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- Bennet, Louise, et al.
(författare)
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Clinical appearance of erythema migrans caused by Borrelia afzelii and Borrelia garinii : effect of the patient´s sex
- 2006
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Ingår i: Wiener Klinische Wochenschrift. - : SPRINGER WIEN. - 0043-5325 .- 1613-7671. ; 118:17-18, s. 531-537
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim in this survey was to study the clinical characteristics of infections caused by Borrelia genospecies in patients with erythema migrans where Borrelial origin was confirmed by polymerase chain reaction. The aim was also to study factors influencing the clinical appearance of erythema migrans. Methods: The study was conducted in southern Sweden from May 2001 to December 2003 on patients 18 years and older attending with erythema migrans at outpatient clinics. All erythema migrans were verified by polymerase chain reaction, photographed and categorized into “annular” or “non-annular” lesions. A logistic regression model was used to analyze relations between the appearance of the erythema migrans (i.e., annular or non-annular) and factors that influenced its clinical appearances. Results: A total of 118 patients, 54 women (45.8%) and 64 men (54.2%), fulfilled the inclusion criteria. Of these patients, 74% were infected by B. afzelii, 26% by B. garinii ( p < 0.001). A total of 45% (38/85) of the erythema migrans were annular, 46% (39/85) were non-annular and 9.4% (8/85) were atypical. For men infected by B. afzelii the odds ratio of developing non-annular erythema migrans was 0.09 (95% CI: 0.03 - 0.33) in comparison with women with the same infection. Conclusions: In this prospective study of a large series of erythema migrans, where infecting genospecies were confirmed by polymerase chain reaction, the sex of patients infected with B. afzelii had a strong influence on the appearance of the rash. Patients infected by B. garinii more often had non-annular erythema migrans and a more virulent infection with more individuals presenting with fever, raised levels of C-reactive protein and seroreactivity in the convalescence sera.
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| 2. |
- Bennet, Louise, et al.
(författare)
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Clinical Aspects of Erythema Migrans in Southern Sweden
- 2005
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Konferensbidrag (refereegranskat)abstract
- Background: The aim of this study was to describe and categorize the different predominant patterns of PCR confirmed erythema migrans (EM) and to study possible correlations according to the clinical pictures and Borrelia substrains. Methods: Patients over 18 years old, seeking care with tick exposure and an EM were consecutively included during a study period of three years. We evaluated clinical and laboratory findings with regard to Borrelia burgdorferi s.l. spirochetes detected with nested Osp A PCR in skin biopsy specimens. Laboratory and serology testing were done acute, after 6 weeks and after 6 months. The patients were clinically evaluated at the initial visit and repeatedly after 14 days unitl recovery. Results: 118 patients (women=54, men=64) with a positive B. Burgdorferi s.l. PCR analysis were included. In this area totally 73.7% of the EM were caused by B. afzelii and 26.3% by B. garinii (p=0.0001). Leisons caused by B. garinii had a shorter duration from tick bite to the initial visit (p= 0.001) but there were no differences between the sizes of the EM, indicating a faster development of lesions caused by B. garinii. Patients with lesions caused by B. garinii to a greater extent had presented with fever at the initial visit (p=0.02). Also patients with B. garinii lesions to a greater extent had elevated levels of CRP at the initial visit (p=0.006). 45% of the EM were categorized as “annular”, 27% as “homogeneous”, 19% as “central erythemas” and 9% as “atypical”. The lesions caused by B. afzelii were predominately “annular” and the lesions caused by B. gaarinii were predominately “homogeneous”. Conclusions: In this study most EM were caused by B. afzelii. Leisons caused by B. garinii developed faster and the patients to a greater extent presented with fever and elevated levels of CRP at the initial visit. Leisons caused by B. garinii were mostly homogenous and by B. afzelii were mostly annular.
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| 3. |
- Fraenkel, Carl-Johan, et al.
(författare)
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Determination of Novel Borrelia Genospecies in Swedish Ixodes ricinus Ticks.
- 2002
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Ingår i: Journal of Clinical Microbiology. - 1098-660X. ; 40:9, s. 3308-3312
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Tidskriftsartikel (refereegranskat)abstract
- A total of 301 adult questing Ixodes ricinus ticks were collected at 15 different locations along the south and east coasts of Sweden to determine the Borrelia genospecies diversity. Thirty-two ticks (11%) were found to be positive by nested PCR with Borrelia burgdorferi sensu lato-specific primers. Species determination was based on partial sequencing of the 16S rRNA gene and the flagellin gene. Five different Borrelia species were found. The nucleotide sequence of the Borrelia DNA found in two ticks differed extensively from the nucleotide sequences of the Borrelia DNA found in the other ticks, and analysis revealed that they were closely related to the relapsing fever borrelia species Borrelia miyamotoi. This is the first report of a B. miyamotoi-like borrelia in I. ricinus and in Europe. Moreover, the Borrelia DNA of two ticks (6%) clustered within the B. valaisiana complex. B. valaisiana has not previously been reported in Sweden. B. afzelii DNA was found in 14 ticks (44%), and B. garinii DNA was found in 10 ticks (31%). B. burgdorferi sensu stricto DNA was found in four ticks (13%). We conclude that all of the known human-pathogenic species (B. garinii, B. afzelii, and B. burgdorferi sensu stricto) and B. valaisiana found elsewhere in Europe are also present in the Swedish host-seeking tick population and that a B. miyamotoi-like Borrelia species seems to be present in I. ricinus ticks in Europe.
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| 4. |
- Fraenkel, Carl-Johan, et al.
(författare)
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In vitro activities of three carbapenems against recent bacterial isolates from severely ill patients at Swedish hospitals
- 2006
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 38:10, s. 853-859
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Tidskriftsartikel (refereegranskat)abstract
- To study the in vitro activity of imipenem, meropenem and ertapenem against common pathogens isolated from patients in intensive care, haematology and dialysis/nephrology units at 7 Swedish university hospitals, a total of 788 isolates were collected during 2002-2003. The distribution of the isolates was as follows: Escherichia coli (n = 140), Klebsiella spp. (n = 132), Proteus spp. (n = 97), Enterobacter spp. (n = 113), Pseudomonas aeruginosa (n = 126), Acinetobacter spp. (n = 53) and Enterococcus faecalis (n = 127). The susceptibility to the 3 carbapenems was determined by E-test, and the MICs were interpreted according to SRGA criteria. All 3 carbapenems were highly active against Enterobacteriaceae. The overall susceptibility to imipenem, meropenem and ertapenem was 90%, 98% and 93%, respectively. Against Enterobacteriaceae, Enterobacter spp. excluded, ertapenem had an equal or lower MIC(90) than meropenem. Apart from being the most active carbapenem against Enterobacteriaceae, meropenem was also the most active carbapenem against P. aeruginosa, whereas imipenem was the most active drug against Acinetobacter spp. The carbapenems are still potent antibiotics. With the introduction of ertapenem, and an expected increase in the carbapenem consumption due to an increased prevalence of strains with extended-spectrum beta-lactamases, continuous surveillance of carbapenem resistance appears to be warranted, with special attention to P. aeruginosa, Enterobacter and Proteus spp.
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| 5. |
- Spreco, Armin, et al.
(författare)
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Nowcasting (Short-Term Forecasting) of COVID-19 Hospitalizations Using Syndromic Healthcare Data, Sweden, 2020
- 2022
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Ingår i: Emerging Infectious Diseases. - : Centers for Disease Control and Prevention (CDC). - 1080-6040 .- 1080-6059. ; 28:3, s. 564-571
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Tidskriftsartikel (refereegranskat)abstract
- We report on local nowcasting (short-term forecasting) of coronavirus disease (COVID-19) hospitalizations based on syndromic (symptom) data recorded in regular healthcare routines in Östergötland County (population ≈465,000), Sweden, early in the pandemic, when broad laboratory testing was unavailable. Daily nowcasts were supplied to the local healthcare management based on analyses of the time lag between telenursing calls with the chief complaints (cough by adult or fever by adult) and COVID-19 hospitalization. The complaint cough by adult showed satisfactory performance (Pearson correlation coefficient r>0.80; mean absolute percentage error <20%) in nowcasting the incidence of daily COVID-19 hospitalizations 14 days in advance until the incidence decreased to <1.5/100,000 population, whereas the corresponding performance for fever by adult was unsatisfactory. Our results support local nowcasting of hospitalizations on the basis of symptom data recorded in routine healthcare during the initial stage of a pandemic. © 2022 Centers for Disease Control and Prevention (CDC). All rights reserved.
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| 9. |
- Alsved, Malin, et al.
(författare)
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Droplet, aerosol and SARS-CoV-2 emissions during singing and talking
- 2021
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Konferensbidrag (refereegranskat)abstract
- IntroductionAs the pandemic continues to spread, more knowledge is needed about the viral transmission routes. Several super spreading events during the Covid-19 pandemic have been linked to singing in choirs and talking loud. However, in the beginning of the pandemic there was only one study about emitted aerosols and droplets from singing, published in 1968, and only a handful on emissions from talking. Therefore, we conducted a study to measure the aerosol and droplet emissions from talking and singing. We also evaluated the emissions from singing when wearing a face mask.We have further developed our setup so that we collect the aerosol particles from Covid-19 infected patients that are talking and singing, and analyze our samples for SARS-CoV-2, the virus causing Covid-19.MethodTwelve healthy singers (7 professionals, 5 amateurs) were included in the first study part on quantifying the amount of emitted aerosols and droplets. The singers were singing or talking a short consonant rich text repeatedly at a constant pitch with their face in the opening of a funnel. The aerosol particle size and concentration was measured from the other end of the funnel using an aerodynamic particle sizer (APS, 3321, TSI Inc). In addition, the amount of un-evaporated droplets were captured with a high-speed camera and quantified using image analysis.During February and March 2021 we will collect aerosol particles from patients with confirmed Covid-19 that are singing and talking into a funnel. We will use a growth tube condensation collector, a BioSpot (Aerosol Devices), operating at 8 L min-1, and a NIOSH BC-251 cyclone sampler operating at 3.5 L min-1 (TISCH Environmental). The BioSpot collects the whole range of exhaled aerosol particles with high (95%) efficiency into liquid, and the NIOSH cyclone sampler collects particles into three size fractions: <1 µm (filter), 1-4 µm (liquid), >4 µm (liquid). The APS is again used to measure size and concentration of the emitted aerosol particles, so that emissions from infected test subjects can be compared with those of the healthy test subjects. Air samples will be analyzed for detection of SARS-CoV-2 genes, and if possible, SARS-CoV-2 infectivity in cell cultures.ResultsAerosol particle emissions from healthy test subjects were significantly higher during normal singing (median 690, range [320–2870] particles/s) than during normal talking (270 [120–1380] particles/s) (Wilcoxon’s signed rank test, p=0.002). Loud singing produced even more aerosol particles (980 [390–2870] particles/s) than normal singing (p=0.002). The amount of non-evaporated droplets detected by the high-speed camera setup showed similar results: more droplets during loud singing or talking. For both aerosol particle concentrations and droplet numbers, the levels were reduced by on average 70-80% when wearing a surgical face mask.ConclusionsSinging and talking give rise to high aerosol and droplet emissions from the respiratory tract. This is likely an important transmission route for Covid-19. In our upcoming part of the study we hope to determine how much SARS-CoV-2 that is emitted during these social activities.
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