| 1. |
- Bruce, Michael G, et al.
(författare)
-
International Circumpolar Surveillance System for invasive pneumococcal disease, 1999-2005
- 2008
-
Ingår i: Emerging Infectious Diseases. - Atlanta, GA : National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC). - 1080-6040 .- 1080-6059. ; 14:1, s. 25-33
-
Tidskriftsartikel (refereegranskat)abstract
- The International Circumpolar Surveillance System is a population-based surveillance network for invasive bacterial disease in the Arctic. The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced for routine infant vaccination in Alaska (2001), northern Canada (2002-2006), and Norway (2006). Data for invasive pneumococcal disease (IPD) were analyzed to identify clinical findings, disease rates, serotype distribution, and antimicrobial drug susceptibility; 11,244 IPD cases were reported. Pneumonia and bacteremia were common clinical findings. Rates of IPD among indigenous persons in Alaska and northern Canada were 43 and 38 cases per 100,000 population, respectively. Rates in children <2 years of age ranged from 21 to 153 cases per 100,000 population. In Alaska and northern Canada, IPD rates in children <2 years of age caused by PCV7 serotypes decreased by >80% after routine vaccination. IPD rates are high among indigenous persons and children in Arctic countries. After vaccine introduction, IPD caused by non-PCV7 serotypes increased in Alaska.
|
|
| 2. |
- Christensson, Bertil, et al.
(författare)
-
D-arabinitol--a marker for invasive candidiasis
- 1999
-
Ingår i: Medical Mycology. - 1460-2709. ; 37:6, s. 391-396
-
Tidskriftsartikel (refereegranskat)abstract
- The five-carbon sugar alcohol D-arabinitol (DA) is a metabolite of most pathogenic Candida species, in vitro as well as in vivo, and can be determined by gas chromatography or enzymatic analysis. Endogenous DA and L-arabinitol (LA) are present in human body fluids, and serum DA and LA increase in renal dysfunction. In prospective clinical studies, elevated DA/LA or DA/creatine ratios in serum or urine have been found in immunocompromised, usually neutropenic, patients with invasive candidiasis. In addition, positive DA results have been obtained several days to weeks before positive blood cultures, and the normalization of DA levels has been correlated with therapeutic response in both humans and animals. However, to date, only a few prospective studies have been conducted in which adequate analytical methods were used. Thus, further investigation of various patient groups is needed to establish the applicability of the 'arabinitol method' in the diagnostic battery for invasive Candida infections.
|
|
| 3. |
- Eisen, DP, et al.
(författare)
-
Urine D-arabinitol/L-arabinitol ratio in diagnosing Candida infection in patients with haematological malignancy and HIV infection
- 2002
-
Ingår i: Diagnostic Microbiology and Infectious Disease. - 1879-0070. ; 42:1, s. 39-42
-
Tidskriftsartikel (refereegranskat)abstract
- Adult patients with hematologic malignancies along with HIV infected patients were prospectively studied to determine the performance of urine D-arabinitol/L-arabinitol (DA/LA) ratio in diagnosing invasive candidiasis. Ten evaluable febrile neutropenic patients had proven invasive candidiasis and elevated DA/LA ratios were found in 5. Invasive candidiasis with normal DA/LA ratios was most frequently due to Candida krusei infection. This Candida species is a non-producer of arabinitol. Only 4 of 81 febrile neutropenic patients given either antifungal prophylaxis or empiric antifungal treatment had elevated DA/LA ratios. Only 1 of 15 HIV positive patients with either oropharyngeal or esophageal candidiasis had elevated DA/LA ratios. Widespread use of fluconazole prophylaxis in bone marrow transplantation patients at the study hospital has led to an increased prevalence of C. krusei infection. This is the likely reason for the low sensitivity of the test in proven and suspected invasive Candida infections reported here. (C) 2002 Elsevier Science Inc. All rights reserved.
|
|
| 4. |
- Sigmundsdottir, Gudrun, et al.
(författare)
-
Clinical experience of urine D-arabinitol/L-arabinitol ratio in the early diagnosis of invasive candidiasis in paediatric high risk populations
- 2007
-
Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 1651-1980 .- 0036-5548. ; 39:2, s. 146-151
-
Tidskriftsartikel (refereegranskat)abstract
- In 2 prospective studies, we previously reported on the early and accurate diagnosis of invasive candidiasis by determining the D-arabinitol/L-arabinitol (DA/LA) ratio in urine in neutropenic children with cancer at the paediatric oncology unit (POU) and in premature infants at the neonatal intensive care unit (NICU) at our hospital. In this retrospective study at the same units, we report how the DA/LA assay was implemented in clinical practice immediately after the prospective study periods. We found that, in the POU, the recommendation of regularly monitoring urine DA/LA ratios in patients at risk and considering antifungal therapy in the case of elevated ratios had been followed. A significant decrease in the incidence of culture positive invasive candidiasis may have been attributed to the introduction of the DA/LA assay. At the NICU, where the DA/LA assay was recommended only as an adjunct to other diagnostic tools, morbidity in invasive candidiasis remained unchanged. While regular monitoring of the urine DA/LA ratio probably facilitates the early detection of invasive candidiasis in paediatric oncology, it remains to be determined if the test can be used in a similar way in neonatal intensive care.
|
|
| 5. |
- Sigmundsdottir, Gudrun
(författare)
-
D-arabinitol in the diagnosis of invasive candidiasis
- 2010
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Invasive candidiasis (IC) is a serious condition and timely diagnosis with early initiation of antifungal therapy is imerative for improving outcomes. Arabinitol is a sugar alcohol with two stereoisomers, D-arabinitol (DA) and L-arabintiol (LA). Several pathogenic Candida species produce DA in vitro and high DA levels have been detected in serum and urine in patients with IC. Renal dysfunction affects serum DA levels, serum and urine DA/LA or serum DA/creatinine are therefore measured to correct for kidney dysfunction. DA/LA ratio in urine was examined in neonatal infants in Lund, in patients with hematologic malignancies in Brisbane, Australia, and in HIV patients. Urine samples were collected on filter paper, which was found easy to apply and facilitated shipment of samples. DA/LA ratio is a reliable diagnostic method of IC in neonatal infants, all six infants with IC had elevated DA/LA ratios. Additionally five of eight infants receiving empirical antifungal treatment had elevated DA/LA ratios. The DA/LA ratio had lower sensitivity in hematology patients in Australia probably reflecting local changes in the epidemiology of candidemia with increased proportion of fungemias caused by C. krusei. HIV patients had normal DA/LA ratios and elevated ratios were not detected in five patients with Candida esophagitis. Clinical usage of DA/LA ratio in urine was studied iat the pediatric oncology unit (POU) and at the neonatal intensive care unit (NICU) in Lund. Screening of neutropenic children with cancer at the POU was found to decrease the number of IC but at the NICU the number of IC remained unchanged where the DA/LA ration was obtained only when IC was suspected. In vitro studies on DA production showed DA production in C. dubliniensis and C. krusei although C. krusei was found to produce low levels of DA. Neither in vitro nor in vivo DA production was detected in C. glabrata. DA production rate was highest in C. albicans and both intra and inter species variation of in vitro DA production was observed, which warrants further studies on the DA production rate and the sensitivity of DA/LA ratio in clinical use.
|
|
| 6. |
- Sigmundsdottir, Gudrun, et al.
(författare)
-
Urine D-arabinitol/L-arabinitol ratio in diagnosis of invasive candidiasis in newborn infants
- 2000
-
Ingår i: Journal of Clinical Microbiology. - 1098-660X. ; 38:8, s. 3039-3042
-
Tidskriftsartikel (refereegranskat)abstract
- Infants treated in neonatal intensive care units suffer an increased risk for invasive candidiasis, but the diagnosis is sometimes difficult. D-arabinitol is a metabolite of most pathogenic Candida species. An elevated urine D-arabinitol/L-arabinitol (DA/LA) ratio is a sensitive sign of invasive candidiasis in children with cancer, but the method has not been previously evaluated for newborn infants. We therefore enrolled 117 infants in a neonatal intensive care unit, and 411 urine samples were obtained on filter paper. The DA/LA ratio was measured by gas chromatography-mass spectrometry. For 81 infants with no suspicion of superficial or invasive candidiasis, the urine DA/LA ratio was 2.7 +/- 0.7 (mean +/- standard deviation [SD]). The upper cutoff level was set at 4.8 (mean plus 3 SD). Of 22 infants with mucocutaneous candidiasis and not given systemic antifungal treatment, two had elevated DA/LA ratios, which normalized after removal of intravascular catheters. Eight other infants were given empiric antifungal treatment but had negative cultures; five of these had repeatedly elevated DA/LA ratios. Six infants with culture-positive invasive candidiasis all had one or more samples with elevated ratios. For seven infants, three with suspected and four with confirmed invasive candidiasis (for which follow-up samples were available), ratios normalized during antifungal treatment. In conclusion, urine DA/LA ratio determination is a rapid test and can be used for newborns. It is possibly more sensitive than fungal blood cultures in the diagnosis of invasive candidiasis and can also be used for monitoring the effect of antifungal treatment.
|
|
