers, and 23 clinical variables were recorded for each patient. Using O-PLS (orthogonal projection to latent structures), a model was constructed based on these 139 variables that could separate the infected from the non-infected patients. Non-discriminatory variables were discarded until a final model was reached. Finally, the capacity of this model to accurately classify a validation set of febrile neutropenic patients (n = 10) as infected or non-infected was tested. Results: A model that could segregate infected from non-infected patients was achieved based on discrete differences in the levels of 40 variables. These variables included acute phase proteins, cytokines, measures of coagulation, metabolism, organ stress and iron turn-over. The model correctly identified the infectious status of nine out of ten subsequently recruited febrile neutropenic hematology patients. Conclusions: It is possible to separate patients with infectious inflammation from those with sterile inflammation based on inflammatory mediator patterns. This strategy could be developed into a decision-making tool for diverse clinical applications.
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| 2. |
- Browall, Sarah, et al.
(författare)
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Clinical manifestations of invasive pneumococcal disease by vaccine and non-vaccine types
- 2014
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 44:6, s. 1646-1657
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Tidskriftsartikel (refereegranskat)abstract
- Pneumococcal conjugated vaccines (PCVs) have shown protection against invasive pneumococcal disease by vaccine serotypes, but an increase in non-vaccine serotype disease has been observed. Type-specific effects on clinical manifestation need to be explored.Clinical data from 2096 adults and 192 children with invasive pneumococcal disease were correlated to pneumococcal molecular serotypes. Invasive disease potential for pneumococcal serotypes were calculated using 165 invasive and 550 carriage isolates from children.The invasive disease potential was lower for non-PCV13 compared to vaccine-type strains. Patients infected with non-PCV13 strains had more underlying diseases, were less likely to have pneumonia and, in adults, tended to have a higher mortality. Furthermore, patients infected with pneumococci belonging to clonal serotypes only expressing non-PCV13 capsules had a higher risk for septicaemia and mortality.PCV vaccination will probably lead to a decrease in invasive pneumococcal disease but an alteration in the clinical manifestation of invasive pneumococcal disease. Genetic lineages causing invasive pneumococcal disease in adults often express non-vaccine serotypes, which can expand after vaccination with an increased risk of infection in patients with underlying diseases.
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| 3. |
- Colque-Navarro, Patricia, et al.
(författare)
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Levels of antibody against 11 Staphylococcus aureus antigens in a healthy population.
- 2010
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Ingår i: Clinical and vaccine immunology : CVI. - 1556-679X. ; 17:7, s. 1117-23
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Tidskriftsartikel (refereegranskat)abstract
- Serum samples from 151 healthy individuals aged from 15 to 89 years were investigated by enzyme-linked immunosorbent assay (ELISA) for IgG levels against 11 different purified antigens from Staphylococcus aureus. Surface antigens, such as teichoic acid, clumping factors A and B, and bone sialoprotein binding protein, and extracellular proteins, such as alpha-toxin, lipase, enterotoxin A, toxic shock syndrome toxin, scalded-skin syndrome toxin, fibrinogen binding protein, and extracellular adherence protein, were used. The IgG values were analyzed in relation to the state of nasal carriage at the time of sampling. There was great individual variation in antibody levels in both young and elderly healthy subjects. Occurrence of S. aureus in the nares at the time of sampling was correlated with higher antibody levels, while elderly individuals over 65 years of age showed slightly lower levels than younger adults. More individuals than was expected from random probability calculations showed high antibody levels against several antigens, and more individuals than would be expected showed low levels against several antigens. Certain extracellular proteins had more often induced IgG levels of the same magnitude in the same individuals, indicating that among these individuals, there was a tendency to respond to certain antigens in the same way. Most individuals had circulating IgG antibodies to the 11 tested antigens, and some individuals had the tendency to be "good responders" to several antigens, while others were "poor responders." These findings constitute basic knowledge for the development of improved serological diagnostics, immune prophylaxis, individual prognosis tools, and therapy against invasive Staphylococcus aureus infections.
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| 4. |
- Johansson, Inger, 1953, et al.
(författare)
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Lower incidence of CMV infection and acute rejections with valganciclovir
- 2013
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Ingår i: BMC Infectious Diseases. - : Springer Science and Business Media LLC. - 1471-2334. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background Cytomegalovirus (CMV) is the most common opportunistic infection following lung transplantation. CMV replication in the lung allograft is described as accelerating the development of bronchiolitis obliterans syndrome (BOS).Finding a strategy to prevent CMV infection is an important issue. Methods We performed a retrospective, single-centre study of 114 lung transplant recipients (LTRs) who underwent lung transplantation from January 2001 to December 2006. In a smaller cohort of 88 CMV seropositive (R+) LTRs, three months of valganciclovir prophylaxis (2004-2006) was compared to three months of oral ganciclovir (2001-2003) with respect to the incidence of CMV infection/disease, the severity of CMV disease, acute rejection, BOS-free 4 year survival and 4 year survival. In the whole group of 114 LTRs the impact of CMV infection on long-term survival (BOS free 4 year survival and 6 year survival) was assessed. Results For the cohort of 88 CMV seropositive LTRs, the incidence of CMV infection/disease at one year was lower in the valganciclovir group compared to the ganciclovir group (24% vs. 54%, p = 0.003). There was a tendency towards reduced CMV disease, from 33% to 20% and a significant lower incidence of asymptomatic CMV infection (22% vs. 4%, p = 0.005). A lower incidence of acute rejection was observed in the valganciclovir group. However, there was no significant difference between the two groups in BOS free 4 year survival and 4 year survival. For the entire group of 114 LTRs, BOS-free 4 year survival for recipients with CMV disease was (32%, p = 0.005) and among those with asymptomatic CMV infection (36%, p = 0.061) as compared with patients without CMV infection (69%). Six year survival was lower among patients with CMV disease, (64%, p = 0.042) and asymptomatic CMV infection (55%, p = 0.018) than patients without CMV infection (84%). Conclusions A lower incidence of CMV infection/disease and acute rejections was observed with valganciclovir (3 months) when compared to oral ganciclovir (3 months). The long-term impact of CMV infection/disease was significant for BOS-free survival and survival.
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| 5. |
- Johanssson, Inger, et al.
(författare)
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Cytomegalovirus and long-term outcome after lung transplantation in Gothenburg, Sweden.
- 2010
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Ingår i: Scandinavian journal of infectious diseases. - : Informa UK Limited. - 1651-1980 .- 0036-5548. ; 42:2, s. 129-36
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Tidskriftsartikel (refereegranskat)abstract
- Prophylaxis with ganciclovir has decreased the initially high morbidity related to cytomegalovirus (CMV) after lung transplantation, but the optimal length of prophylaxis and the long-term outcome have not yet been established. The impact of CMV on the short- and long-term outcome was studied in 187 lung transplant recipients in Gothenburg, Sweden, 1990-2002. Among CMV-seronegative patients receiving grafts from seropositive donors (D+/R-), 88% developed CMV disease, 40% if both donor and recipient were CMV-seropositive (D+/R+) and 26% if only the recipient was CMV-seropositive (D-/R+). Among CMV-seropositive recipients (R+) on oral acyclovir prophylaxis, 38% developed CMV disease, as compared with 39% on intravenous ganciclovir for 4 weeks and 28% on oral ganciclovir for 14 weeks. On average, CMV disease appeared at 41 days in the R+ on acyclovir prophylaxis, at 75 days on 4 weeks of i.v. ganciclovir and at 162 days on 14 weeks of oral ganciclovir. CMV disease was associated with a statistically significant increased risk of developing chronic rejection (bronchiolitis obliterans syndrome) at both 1 and 2 y after transplantation. CMV disease also had a significant negative impact on survival, with a 10-y survival of only 32% as compared with 53% after asymptomatic CMV infection and 57% with no CMV.
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| 6. |
- Lindahl, Jenny K, et al.
(författare)
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Cytomegalovirus DNAemia and treatment following allogeneic stem cell transplantation with a focus on long-term outcome.
- 2010
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 1651-1980 .- 0036-5548. ; 42:9, s. 691-698
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Tidskriftsartikel (refereegranskat)abstract
- Cytomegalovirus (CMV) is an important factor for morbidity and long-term outcome after allogeneic haematopoetic stem cell transplantation (allo-SCT). Cases of proven and probable CMV infection and disease among 97 allo-SCT recipients in Gothenburg, Sweden, 1997–2001, were analysed. CMV DNAemia was detected in 60 patients at a median of 30 days after SCT. Four patients (4%) had CMV disease; 2 had proven and 2 had probable CMV disease. Of these 4 patients, 1 died of CMV disease. In 1 additional patient, CMV was considered to have contributed to the patient's death. Fifty patients (51%) were treated in a total of 93 treatment episodes. The overall 1-y survival was 75% and the 5-y survival 55%. Patients with diagnosed CMV DNAemia had improved survival. No significant differences in survival rates were seen between the donor/recipient serological groups. An increased risk of CMV DNAemia was seen after SCT with a seronegative donor to a seropositive recipient. CMV disease with debut more than 110 days after transplantation was related to steroid treatment for graft-versus-host disease. The morbidity related to CMV disease following allo-SCT was low over the past 10 y, probably due to CMV surveillance and early treatment.
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| 7. |
- Lindahl, Jenny K, et al.
(författare)
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Human herpesvirus type 6 DNAemia and infection following allogeneic stem cell transplantation with a focus on long-term outcome.
- 2013
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Ingår i: Scandinavian journal of infectious diseases. - : Informa UK Limited. - 1651-1980 .- 0036-5548. ; 45:7, s. 557-61
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Tidskriftsartikel (refereegranskat)abstract
- Cases of human herpesvirus type 6 (HHV-6) infection and disease were retrospectively analysed in a cohort of 97 allogeneic haematopoietic stem cell transplantation (allo-SCT) patients in Gothenburg, Sweden (1997-2001). Altogether 54 of 97 (56%) patients were tested for HHV-6. HHV-6 DNAemia was detected in 15 of the tested patients at a median of 76 (range 24-387) days after SCT. Nine of these patients were treated against HHV-6 infection and disease for a total of 11 treatment episodes. The morbidity associated with HHV-6 DNAemia following allo-SCT was in most cases moderate. The overall 1-y survival among the patients with HHV-6 DNAemia was 11/15 (73%) and the 5-y survival was 10/15 (67%), which was not significantly different from the whole cohort.
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| 8. |
- Maimaiti, Rena, 1968, et al.
(författare)
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Frequent Coinfection with Hepatitis among HIV-Positive Patients in Urumqi, China.
- 2013
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Ingår i: Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002). - : SAGE Publications. - 1545-1097. ; 12:1, s. 58-61
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To analyze the epidemiology and outcome for patients with HIV coinfected with hepatitis in comparison with monoinfected patients. METHODS: At the First Affiliated Hospital at Xinjiang Medical University in Urumqi, China, 395 patients were diagnosed with HIV between 2001 and 2010. The main routes of transmission were sexual (30%) and intravenous drug use (33%). The patient records were studied retrospectively. RESULTS: A total of 135 patients had markers of viral hepatitis (34.2%). Abnormal liver function was seen among 48.9% of these patients. Hepatitis B surface antigen was positive in 24 patients (6.1%), with 15 (3.8%) being hepatitis B virus (HBV)-DNA positive, none on tenofovir treatment, because it is still not provided free in Xinjiang. Hepatitis C antibodies were found in 98 patients (24.8%), 46 (11.6%) were hepatitis C virus (HCV)-RNA positive. Only 1 patient had been treated with interferon and ribavirin. Both HBV and HCV were found in 13 (3.3%) of the patients. Conclusions: Nearly half of the HIV patients in Urumqi had markers of hepatitis. Only antiretroviral treatment is provided free, and most of the patients cannot afford the hepatitis treatment they need, which has to be addressed in the treatment programs.
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| 9. |
- Molander, Viktor, 1985, et al.
(författare)
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Invasive pneumococcal infections in Vellore, India: clinical characteristics and distribution of serotypes.
- 2013
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Ingår i: BMC infectious diseases. - : Springer Science and Business Media LLC. - 1471-2334. ; 13:532
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Tidskriftsartikel (refereegranskat)abstract
- Streptococcus pneumoniae infection is a serious problem worldwide and the case fatality rate remains high. The aim of this study was to analyze the distribution of pneumococcal serotypes causing invasive pneumococcal disease (IPD), to survey the potential coverage of present and future vaccines, and to investigate differences between serotypes and groups of serotypes with regard to manifestation, case fatality rate, age, and other risk factors.
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| 10. |
- Sandqvist, Josefin, 1983, et al.
(författare)
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HIV awareness and risk behavior among pregnant women in Mateete, Uganda (2010)
- 2011
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Ingår i: ISRN Obstetrics and Gynecology. ; 2011:Atricle ID 709784
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Tidskriftsartikel (refereegranskat)abstract
- Background. The aim of the study was to evaluate current knowledge, risk behavior, and attitudes among pregnant women in Mateete, Uganda. Methods. We collected 100 questionnaires and performed 20 interviews among women who attended antenatal care. Findings. All the women had heard about HIV/AIDS, and 92% were aware of mother-to-child transmission. The women overestimated the risk of achieving the virus since 45% believed in transmission by mosquitoes and 44% by kissing. Many pointed out that married women as a group were infected more often because of unfaithful partners who refused to use condoms during sex. Conclusion. The women were well aware of the routes of HIV transmission. Schools and governmental campaigns have played an important role in educating people about the disease but there is still a great need to reach out to people in rural areas with both health care and correct information.
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