| 1. |
- Gunnarsson, Ronny K, 1955
(författare)
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Microbiologic diagnostic tests when asymptomatic carriers are present. Aspects of the use of conventional throat and nasopharyngeal culture as examples
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Carriers of potentially pathogenic bacteria simultaneously ill from a viral infection complicatethe diagnostic procedure in respiratory tract infections. The present statistical methodsavailable to evaluate common diagnostic tests either ignore the phenomenon of carriers orprovide test characteristics that are difficult to apply in clinical decision making. In thisdissertation, the influence of carriers on the diagnostic process has been elucidated.· The etiologic predictive value (EPV) is a new statistical method developed to predictdisease caused by the bacteriological findings, taking carriers into consideration. Tocalculate EPV, it is necessary to have the proportion of positive tests among patients, theproportion of positive tests among a healthy control population and the sensitivity of thetest. This enables calculating the positive and negative EPV with a 95% confidenceinterval.· A throat culture was found to be a reliable indicator for illness caused by group A beta-haemolyticstreptococci (GABHS) in adult patients with a sore throat. Positive EPV(PEPV) was 99% (95% confidence interval is 94-100%). A seasonal variation, however,was found in pre-school children (0-6 years of age). A throat culture with growth ofGABHS was found to be reliable only in the winter season, with a PEPV of 94% (75-100%) as opposed to only 61% (0-91%) in the summer. However, our data did not permitus to conclude that this seasonal variation will be found every year.· Findings of Haemophilus influenzae in a nasopharyngeal culture, taken from patients witha sore throat, may indicate the true etiology of the disease. The prediction in regard todisease caused by H. influenzae (PEPV) was 93% (73-99%) for adults ³16 years of ageand 86% (28-99%) for pre-school children 0-6 years of age.· In adults with a long-standing cough combined with other symptoms of a respiratory tractinfection, it was found that growth of H. influenzae in a nasopharyngeal culture wouldindicate the etiology for infection with PEPV 90% (30-99%). Growth of Moraxellacatarrhalis in a nasopharyngeal sample, taken from a pre-school child with a long-standingcough 0-6 years of age, will indicate the etiology for infection with a PEPV of90% (66-99%).· A questionnaire sent to different microbiologic laboratories revealed a substantialvariation between different geographical areas propensity to perform a throat ornasopharyngeal culture. There was also a large variation between the different areas in theoutcome of these cultures. It could be shown that the variation in outcome of the culturesmakes it difficult to directly apply predictive values calculated from many scientificstudies.
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| 2. |
- Gunnarsson, Ronny K, 1955, et al.
(författare)
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The prevalence of potential pathogenic bacteria in nasopharyngeal samples from individuals with a respiratory tract infection and a sore throat--implications for the diagnosis of pharyngotonsillitis
- 2001
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Ingår i: Fam Pract. - 0263-2136. ; 18:3, s. 266-71
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Treatment failure in patients with pharyngotonsillitis after a traditional course of penicillin V is a common finding. Several factors have been proposed to explain the failure rate, but the presence of aetiological agents other than group A beta-haemolytic streptococci has attracted little attention. OBJECTIVES: The aim of the present study was to investigate if a nasopharyngeal sample could suggest the aetiology of a sore throat in patients with a respiratory tract infection. METHODS: The prevalence of potentially pathogenic bacteria (Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis) in nasopharyngeal samples from 618 healthy individuals was compared with that from 108 patients with a respiratory tract infection and a sore throat. RESULTS: The prevalence of H.influenzae was higher in patients with a sore throat than in healthy individuals of the same age. For the adult patients with a sore throat, the prevalence was 27.5% compared with 2.7% for the healthy carriers (P < 10(-7)). The corresponding figures for schoolchildren were 31.3% versus 6.1% (P = 0.004) and for pre-school children 37.8% versus 13.2% (P = 0.0003). CONCLUSIONS: If H.influenzae is found in a nasopharyngeal sample from a patient with a respiratory tract infection and a sore throat, it might be the aetiological agent.
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| 3. |
- Gunnarsson, Ronny K, 1955, et al.
(författare)
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The prevalence of potentially pathogenic bacteria in nasopharyngeal samples from individuals with a long-standing cough-clinical value of a nasopharyngeal sample
- 2000
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Ingår i: Fam Pract. - 0263-2136 .- 0263-2136. ; 17:2, s. 150-5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A long-standing cough is a common cause for visits to a GP. If the patient also has a respiratory tract infection, one of the concerns of the doctor is to decide if the cough is caused by an underlying bacterial infection. OBJECTIVES: Our aim was to investigate whether a nasopharyngeal sample, obtained in routine medical practice, could yield information about the aetiology of a long-standing cough in patients with a respiratory tract infection. METHODS: The prevalence of potentially pathogenic bacteria (Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis) in nasopharyngeal swab samples from 618 healthy individuals was compared with that from 236 patients with a respiratory tract infection and long-standing cough (>9 days) of the same age in a defined geographical area. RESULTS: The proportion of cultures with potentially pathogenic bacteria decreased with age and was 44% among healthy individuals of pre-school age, 13% in schoolchildren and 6% in adults. The corresponding figures for patients with a long-standing cough were 83, 35 and 36%, respectively. All types of potentially pathogenic bacteria were found more frequently in pre-school children and in adults with a long-standing cough compared with healthy individuals of the same age. CONCLUSIONS: In patients with a respiratory tract infection and a long-standing cough, where a bacterial infection is suspected on clinical grounds, a nasopharyngeal culture could yield information about the aetiology. If M.catarrhalis is found in pre-school children, or if H.influenzae is found in adults, they are likely to be the aetiological agent.
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| 4. |
- Hansson, Markus, et al.
(författare)
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Hematopoietic secretory granules as vehicles for the local delivery of cytokines and soluble cytokine receptors at sites of inflammation.
- 2004
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Ingår i: European Cytokine Network. - 1952-4005. ; 15:3, s. 167-176
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Forskningsöversikt (refereegranskat)abstract
- Cytokines play an important role in the regulation of homeostasis and inflammation. A de-regulated cytokine function can subsequently promote chronic inflammation. This is supported by clinical evidence showing the beneficial effect of inhibiting TNF-alpha through injection of antibodies and soluble receptor in disorders such as rheumatoid arthritis and Crohn's disease. Systemic anti-TNF-alpha therapy however is associated with infectious complications. We therefore suggest a concept for the local deposition of therapeutically active agents into areas of inflammation or malignancy, based on the use of hematopoietic storage and secretory granules as delivery vehicles. Hematopoietic cells are induced to express the therapeutically active protein and to store it in the secretory lysosomes. The cells migrate into a tumour or site of inflammation, where the cells become activated and release the contents of their secretory lysosomes resulting in the local delivery of the therapeutically active protein. In support of this concept, gene transfer and granule loading can be achieved using the soluble TNF-alpha receptor (sTNFR1) after cDNA expression in hematopoietic cell lines. Endoplasmic reticulum (ER)-export can be facilitated by the addition of a transmembrane domain, and constitutive secretion can be prevented by incorporating a cytosol-sorting signal resulting in secretory lysosome targeting. The sTNFR1 is released from the transmembrane domain by proteolytic cleavage and finally, regulated sTNFR1-secretion can be triggered by a calcium signal. In vivo investigations are currently determining the feasibility of local protein delivery at sites of inflammation.
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| 5. |
- Olaison, Lars, 1949, et al.
(författare)
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Current best practices and guidelines. Indications for surgical intervention in infective endocarditis.
- 2003
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Ingår i: Cardiology clinics. - 0733-8651. ; 21:2, s. 235-51, vii
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Tidskriftsartikel (refereegranskat)abstract
- Optimal diagnosis and management of patients with infective endocarditis requires sound clinical judgment based on extensive experience. This is especially important in regard to the indications and timing for surgery. To achieve the best possible outcomes, surgical intervention during treatment is required in 25% to 30% of patients with infective endocarditis. Heart failure and progressive left-sided valvular dysfunction are the most common indications for operation. Valve repair should be considered as an alternative to valve replacement whenever feasible, especially in younger patients. Successful management of perivalvular abscesses and prosthetic valve infections requires radical removal of infected tissue followed by reconstructive procedures performed by experienced surgeons. Emergency or urgent surgery should seldom be delayed.
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| 6. |
- Olaison, Lars, 1949, et al.
(författare)
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Current best practices and guidelines indications for surgical intervention in infective endocarditis.
- 2002
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Ingår i: Infectious disease clinics of North America. - 0891-5520. ; 16:2, s. 453-75, xi
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Tidskriftsartikel (refereegranskat)abstract
- Optimal diagnosis and management of patients with infective endocarditis requires sound clinical judgment based on extensive experience. This is especially important in regard to the indications and timing for surgery. To achieve the best possible outcomes, surgical intervention during treatment is required in 25% to 30% of patients with infective endocarditis. Heart failure and progressive left-sided valvular dysfunction are the most common indications for operation. Valve repair should be considered as an alternative to valve replacement whenever feasible, especially in younger patients. Successful management of perivalvular abscesses and prosthetic valve infections requires radical removal of infected tissue followed by reconstructive procedures performed by experienced surgeons. Emergency or urgent surgery should seldom be delayed.
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| 7. |
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| 8. |
- Studahl, Marie, 1957, et al.
(författare)
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Bone and joint infection after traumatic implantation of Scedosporium prolificans treated with voriconazole and surgery.
- 2003
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Ingår i: Acta paediatrica (Oslo, Norway : 1992). - 0803-5253. ; 92:8, s. 980-2
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Tidskriftsartikel (refereegranskat)abstract
- Scedosporium prolificans is an environmental mould that may cause local infection in bone and joints after traumatic implantation, or generalized infection in immunocompromised patients. The fungus is highly drug resistant, both in vitro and in vivo. We present a case of osteomyelitis and arthritis caused by S. prolificans in a 9-y-old boy whose knee had been punctured by a hawthorn spike. Treatment with different drugs was difficult and arthrodesis was necessary. Concomitantly, voriconazole was given, and after three months bone biopsies were sterile despite a high in vitro MIC-value of the fungus against voriconazole. Reversible skin depigmentation and fingernail oncholysis appeared toward the end of 17 months of voriconazole treatment. Twelve months after discontinuation of treatment, no signs of relapse were detected.Voriconazole may be a valuable adjunct to surgical treatment of bone and joint infection by Scedosporium prolificans.
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| 9. |
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| 10. |
- Andersson, Emma, et al.
(författare)
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Antimicrobial activities of heparin-binding peptides.
- 2004
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Ingår i: European Journal of Biochemistry. - : Wiley. - 0014-2956. ; 271:6, s. 1219-1226
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Tidskriftsartikel (refereegranskat)abstract
- Antimicrobial peptides are effector molecules of the innate immune system. We recently showed that the human antimicrobial peptides alpha-defensin and LL-37 bind to glycosaminoglycans (heparin and dermatan sulphate). Here we demonstrate the obverse, i.e. structural motifs associated with heparin affinity (cationicity, amphipaticity, and consensus regions) may confer antimicrobial properties to a given peptide. Thus, heparin-binding peptides derived from laminin isoforms, von Willebrand factor, vitronectin, protein C inhibitor, and fibronectin, exerted antimicrobial activities against Gram-positive and Gram-negative bacteria. Similar results were obtained using heparin-binding peptides derived from complement factor C3 as well as consensus sequences for heparin-binding (Cardin and Weintraub motifs). These sequence motifs, and additional peptides, also killed the fungus Candida albicans. These data will have implications for the search for novel antimicrobial peptides and utilization of heparin-protein interactions should be helpful in the identification and purification of novel antimicrobial peptides from complex biological mixtures. Finally, consensus regions may serve as templates for de novo synthesis of novel antimicrobial molecules.
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