| 1. |
- Edvinsson, Marie, et al.
(author)
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Bartonella spp. seroprevalence in tick-exposed Swedish patients with persistent symptoms
- 2021
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In: Parasites & Vectors. - : BioMed Central (BMC). - 1756-3305. ; 14
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Journal article (peer-reviewed)abstract
- Background: Bartonella spp. are emerging pathogens transmitted by arthropod vectors, possibly including ticks. We have investigated signs of bartonellosis in Swedish patients with presumed tick-bite exposure and symptom duration of at least 6 months.Methods: Serological testing for Bartonella henselae and Bartonella quintana was performed in 224 patients. Symptoms, tick exposure, evidence of co-infection and previous treatments were evaluated. Seropositive patients were compared to a matched group (twofold larger and negative serology) from the same study cohort.Results: Seroprevalence was 7% for B. henselae and 1% for B. quintana, with one patient testing positive to both agents. Tick bites were reported by 63% of the patients in the seropositive group and 88% in the seronegative group and presumed tick exposure was more common in the seronegative group. Animal contact was equally common in both groups, along with reported symptoms. The most common symptoms were fatigue, muscular symptoms, arthralgia and cognitive symptoms. Exposure to co-infections was evenly distributed in the seropositive and seronegative groups.Conclusions: Antibodies to Bartonella were more common in this cohort of patients than in cohorts of healthy Swedish blood donors in previous studies but lower than those in blood donors from southern Europe. Positive Bartonella serology was not linked to any specific symptom, nor to (suspected) tick-bite exposure.
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| 2. |
- Höper, Linnea, et al.
(author)
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Vasculitis due to Candidatus Neoehrlichia mikurensis : a cohort study of 40 Swedish patients
- 2021
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In: Clinical Infectious Diseases. - : Oxford University Press. - 1058-4838 .- 1537-6591. ; 73:7, s. e2372-e2378
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Journal article (peer-reviewed)abstract
- BACKGROUND: Candidatus (Ca.) Neoehrlichia (N.) mikurensis is an emerging tick-borne pathogen of humans that is closely related to Ehrlichia and Anaplasma species. This strict intracellular bacterium escapes detection by routine microbiologic diagnostic methods such as blood culture leading to considerable under-diagnosis of the infectious disease it causes, neoehrlichiosis.METHODS: Here, we describe the vascular and thromboembolic events afflicting a series of 40 patients diagnosed with neoehrlichiosis in Sweden during a 10-year period (2009-2019).RESULTS: The majority of the patients (60%) developed vascular events ranging from repeated thrombophlebitis, deep vein thrombosis, pulmonary embolism, transitory ischemic attacks to arteritis. Younger age was a risk factor for vascular complications. In contrast, there was no difference in the incidence of vascular events between immunosuppressed and immunocompetent patients. However, there were qualitative differences such that deep vein thrombosis exclusively afflicted the immunosuppressed patients whereas arteritis was restricted to the immunocompetent ones. We also present the case histories of two patients who developed vasculitis mimicking polyarteritis nodosa and giant cell arteritis. Both were cured by doxycycline treatment.CONCLUSIONS: Ca. N. mikurensis infection should be considered in patients living in tick-endemic areas of Europe and northern Asia who present with atypical vascular and/or thromboembolic events. Early diagnosis and antibiotics targeting this emerging infectious agent can eradicate the infection and prevent the development of new vascular events.
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| 3. |
- Nilsson, Kenneth, Docent, 1953-, et al.
(author)
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A comprehensive clinical and laboratory evaluation of 224 patients with persistent symptoms attributed to presumed tick-bite exposure
- 2021
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:3
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Journal article (peer-reviewed)abstract
- Background Persistent symptoms attributed to presumed tick-bite exposure constitute an unresolved medical controversy. We evaluated whether Swedish adults who met the criteria for post-treatment Lyme disease syndrome (PTLDS) exhibited characteristics distinguishable from adults who did not, but who displayed similar symptoms and disease course after suspected previous tick-bite infection (TBI). Methods and findings During 2015-2018, 255 patients-referred to the Centre for Vector-borne Infections, Uppsala University Hospital, Sweden with symptoms lasting longer than six months-were recruited. Of this group, 224 completed the study. Each patient was examined by an infectious disease specialist and, besides a full medical history, underwent a panel of blood and cerebrospinal fluid laboratory tests including hematological, biochemical, microbiological and immunological analyses, and the RAND-36 scale to measure quality of life. For analysis purposes, patients were divided into five subgroups, of which one represented PTLDS. According to serological results indicating TBI and documented/ reported objective signs of Lyme disease, 85 (38%) patients fulfilled the criteria for PTLDS and were compared with the other 139 (62%) serologically classified patients. In the PTLDS group, erythema chronicum migrans (ECM) was documented/reported in 86% of patients, previous neuroborreliosis in 15%, and acrodermatitis chronica atroficans (ACA) in 3.5%. However, there were no significant differences regarding symptoms, laboratory results or disease course between patients with PTLDS and those without laboratory evidence of Borrelia exposition. Most reported symptoms were fatigue-related (70%), musculoskeletal (79%), neurological (82%) and neurocognitive (57%). Tick bites were recalled by 74%. The RAND-36 score was significantly below that of the general Swedish population. Signs of immunological/inflammatory reactivity with myositis antibodies were detected in 20% of patients, fibrinogen levels were moderately increased in 21% and elevated rheumatoid factor in 6%. Conclusions The PTLDS group did not differ exclusively in any respect from the other subgroups, which either lacked previously documented/reported evidence of borreliosis or even lacked detectable serological signs of exposure to Lyme disease. The results suggest that symptoms often categorized as Chronic-Lyme-Disease (CLD) in the general debate, cannot be uniquely linked to Lyme disease. However, approximately 20% of the total group of patients showed signs of autoimmunity. Further studies are needed to elucidate the underlying causes and mechanisms of PTLDS and there is reason to consider a multifactorial approach.
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| 4. |
- Nilsson, Kenneth, Docent, 1953-, et al.
(author)
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Protein biomarker profiles in serum and CSF in 158 patients with PTLDS or persistent symptoms after presumed tick-bite exposure compared to those in patients with confirmed acute neuroborreliosis
- 2022
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:11
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Journal article (peer-reviewed)abstract
- Background Current diagnostics for patients with lingering symptoms categorized as post-treatment Lyme disease syndrome (PTLDS) have their limitations and may be difficult to interpret. The aim of this exploratory study was to evaluate the feasibility of protein biomarker profiling as a diagnostic platform for this category of patients and to compare these results with similarly obtained results from a group of patients with acute neuroborreliosis.Methods and findings Two groups of patient cohorts (Cohort 1 and 2) were analyzed for biomarkers in serum and cerebrospinal fluid (CSF); the results were used for group-level comparison. Cohort 1 comprised 158 adult patients selected from 224 previously diagnosed patients, who between October 2015 and December 2018, after referral, were enrolled and structurally investigated based on defined inclusion criteria. They displayed similar lingering symptoms, with a duration of at least 6 months, after presumed previous tick-borne infection (TBI) and are fully described in a previously published study originating from the Center for Vector-borne Infections (CVI), Uppsala University Hospital, Sweden. Cohort 2, comprised 30 patients diagnosed at Uppsala University Hospital between 2016 and 2019 with laboratory-confirmed acute neuroborreliosis. Their proteomic results, based on serum and CSF analyses, were compared with the 158 patients in Cohort 1. The expression and the concentration of potential biomarkers in each patient's serum and CSF samples were measured based on two multiplex protein panels enabling simultaneous analysis of 92 inflammatory and neurology biomarkers. The PTLDS patient subgroup showed no nominally significant proteins compared to the other CVI patients in Cohort 1. However, CVI patients with signs of inflammation, which were evenly distributed in Cohort 1, showed 16 significantly (p <0.05) different proteins in both CSF and serum, but no association was seen with laboratory-confirmed exposure to Borrelia spp or other TBIs. When comparing the two cohorts, different protein profiles were observed, with 125/148 significantly different proteins in CSF and 93/174 in serum, in patients with laboratory confirmed acute neuroborreliosis, of which 6 in CSF and 6 in serum were significant at the p <0.001 level.Conclusions In this first comprehensive inflammatory and neurological biomarker profile study no differences in biomarker profiles were detected between patients with PTLDS and patients with similar persisting symptoms but who did not meet the PTLDS criteria, regardless of whether laboratory verified previous exposure to Borrelia or other TBI's were present. However, the expressed markers differed from those found in patients with confirmed acute neuroborreliosis, which does not support the view that PTLDS reflects an ongoing Borrelia infection. Further studies are needed to understand and assess the usefulness of biosignatures of patients with PTLDS before they can be applied in a clinical setting.
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| 5. |
- Samuelsson, Jessica, et al.
(author)
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A Western-style dietary pattern is associated with cerebrospinal fluid biomarker levels for preclinical Alzheimer's disease -A population-based cross-sectional study among 70-year-olds
- 2021
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In: Alzheimer's & dementia (New York, N. Y.). - 2352-8737. ; 7:1, s. 1-11
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Journal article (peer-reviewed)abstract
- Background: Diet may be a modifiable factor for reducing the risk of Alzheimer's disease (AD). Western-style dietary patterns are considered to increase the risk, whereas Mediterranean-style dietary patterns are considered to reduce the risk. An association between diet and AD-related biomarkers have been suggested, but studies are limited.Aim: To investigate potential relations between dietary patterns and cerebrospinal fluid (CSF) biomarkers for AD among dementia-free older adults.Methods: Data were derived from the population-based Gothenburg H70 Birth Cohort Studies, Sweden. A total of 269 dementia-free 70-year-olds with dietary and cerebrospinal fluid (CSF) amyloid beta (Aβ42 and Aβ40), total tau (t-tau), and phosphorylated tau (p-tau) data were investigated. Dietary intake was determined by the diet history method, and four dietary patterns were derived by principal component analysis. A Western dietary pattern, a Mediterranean/prudent dietary pattern, a high-protein and alcohol pattern, and a high-total and saturated fat pattern. Logistic regression models, with CSF biomarker pathology (yes/no) as dependent variables, and linear regression models with continuous CSF biomarker levels as dependent variables were performed. The analyses were adjusted for sex, energy intake, body mass index (BMI), educational level, and physical activity level.Results: The odds ratio for having total tau pathology (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.02 to 2.01) and preclinical AD (Aβ42 and tau pathology; OR 1.79; 95% CI 1.03 to 3.10) was higher among those with a higher adherence to a Western dietary pattern. There were no other associations between the dietary patterns and CSF biomarkers that remained significant in both unadjusted and adjusted models.Discussion: Our findings suggest that higher adherence to a Western dietary pattern may be associated with pathological levels of AD biomarkers in the preclinical phase of AD. These findings can be added to the increasing amount of evidence linking diet with AD and may be useful for future intervention studies investigating dietary intake in relation to AD.
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| 6. |
- Samuelsson, Jessica, et al.
(author)
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Associations between dietary patterns and structural neuroimaging measures of relevance for dementia : Alzheimer’s Association International Conference (AAIC)
- 2022
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Conference paper (peer-reviewed)abstract
- Associations between dietary patterns and structural neuroimaging measures of relevance for dementia Jessica Samuelsson, M.S.c¹, Anna Marseglia, PhD2, Olof Lindberg, PhD2, Eric Westman, PhD2, Silke Kern, MD, PhD¹, Felicia Ahlner M.S.c¹, Elisabet Rothenberg, PhD4, Ingmar Skoog, MD, PhD1,3*, Anna Zettergren, PhD¹* 1Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Sweden, 2 Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden, 3Department of Psychiatry Cognition and Old Age Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Mölndal, Sweden, 4Food and Meal Science, Kristianstad University, Kristianstad, Sweden Abstract Background: Diet is one of the lifestyle factors that could influence the risk of developing dementia, but effects of diet on the brain are not fully understood. Investigating associations between dietary patterns and structural neuroimaging measures of relevance for dementia could potentially increase this understanding. Methods: This study includes cross-sectional data from the population-based Gothenburg H70 Birth Cohort Studies based in Sweden, including 610 dementia-free 70-year-olds (born 1944, examined 2014-16) with dietary and magnetic resonance imaging (MRI) data (54 % women). Three dietary patterns were derived with principal component analysis, one labelled Western (e.g., refined cereal products, sweets, savory bakery/fast food), one Mediterranean (e.g., vegetables, fruits, whole grain cereal products) and one Low-fiber and high-alcohol (e.g., red meat/processed red meat, eggs, alcoholic beverages). Magnetic resonance imaging (MRI) measures of cortical thickness, white matter microstructure (based on diffusion tensor imaging), and a small vessel disease score (sum of white matter hyperintensities, lacunes,cerebral microbleeds, perivascular spaces) of relevance for dementia were included. Analyses (linear and ordinal regression models) were adjusted for sex, energy intake, educational level, physical activity level, smoking and body mass index. Results: Results from this study showed a positive association between higher adherence to the Mediterranean dietary pattern and higher white matter microstructural integrity (B 0.077; 95% CI 0.002 – 0.153), and that a higher adherence to the Low-fibre and high-alcohol dietary pattern was negatively associated with total mean cortical thickness (B -0.011; 95% CI -0.019 – -0.003) and an Alzheimer’s disease signature of cortical thickness (mean entorhinal, inferior temporal, middle temporal, and fusiform thickness) (B -0.013; 95% CI -0.024 – -0.001) in the fully adjusted models. No associations were found between the small vessel disease score and the dietary patterns. Nor were there any associations between the western dietary pattern and the MRI measures. Conclusions: The result from this study suggests that there may be an association between diet and dementia-related brain alterations. These findings could be of importance for dementia prevention strategies and for future intervention studies investigating the effect of dietary patterns in relation to dementia incidence.
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| 7. |
- Samuelsson, Jessica, et al.
(author)
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Associations of dietary patterns and CSF biomarkers for Alzheimer’s disease in a population-based sample of 70-year-olds
- 2020
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In: Alzheimer's & Dementia. - : Wiley. - 1552-5260 .- 1552-5279.
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Conference paper (peer-reviewed)abstract
- Background: Diet could be a modifiable factor in the prevention of Alzheimer’s disease (AD). Western-style dietary patterns are considered to increase the risk, while Mediterranean-style dietary patterns are considered protective. The aim of this study was to investigate the relation between dietary patterns and CSF biomarkers of relevance for AD. Method: Data was derived from the population based Gothenburg H70 Birth Cohort Studies in Gothenburg, Sweden (n=1203). CSF levels of β-amyloid (Aβ)42, total tau, and phosphorylated tau were measured with ELISA. Dietary intake was determined by the diet history method (n=861). Principal component analysis were performed to reduce 21 food groups into factors representing dietary patterns. Logistic regression analyses, with CSF biomarkers as dependent variables (pathological/not pathological), and linear regression analyses with CSF biomarkers as continuous variables, were performed on the dementia-free participants with both CSF and dietary data (n=269, 49% women). Analyses were adjusted for APOE ε4 status, energy intake, education, BMI, physical activity and sex. Analyses were also performed stratified by sex. Result: Four factors representing dietary patterns were derived from the principal component analysis. A western-style dietary pattern, a Mediterranean-style dietary pattern, a mixed dietary pattern with alcoholic beverages and a dietary pattern of high fat dairy products, eggs and refined cereal products. The odds ratio of having pathological values of total tau was higher among those with a higher compliance to a western-style dietary pattern (OR 1.37; 95%CI 1.02-1.80). The linear regression model indicate the same trend (r2=0.06, B=0.04, p=0.08). When stratified by sex, the odds ratio of having pathological values of phosphorylated tau was higher for those with a higher intake of high fat dairy products, eggs and refined cereal products among men (OR 3.38; 95%CI 1.22-9.36). We could not find an association between the other dietary patterns and CSF biomarkers. Conclusion: Our results indicate an association between western-style dietary patterns and increased levels of total tau and phosphorylated tau. However, there was no relation between a healthier Mediterranean-style dietary pattern and CSF biomarkers for AD.
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| 8. |
- Samuelsson, Jessica, et al.
(author)
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Interactions between dietary patterns and genetic factors in relation to incident dementia among 70-year-olds
- 2021
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In: Alzheimer's & Dementia. - : Wiley. - 1552-5260 .- 1552-5279.
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Conference paper (peer-reviewed)abstract
- Abstract Background Genetic and lifestyle factors influence the risk of developing dementia. Diet is one of the modifiable lifestyle factors thought to affect risk, but it is unclear whether there is an interplay with genetic risk factors in relation to incident dementia. Method Data was derived from the population-based Gothenburg H70 Birth Cohort Studies based in Sweden, including 602 dementia-free 70-year-olds (born 1922 or 1930; 64% women) with dietary and genetic data followed for incident dementia until 2016. Two dietary patterns were derived with reduced rank regression analysis, one healthy (e.g., fruits, vegetables, fish) and one western (e.g., full-fat dairy products, refined bread, red and processed meat). Genetic risk was determined by APOE ε4 status and four non-APOE AD-polygenic risk scores (AD-PRSs). Gene-diet interactions in relation to incident dementia were analysed with cox regression models. If an interaction at a p-value threshold of p< 0.20 was detected, stratified analyses were performed. Analyses were adjusted for sex, energy intake, birth year, age at examination, educational level, physical activity level, cardiovascular risk factors and 10 principal components (to correct for population stratification). Result There was an interaction between APOE ε4 status and a healthy and a western dietary pattern in relation to incident dementia (p=0.13 and p=0.07), while no interactions were found between AD-PRSs and dietary patterns. Those with higher adherence to a healthy dietary pattern had a reduced risk of dementia (HR 0.77; 95% CI 0.64–0.94, p=0.008) among ε4 non-carriers, but not among ε4 carriers. There was a borderline association between a western dietary pattern and an increased risk of dementia among ε4 carriers (HR 1.25; 95% CI 0.97–1.61, p=0.08), while no association was observed among ε4 non-carriers. Conclusion The results suggest an interplay between APOE ε4 status and adherence to dietary patterns in relation to incident dementia. The findings from this study could be of importance for dementia prevention strategies and for future intervention studies investigating the effect of dietary patterns in relation to dementia incidence.
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| 9. |
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| 10. |
- von Berens, A., et al.
(author)
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Sarcopenic obesity and associations with mortality in older women and men : a prospective observational study
- 2020
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In: BMC Geriatrics. - 1471-2318 .- 1471-2318. ; 20:1
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Journal article (peer-reviewed)abstract
- Background The combined effect of sarcopenia and obesity, i.e., sarcopenic obesity, has been associated with disability and worse outcomes in older adults, but results are conflicting. The objectives of this study were to describe the prevalence of sarcopenic obesity (SO) in older adults, and to examine how the risk of mortality is associated with SO and its various components. Methods Data were obtained from two Swedish population studies, the Gothenburg H70 Birth Cohort Studies of 521 women and men at the age of 75, and the Uppsala Longitudinal Study of Adult Men (ULSAM), which included 288 men aged 87 years. Sarcopenia was defined using the recently updated EWGSOP2 definition. Obesity was defined by any of three established definitions: body mass index >= 30 kg/m(2), fat mass > 30%/ > 42% or waist circumference >= 88 cm/>= 102 cm for women and men, respectively. The Kaplan-Meier survival curve and the Cox proportional hazard model were used for 10-year and 4-year survival analyses in the H70 and ULSAM cohorts, respectively. Results SO was observed in 4% of the women and 11% of the men in the H70 cohort, and in 10% of the ULSAM male cohort. The 75-year-old women with SO had a higher risk (HR 3.25, 95% confidence interval (1.2-8.9)) of dying within 10 years compared to those with a "normal" phenotype. A potential similar association with mortality among the 75-year-old men was not statistically significant. In the older men aged 87 years, obesity was associated with increased survival. Conclusions SO was observed in 4-11% of community-dwelling older adults. In 75-year-old women SO appeared to associate with an increased risk of dying within 10 years. In 87-year-old men, the results indicated that obesity without sarcopenia was related to a survival benefit over a four-year period.
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