| 1. |
- Bergfors, Elisabet, et al.
(author)
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How common are long-lasting, intensely itching vaccination granulomas and contact allergy to aluminium induced by currently used pediatric vaccines? A prospective cohort study
- 2014
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In: European Journal of Pediatrics. - : Springer Berlin/Heidelberg. - 0340-6199 .- 1432-1076. ; 173:10, s. 1297-1307
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Journal article (peer-reviewed)abstract
- The frequency of long-lasting, intensely itching subcutaneous nodules at the injection site for aluminium (Al)-adsorbed vaccines (vaccination granulomas) was investigated in a prospective cohort study comprising 4,758 children who received either a diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b vaccine (Infanrix®, Pentavac®) alone or concomitant with a pneumococcal conjugate (Prevenar). Both vaccines were adsorbed to an Al adjuvant. Altogether 38 children (0.83 %) with itching granulomas were identified, epicutaneously tested for Al sensitisation and followed yearly. Contact allergy to Al was verified in 85 %. The median duration of symptoms was 22 months in those hitherto recovered. The frequency of granulomas induced by Infanrix® was >0.66 % and by Prevenar >0.35 %. The risk for granulomas increased from 0.63 to 1.18 % when a second Al-adsorbed vaccine was added to the schedule. Conclusion: Long-lasting itching vaccination granulomas are poorly understood but more frequent than previously known after infant vaccination with commonly used diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b and pneumococcal conjugate vaccines. The risk increases with the number of vaccines given. Most children with itching granulomas become contact allergic to aluminium. Itching vaccination granulomas are benign but may be troublesome and should be recognised early in primary health care to avoid unnecessary investigations, anxiety and mistrust.
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| 2. |
- Edberg, Andreas, et al.
(author)
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A comparative study of three different PCR assays for detection of Mycoplasma genitalium in urogenital specimens from men and women
- 2008
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In: Journal of Medical Microbiology. - : Microbiology Society. - 0022-2615 .- 1473-5644. ; 57:Pt 3, s. 304-309
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Journal article (peer-reviewed)abstract
- The aim of this study was to compare conventional 16S rRNA gene PCR, real-time 16S rRNA gene PCR and real-time Mycoplasma genitalium adhesin protein (MgPa) gene PCR as detection methods for M. genitalium infection. The study also determined the prevalence of M. genitalium in male and female patients attending a sexually transmitted infections clinic in a rural area in the west of Sweden. First void urine (FVU) and/or urethral swabs were collected from 381 men, and FVU and/or cervical swabs and/or urethral swabs were collected from 298 women. A total of 213 specimens were used in the PCR comparative study: 98 consecutively sampled specimens from patients enrolled in the prevalence study, 36 consecutively sampled specimens from patients with symptoms of urethritis and 79 specimens from patients positive for M. genitalium by real-time MgPa gene PCR in the prevalence study. A true-positive M. genitalium DNA specimen was defined as either a specimen positive in any two PCR assays or a specimen whose PCR product was verified by DNA sequencing. The prevalence of M. genitalium infection in men and women was 27/381 (7.1 %) and 23/298 (7.7 %), respectively. In the PCR comparative study, M. genitalium DNA was detected in 61/76 (80.3 %) of true-positive specimens by conventional 16S rRNA gene PCR, in 52/76 (68.4 %) by real-time 16S rRNA gene PCR and in 74/76 (97.4 %) by real-time MgPa gene PCR. Real-time MgPa gene PCR thus had higher sensitivity compared with conventional 16S rRNA gene PCR and had considerably increased sensitivity compared with real-time 16S rRNA gene PCR for detection of M. genitalium DNA. Real-time MgPa gene PCR is well suited for the clinical diagnosis of M. genitalium.
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| 3. |
- Falk, Lars, 1954-
(author)
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Challenges of treatment for urethritis and cervicitis, (SY06:5)
- 2012
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Conference paper (other academic/artistic)abstract
- Challenges of treatment for urethritis and cervicitis Urethritis in men caused by gonorrhoea is symptomatic. Non-gonorrhoic-urethritis (NGU) i.e. caused by Chlamydia trachomatis, Mycoplasma genitalium and occasionally other bacteria is in most cases an asymptomatic infection. Swartz’ definition of microscopic urethritis > 4 polymorphonucleated leucocytes (PML) per high power field (HPF) in > 4 HPF is the general accepted, but has limitations and is dependant on the sampling, microscope, the physician and the patient as well. Cervicitis is even more cumbersome since it is even more often asymptomatic. Other factors such as which contraception method is used, concurrent infections (bacterial vaginosis, candidosis), the microscope and the physician, may have a great impact. Brunham proposed as definition observed mucopurulent discharge from the cervix orifice combined with > 10 PML per HPF in stained endocervical smear. Lindner proposed sign of friability of the portio cervicis. Weström found a correlation of more PML than vaginal epithelial cells in wet mount. The variety of definitions causes problem in comparing scientific studies and at the clinic as well. The intention to treat also means testing and treatment of a current sexual partner as well. The ever emerging decreased susceptibility of various antibiotics especially against Neisseria gonorrhoeae and M. genitalium makes it even more important to choose whether to treat immediately without having positive tests or to miss a treatment of a potential serious infection. N. gonorrhoeae is visible microscopically in urethral stains from men, but can be missed in smears from endocervix and urethra in women. Cefixim 400 mg stat is the recommended first line antibiotic treatment. Ceftriaxone 500 mg is under consideration to become the first treatment of choice due to emerging decreased susceptibility. M.genitalium will be discussed in another speech by Jørgen Skov Jensen. There are some few reports of antibiotic resistance of Chlamydia trachomatis but this infection is generally still eradicated by tetracycline and macrolide treatment. In an NGU and or unspecific cervicitis doxycycline 100 mg bid for one week is the first treatment of choice. Azithromycin 1 g stat should be used with precaution. If there are persisting signs and or symptoms after doxycycline treatment, azithromycin 500 mg day 1 and 250 mg following four days should be prescribed. Bacterial vaginosis may give symptoms and signs of cervicitis and is also a very common concurrent infection in women with C. trachomatis and M.genitalium as well and treatment with metronidazole or clindamycin should be considered. The fast ways of communication via the Internet and the easy accessible and legal way of an individual to buy antibiotics just for safe or to avoid attending a clinic is a big threat now and even more in the future because of the potential rapid increasing antibiotic resistance of many bacterial infections including STIs
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| 4. |
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| 5. |
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| 6. |
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| 7. |
- Falk, Lars, 1954-, et al.
(author)
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Sampling for Chlamydia trachomatis infection : a comparison of vaginal, first-catch urine, combined vaginal and first-catch urine and endocervical sampling
- 2010
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In: International Journal of STD and AIDS (London). - : SAGE Publications. - 0956-4624 .- 1758-1052. ; 21:4, s. 283-287
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Journal article (peer-reviewed)abstract
- The aim of the study was to evaluate the sensitivity of patients' self-sampled vaginal specimens, first-catch urine (FCU), combined vaginal/FCU specimens and endocervical specimens for detecting chlamydial infection in women. Women attending sexually transmitted disease clinics, youth clinics and a women's health clinic were enrolled. They self-collected a vaginal specimen with two swabs, which were placed into a sterile tube and into a tube containing a buffer medium, respectively. An FCU sample was collected and aliquoted into both an empty tube and the tube containing the vaginal swab. A clinician collected an endocervical swab. The samples were sent to laboratories for analysis using polymerase chain reaction testing and strand displacement amplification testing, respectively. The sensitivities calculated in all 171 Chlamydia trachomatis-infected women were equal for endocervical specimens (97.1%), vaginal specimens (96.5%) and combined vaginal/FCU specimens (95.3%), whereas the sensitivity for FCU was significantly lower (87.7%). The sensitivity of vaginal specimens for the detection of C. trachomatis is as high as that of combined vaginal/FCU specimens.
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| 8. |
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| 9. |
- Falk, Lars, 1954-
(author)
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The overall agreement of proposed definitions of mucopurulent cervicitis in women at high risk of chlamydia infection
- 2010
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In: Acta Dermato-Venereologica. - : Medical Journals Sweden AB. - 0001-5555 .- 1651-2057. ; 90, s. 506-511
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Journal article (peer-reviewed)abstract
- The overall agreement between different criteria for cervicitis in women infected with Chlamydia trachomatis and/or Mycoplasma genitalium, and in women who tested negative was examined. Women attending a clinic for sexually transmitted diseases were enrolled because of sexual partners’ suspected chlamydia infection. M. genitalium was tested in a sample of first-catch urine and an endocervical specimen, whereas specimens from four different sites were used for detection of C. trachomatis. Signs of friability and purulent endocervical discharge were documented at gynaecological examination. Specimens for microscopy were taken from the endocervix and urethra as well as the vaginal discharge, and bacterial vaginosis was examined for. The criteria being evaluated included cervical friability and/or pus; polymorphonuclear leukocytes (PMNL)/epithelium cell ratio in the vaginal discharge; and more than 30 PMNL per high-power field in the endocervical smear. The overall agreement of the indicators of cervicitis in women infected with C. trachomatis and/or M. genitalium was 40.5% (15/37), and for those women with negative tests 35.3% (12/34). The criteria for cervicitis require further evaluation, including study of a control group of women at low risk of having a sexually transmitted infection.
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| 10. |
- Falk, Lars, 1954-, et al.
(author)
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Time to eradication of Mycoplasma genitalium after antibiotic treatment in men and women.
- 2015
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In: Journal of Antimicrobial Chemotherapy. - : Oxford University Press. - 0305-7453 .- 1460-2091. ; 70:11, s. 3134-3140
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Journal article (peer-reviewed)abstract
- OBJECTIVES:The objectives of this study were to evaluate the time to a Mycoplasma genitalium-negative test after start of treatment and to monitor if and when antibiotic resistance developed.METHODS:Sexually transmitted disease (STD) clinic attendees with suspected or verified M. genitalium infection were treated with azithromycin (5 days, 1.5 g; n = 85) or moxifloxacin (n = 5). Subjects with symptomatic urethritis or cervicitis of unknown aetiology were randomized to either doxycycline (n = 49) or 1 g of azithromycin as a single dose (n = 51). Women collected vaginal specimens and men collected first-catch urine 12 times during 4 weeks. Specimens were tested for M. genitalium with a quantitative MgPa PCR and for macrolide resistance-mediating mutations with a PCR targeting 23S rRNA.CLINICAL TRIALS REGISTRATION:NCT01661985.RESULTS:Ninety M. genitalium cases were enrolled. Of 56 patients with macrolide-susceptible strains before treatment with azithromycin (1.5 g, n = 46; 1 g single oral dose, n = 10), 54 (96%) had a negative PCR test within 8 days. In four patients, M. genitalium converted from macrolide susceptible to resistant after a 10 day lag time with negative tests (azithromycin 1.5 g, n = 3; 1 g single oral dose, n = 1). Moxifloxacin-treated subjects (n = 4) were PCR negative within 1 week. Six of eight (75%) remained positive despite doxycycline treatment.CONCLUSIONS:PCR for M. genitalium rapidly became negative after azithromycin treatment. Macrolide-resistant strains were detected after initially negative tests. Test of cure should be recommended no earlier than 3-4 weeks.
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| 11. |
- Falk, Lars, 1954-
(author)
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Urethritis and cervicitis with special reference to Chlamydia trachomatis and Mycoplasma genitalium : diagnostic and epidemiological aspects
- 2004
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Doctoral thesis (other academic/artistic)abstract
- The aim of this thesis was to elucidate urethritis and cervicitis and the possible causes with special reference to Chlamydia trachomatis and Mycoplasma genitalium. Despite mandatory partner notification legislated in 1988, the incidence of C trachomatis infection in Sweden has undergone a 10% annual increase since 1997, following a decline in the early 1990s. Nonchlamydial-non-gonococcal urethritis (and cervicitis) (NCNGU) is more common than chlamydial infection and gonorrhoea at Sexually transmitted disease (SID) clinics. Mycoplasma genitalium, originally isolated in 1980, is one probably important cause of NCNGU.Specimens from men and women infected with C trachomatis who attended the Örebro STD-clinic (1999-2000) were genotyped by sequencing of the omp 1, which encodes the major outer membrane protein (MOMP) (I, II). Both invasive and first void urine (FVU) specimens (n=237) were successfully sequenced from 231 C trachomatis-positive individuals (96 women and 135 men). Genotype E was the most common strain (47%) followed by F (17%) and K (9%). The prevalence of Ba, D, D/B-120, D/B-185, G, H, Ia and J genotypes was 0.4 to 6%. There were few gap mutations compared with reference strains. 161 sexual networks comprising 688 individuals were compiled. Specimens were sequenced from at least two patients in 47 of 161 networks. In seven of these 47 networks (15%) there were discrepant genotypes. At the follow-up visit five of 204 individuals (2%) were still C trachomatis-positive. Two harboured a new genotype and thus had contracted a new C trachomatis infection. Partner notification was successful in only 30 of 161 networks (19%), meaning that all elicited partners were tested and transmission of infection ceased. The main reason for non-success was insufficient information for partner identification from the index patients and, if the partner attended another clinic, the results of the C trachomatis test were prohibited by Swedish law from being revealed to the tracer.Microscopic signs, symptoms of infection and prevalence of C trachomatis and M genitalium were compared among men and women attending the Örebro STD-clinic in 2000 (III, IV). In a study performed in 2002, 59 young women invited to the national cervical cancer-screening program were tested for C trachomatis and M genitalium (IV). There was no statistically significant difference in microscopic signs in men or women infected with either of the bacteria. Women infected with C trachomatis or M genitalium more often had microscopic signs of infection than those women in the cancer screening group without infection, and the difference was statistically significant (IV). Symptomatic urethritis was more prevalent in M genitalium than in C trachomatis infected men (III). The prevalence of C trachomatis and M genitalium in male STD-attendees was 12% and 7%, respectively. In female STD-attendees the corresponding figures were 10% and 6%, respectively, whereas only one woman in the screening group was C trachomatis-positive and none was infected with M genitalium (IV). Both C trachomatis and M genitalium were found significantly more often in partners of men and partners of women with the corresponding infection, than in partners of men with a non specific urethritis (NSU) or women with a non-specific urethritis/cervicitis. These studies show that M genitalium is a common infection among STD-clinic attendees and that it is not a widespread commensal bacterium in society.In an open treatment pilot study (V) in men and women infected with M genitalium, the standard treatment for urethritis and cervicitis, i.e. tetracycline, was compared with azithromycin 500 mg the first day and 250 mg the following four days. Tetracyclines did not eradicate M genitalium in 71% of the women and in 63% of the men, whereas all who were treated with azithromycin were M genitalium negative at the follow-up visit. Randomised controlled trials (RCT) are needed to study azithromycin in different dosages.
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| 12. |
- Frölund, Maria, et al.
(author)
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Detection of ureaplasmas and bacterial vaginosis associated bacteria and their association with non-gonococcal urethritis in men
- 2019
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In: PLOS ONE. - San Francisco, CA, United States : Public Library of Science. - 1932-6203.
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Journal article (peer-reviewed)abstract
- No aetiology is found in up to 40% of men with symptomatic urethritis. Male partners of women with bacterial vaginosis (BV) may be at higher risk of non-gonococcal urethritis (NGU). The aim of this study was to examine the role of BV associated bacteria in first-void urine (FVU) in 97 asymptomatic men without urethritis (controls) and 44 men (cases) with NGU including 20 men with idiopathic urethritis (IU) attending a Swedish STD-clinic between January and October 2010. BV-associated bacteria and ureaplasmas were detected by quantitative PCR assays. All BV associated bacteria, except Megasphaera-like type 1, were strongly positively correlated with U. urealyticum p<0.005 and even stronger with the combined U. urealyticum and U. parvum load (p<0.0005) suggesting that ureaplasma induced elevated pH may stimulate the growth of BV associated bacteria. No statistically significant differences were found between IU cases and controls in the prevalence or load of BV associated bacteria or ureaplasmas. In multiple logistic regression, Megasphaera-like type 1 was associated with IU (p = 0.03), but most positive FVU samples contained very few bacteria and the finding may not be clinically relevant.
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| 13. |
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| 14. |
- Heed, Gunilla, 1965-, et al.
(author)
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Det oväntade besöket-syfilisepidemi bland unga män och kvinnor
- 2010
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In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 107:19, s. 1314-1316
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Journal article (peer-reviewed)abstract
- Early sexually transmissible syphilis is still an infection of major importance worldwide despite the fact that it is nowadays curable, with penicillin treatment. Syphilis has during the last decades been considered in many Western countries to appear mainly among men who have sex with men (MSM). In Sweden only 106 cases were reported (76 MSM) in 2008.In the present paper an epidemic of early syphilis among young heterosexual men and women aged 18 to 23 years is described. The suspected primary index case was a 20 year old woman who had been living for some months in a Mediterranean city. During a period of one year 10 persons living in Norrköping, a town of 128 000 inhabitants, had a confirmed infection. In all, almost 55 men and women were notified and examined. This epidemic shows the dynamic of transmission, the unawareness of care givers and common people as well, but also how efficient contact tracing can be.
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| 15. |
- Hjorth, SV, et al.
(author)
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Sequence-based typing of Mycoplasma genitalium reveals sexual transmission
- 2006
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In: Journal of Clinical Microbiology. - 0095-1137 .- 1098-660X. ; 44:6, s. 2078-2083
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Journal article (peer-reviewed)abstract
- Mycoplasma genitalium causes male nonchlamydial, nongonococcal urethritis and is associated with cervicitis and pelvic inflammatory disease in women. Epidemiological studies indicate that M. genitalium is sexually transmitted, and the aim of the present study was to further substantiate this by means of a DNA typing system. A typing assay based on a diagnostic mgpB gene PCR was developed, evaluated, and applied directly to urogenital specimens. The assay had a low limit of detection and hence a high typeability. Sequences of isolates from 52 unrelated patients were divided into 29 different sequence types, giving a discriminatory index of 0.95. Two to six M. genitalium-positive specimens were collected from each of 44 patients over a median interval of 56 days (range, 11 to 1,395). Forty had the same sequence type in consecutive specimens. Specimens collected from two men were repeatedly positive at intervals of 472 and 1,395 days, respectively, but the sequence types had changed. A new strain was introduced in one sexual dyad, and the sequence types changed subsequently. Seventy-nine M. genitalium-positive specimens from 19 couples were investigated, and all partners initially had concordant sequence types, but one couple had discordant types at one time point before a newly introduced strain took over. The present typing system is simple and reproducible and has an excellent discriminatory capacity which might prove useful in studies of sexual networks and for evaluation of treatment failures. In the laboratory, this system may document the uniqueness of newly isolated M. genitalium strains.
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| 16. |
- Strömfors, Lina, et al.
(author)
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Condition-related knowledge among children and adolescents with spina bifida in a Swedish county
- 2014
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In: Scandinavian Journal of Disability Research. - : Taylor & Francis Group. - 1501-7419 .- 1745-3011. ; 16:2, s. 127-140
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Journal article (peer-reviewed)abstract
- Spina bifida is a congenital birth defect, resulting in physical and cognitive dysfunctions. Condition-related knowledge among children and adolescents with spina bifida is essential to facilitate independent management of their condition. The aim was to describe the condition-related knowledge among children and adolescents with spina bifida in a Swedish county. Thirteen persons with spina bifida (10 to 17 years) participated. Condition-related knowledge was assessed (n = 13) using a questionnaire (KOSB) and a semi-structured interview (n = 8). Interview data were analyzed using qualitative content analysis. The participants had well-developed knowledge concerning proper bladder management, but were lacking knowledge of signs of shunt malfunctioning and etiology. Some participants were uninterested in learning about their condition, despite being aware that they lacked knowledge. The findings indicate potential areas that may be included in local educational initiatives. It should be considered that persons with spina bifida may not be motivated to learn more about their condition.
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| 17. |
- Wijkman, Magnus, 1978-, et al.
(author)
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The exaggerated blood pressure response to exercise in the sub-acute phase after stroke is not affected by aerobic exercise.
- 2018
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In: The Journal of Clinical Hypertension. - Hoboken, United States : Le Jacq Communications, Inc.. - 1524-6175 .- 1751-7176. ; 20, s. 56-64
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Journal article (peer-reviewed)abstract
- The prevalence of an exaggerated exercise blood pressure (BP) response is unknown in patients with subacute stroke, and it is not known whether an aerobic exercise program modulates this response. The authors randomized 53 patients (27 women) with subacute stroke to 12 weeks of twice-weekly aerobic exercise (n = 29) or to usual care without scheduled physical exercise (n = 24). At baseline, 66% of the patients exhibited an exaggerated exercise BP response (peak systolic BP ≥210 mm Hg in men and ≥190 mm Hg in women) during a symptom-limited ergometer exercise test. At follow-up, patients who had been randomized to the exercise program achieved higher peak work rate, but peak systolic BP remained unaltered. Among patients with a recent stroke, it was common to have an exaggerated systolic BP response during exercise. This response was not altered by participation in a 12-week program of aerobic exercise.
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