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- Ásgeirsson, Hilmir
(author)
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Staphylococcus aureus bacteraemia and endocarditis : epidemiology, short- and long-term mortality
- 2014
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Doctoral thesis (other academic/artistic)abstract
- Staphylococcus aureus is a major cause of bloodstream infections and endocarditis. S. aureus bacteraemia (SAB) is associated with substantial morbidity and mortality, and endocarditis is a severe complication. Population-based studies on S. aureus bacteraemia have been sparse, and few large studies exist on S. aureus endocarditis (SAE). The objective of this thesis was to study the epidemiology, characteristics, and short- and long-term outcome of S. aureus bacteraemia and endocarditis in Iceland and Stockholm. In paper I and II we studied SAB in the entire Icelandic adult and paediatric populations. Cases were retrospectively identified at the clinical microbiological laboratories. In adults the incidence was 24.5 /100,000 person-years during 1995-2008 (721 cases), increasing by 28% during the study period (p=0.01). The paediatric incidence was 10.9 /100,000 child-years during 1995-2011 (146 cases), decreasing by 36% during the period (p=0.001). At the same time the average annual frequency of blood cultures from children analysed at the main study site decreased by 27% (p<0.001). SAB incidence was highest in infants (<1 year), 58.8 /100,000. The proportion of adults with nosocomial infections decreased from 56% in 1995-99 to 39% in 2005-08 (p=0.001), while community acquired SAB increased from 29% to 46% (p<0.001). Health-care associated community-onset cases were 15%. Among the paediatric cases 34% were nosocomial, 14% health-care associated, and 51% community acquired. Bone or joint infection was the focus of SAB in 40% of children, followed by intravascular catheters in 30%, and an unknown focus in 10%. The 30-day mortality in adults was 17.1%, and decreased from 22.2% during 1995-99 to 11.4% during 2005-08 (p=0.001). The 1-year mortality was 33.0%, and decreased from 38.9% to 28.2% (p=0.06). In children the SAB-related mortality was 0.7%, 30-day mortality 1.4%, and the 1-year mortality 3.6%. These case fatality ratios are lower than those observed in most previous studies. In paper III we studied SAE in adults in Stockholm, and in paper IV we specifically focused on SAE in people who inject drugs. Individuals treated for SAE at the Department of Infectious Diseases at the Karolinska University Hospital were retrospectively identified by diagnostic codes from medical records. The calculated incidence of SAE in adults in Stockholm County was 1.56 /100,000 person-years during 2004-13 (245 cases), and the incidence of SAE related to intravenous drug use (IVDU) was 0.76 /100,000 person-years (120 cases). This incidence is high in comparison with other regions. The SAE incidence increased by 42% during the study period (p=0.002), and this was largely caused by a change in the incidence of the IVDU-related SAE which increased by 91% (p=0.02). The SAE incidence among people who inject drugs in Stockholm was estimated to be 2.5 (range 1.5-6.5) per 1,000 person-years. Thirty-day, in-hospital, and 1-year mortality rates were 6.1%, 9.0%, and 19.7%, respectively, among all SAE cases. In-hospital and 1-year mortality rates associated with IVDU-related SAE were 2.5% and 8.0%, respectively. The case fatality ratios noted are very low compared to previous reports. Age and female sex were independently associated with in-hospital mortality in a multivariate analysis, and age and left-sided disease with the 1-year mortality. Central nervous system (CNS) involvement was observed in 12% of patients, and valvular surgery was performed during hospitalisation in 15%. In left-sided SAE the strongest predictors for surgery were lower age and not being an intravenous-drug-user, and for CNS involvement lower age. In conclusion, we found an increasing incidence of SAB and SAE in adults, probably related to a change in risk factors both for SAB and SAE, and possibly due to more liberal diagnostics. The decrease noted in SAB incidence in children was probably in part due to lower blood culture frequency and possibly a result of infection control measures introduced. The reason for the favourable short- and long-term outcomes associated with SAB and SAE in Iceland and Stockholm is not clear. It could be related to diagnosis of more early and mild cases, but other factors might also have contributed.
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| 2. |
- Babacic, Haris, et al.
(author)
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Comprehensive proteomics and meta-analysis of COVID-19 host response
- 2023
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In: Nature Communications. - : NATURE PORTFOLIO. - 2041-1723. ; 14:1
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Journal article (peer-reviewed)abstract
- COVID-19 is characterised by systemic immunological perturbations in the human body, which can lead to multi-organ damage. Many of these processes are considered to be mediated by the blood. Therefore, to better understand the systemic host response to SARS-CoV-2 infection, we performed systematic analyses of the circulating, soluble proteins in the blood through global proteomics by mass-spectrometry (MS) proteomics. Here, we show that a large part of the soluble blood proteome is altered in COVID-19, among them elevated levels of interferon-induced and proteasomal proteins. Some proteins that have alternating levels in human cells after a SARS-CoV-2 infection in vitro and in different organs of COVID-19 patients are deregulated in the blood, suggesting shared infection-related changes.The availability of different public proteomic resources on soluble blood proteome alterations leaves uncertainty about the change of a given protein during COVID-19. Hence, we performed a systematic review and meta-analysis of MS global proteomics studies of soluble blood proteomes, including up to 1706 individuals (1039 COVID-19 patients), to provide concluding estimates for the alteration of 1517 soluble blood proteins in COVID-19. Finally, based on the meta-analysis we developed CoViMAPP, an open-access resource for effect sizes of alterations and diagnostic potential of soluble blood proteins in COVID-19, which is publicly available for the research, clinical, and academic community. Baba & ccaron;ic et al. performed systematic analyses of blood proteins in COVID-19 patients through mass-spectrometry proteomics, showing that a large part of the soluble blood proteome is altered. The authors then developed an open-access resource, CoViMAPP, for meta-analysis of MS proteomics studies of COVID-19 patients.
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| 3. |
- Bläckberg, Jonas, et al.
(author)
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Flera svenska fall av infektion med rävens dvärgbandmask [Echinococcus multilocularis infection - six cases during two years in Sweden]
- 2020
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In: Läkartidningen. - : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 117
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Research review (peer-reviewed)abstract
- Alveolar echinococcosis (AE) caused by the fox tapeworm Echinococcus multilocularis is a zoonosis presenting with focal liver lesions and has a poor prognosis without treatment. The disease is common in Central and Eastern Europe but has been highly unusual in Sweden. A suspicion of AE usually arises through radiology and the diagnosis may be confirmed by histology and/or serological antibody detection. AE is treated with radical surgery in combination with anti-helminthic drug therapy. During the last two years six cases of AE have been diagnosed in Sweden. In no case was AE suspected clinically before biopsy. A heightened awareness of AE is needed among Swedish physicians, including radiologists, surgeons and pathologists.
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| 4. |
- Hamer, Davidson H., et al.
(author)
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Travel-Associated Zika Virus Disease Acquired in the Americas Through February 2016 A GeoSentinel Analysis
- 2017
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In: Annals of Internal Medicine. - Philadelphia : American College of Physicians. - 0003-4819 .- 1539-3704. ; 166:2, s. 99-108
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Journal article (peer-reviewed)abstract
- Background: Zika virus has spread rapidly in the Americas and has been imported into many nonendemic countries by travelers. Objective: To describe clinical manifestations and epidemiology of Zika virus disease in travelers exposed in the Americas. Design: Descriptive, using GeoSentinel records. Setting: 63 travel and tropical medicine clinics in 30 countries. Patients: Ill returned travelers with a confirmed, probable, or clinically suspected diagnosis of Zika virus disease seen between January 2013 and 29 February 2016. Measurements: Frequencies of demographic, trip, and clinical characteristics and complications. Results: Starting in May 2015, 93 cases of Zika virus disease were reported. Common symptoms included exanthema (88%), fever (76%), and arthralgia (72%). Fifty-nine percent of patients were exposed in South America; 71% were diagnosed in Europe. Case status was established most commonly by polymerase chain reaction (PCR) testing of blood and less often by PCR testing of other body fluids or serology and plaque-reduction neutralization testing. Two patients developed Guillain-Barre syndrome, and 3 of 4 pregnancies had adverse outcomes (microcephaly, major fetal neurologic abnormalities, and intrauterine fetal death). Limitation: Surveillance data collected by specialized clinics may not be representative of all ill returned travelers, and denominator data are unavailable. Conclusion: These surveillance data help characterize the clinical manifestations and adverse outcomes of Zika virus disease among travelers infected in the Americas and show a need for global standardization of diagnostic testing. The serious fetal complications observed in this study highlight the importance of travel advisories and prevention measures for pregnant women and their partners. Travelers are sentinels for global Zika virus circulation and may facilitate further transmission.
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| 5. |
- Jonsson Henningsson, Anna, et al.
(author)
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Two Cases of Borrelia miyamotoi Meningitis, Sweden, 2018
- 2019
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In: Emerging Infectious Diseases. - : CENTERS DISEASE CONTROL & PREVENTION. - 1080-6040 .- 1080-6059. ; 25:10, s. 1965-1968
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Journal article (peer-reviewed)abstract
- We report 2 human cases of Borrelia miyamotoi disease diagnosed in Sweden, including 1 case of meningitis in an apparently immunocompetent patient. The diagnoses were confirmed by 3 different independent PCR assays and DNA sequencing from cerebrospinal fluid, supplemented by serologic analyses.
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| 6. |
- Sundén-Cullberg, Jonas, et al.
(author)
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Anakinra or tocilizumab in patients admitted to hospital with severe covid-19 at high risk of deterioration (IMMCoVA): A randomized, controlled, open-label trial
- 2023
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 18:12
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Journal article (peer-reviewed)abstract
- Background: Anakinra and tocilizumab are used for severe Covid-19, but only one previous randomized controlled trial (RCT) has studied both. We performed a multi-center RCT comparing anakinra or tocilizumab versus usual care (UC) for adults at high risk of deterioration.Methods: The study was conducted June 2020 to March 2021. Eligibility required ≥ 5 liters/minute of Oxygen to maintain peripheral oxygen saturation at ≥ 93%, CRP > 70 mg/L, ferritin > 500 μg/L and at least two points where one point was awarded for lymphocytes < 1x 109/L; D-dimer ≥ 0.5 mg/L and; lactate dehydrogenase ≥ 8 microkatal/L. Patients were randomly assigned 1:1:1 to receive either a single dose of tocilizumab (8 mg/kg) or anakinra 100 mg IV QID for seven days or UC alone. The primary outcome was time to recovery.Results: Recruitment was ended prematurely when tocilizumab became part of usual care. Out of a planned 195 patients, 77 had been randomized, 27 to UC, 28 to anakinra and 22 to tocilizumab. Median time to recovery was 15, 15 and 11 days. Rate ratio for recovery for UC vs anakinra was 0.91, 0.47 to 1.78, 95% [CI], p = 0.8 and for UC vs tocilizumab 1.13, 0.55 to 2.30; p = 0.7. There were non-significant trends favoring tocilizumab (and to limited degree anakinra) vs UC for some secondary outcomes. Safety profiles did not differ significantly.Conclusion: Premature closure of trial precludes firm conclusions. Anakinra or tocilizumab did not significantly shorten time to clinical recovery compared to usual care. (IMMCoVA, NCT04412291, EudraCT: 2020-00174824).
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