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Nyman D, Nordberg M, Nyberg C, Olausson S, Carlströmer Berthen N, Carlsson SA. Diagnostic probability classification in suspected borreliosis by a novel Borrelia C6-peptide IgG1- subclass antibody test. Front Cell Infect Microbiol 2023; 13:1108115. [PMID: 37753485 PMCID: PMC10518385 DOI: 10.3389/fcimb.2023.1108115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 08/15/2023] [Indexed: 09/28/2023] Open
Abstract
The tick-borne multisystemic infection caused by Borrelia burgdorferi sensu lato, Lyme borreliosis, or Lyme disease, occurring in temperate regions of the northern hemisphere, continues to spread geographically with the expanding tick population. Despite the rising perceived risk of infection in the population, the clinical diagnosis of Borrelia infection is not always obvious and the most important laboratory test, antibody detection, has limited accuracy in diagnosing active disease. According to international guidelines, the primary serology test, which has a high sensitivity-low specificity, should, be verified using a high specificity confirmation test to improve the specificity. However, this enhancement in specificity comes at the cost of lower sensitivity. This two-step procedure is often omitted in everyday clinical practice. An optimal primary test would be one where no secondary tests for confirmation would be necessary. In the present study, the performance of a novel assay for quantitating IgG1-subclass antibodies to Borrelia C6-peptide was compared to a commercial reference assay of total IgG and IgM antibodies to Borrelia C6-peptide in the setting of a high endemic area for borreliosis. A derivation study on a retrospective clinical material was performed to compare the performance parameters and assess the discriminatory properties of the assays, followed by a prospective validation study. The IgG1-antibody assay achieved comparable summary performance parameters to those of the reference assay. The sensitivity was almost 100% while the specificity was about 50%. In a high-endemic setting, characterized by high background seropositivity of about 50% and disease prevalence of approximately 10%, antibody tests are unable to rule-in active Borrelia infection. The rule-out assessment of the methods revealed that of 1000 patients, 7 - 54 with negative results based on the reference method could have an active Borrelia infection. Such uncertainty was not found for the index test and may help improve the risk classification of patients.
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Affiliation(s)
- Dag Nyman
- The Åland Group for Borreliosis Research, Mariehamn, Finland
- Bimelix Laboratory, Mariehamn, Finland
| | - Marika Nordberg
- The Åland Group for Borreliosis Research, Mariehamn, Finland
- Department of Infection, Åland Public Health Care Services, Mariehamn, Finland
| | - Clara Nyberg
- The Åland Group for Borreliosis Research, Mariehamn, Finland
- Department of Infection, Åland Public Health Care Services, Mariehamn, Finland
| | - Susanne Olausson
- The Åland Group for Borreliosis Research, Mariehamn, Finland
- Bimelix Laboratory, Mariehamn, Finland
| | | | - Sten-Anders Carlsson
- The Åland Group for Borreliosis Research, Mariehamn, Finland
- Bimelix Laboratory, Mariehamn, Finland
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Tjernberg I, Lager M, Furset Jensen G, Eikeland R, Nyman D, Brudin L, Henningsson AJ. Identification of potential biomarkers in active Lyme borreliosis. PLoS One 2023; 18:e0287586. [PMID: 37363901 DOI: 10.1371/journal.pone.0287586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVES Lyme serology does not readily discriminate an active Lyme borreliosis (LB) from a previous Borrelia infection or exposure. Here, we aimed to investigate a large number of immunological protein biomarkers to search for an immunological pattern typical for active LB, in contrast to patterns found in healthy blood donors, a proportion of whom were previously exposed to Borrelia. METHODS Serum samples from well-characterised adult patients with ongoing LB and healthy blood donors were included and investigated using a proximity extension assay (provided by Olink®) by which 92 different immune response-related human protein biomarkers were analysed simultaneously. RESULTS In total, 52 LB patients and 75 healthy blood donors were included. The blood donors represented both previously Borrelia exposed (n = 34) and not exposed (n = 41) based on anti-Borrelia antibody status. Ten of the examined 92 proteins differed between patients and blood donors and were chosen for further logistic regression (p<0.1). Six proteins were statistically significantly different between LB patients and blood donors (p<0.05). These six proteins were then combined in an index and analysed using receiver-operating-characteristic curve analysis showing an area under the curve of 0.964 (p<0.001). CONCLUSIONS The results from this study suggest that there is an immunological protein pattern that can distinguish a present Borrelia infection from a previous exposure as well as anti-Borrelia antibody negative blood donors. Although this method is not adapted for routine clinical use at this point, the possibility is interesting and may open new diagnostic opportunities improving the laboratory diagnostics of LB.
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Affiliation(s)
- Ivar Tjernberg
- Department of Clinical Chemistry and Transfusion Medicine, Region Kalmar County, Kalmar, Sweden
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linköping University, Linköping, Sweden
| | - Malin Lager
- National Reference Laboratory for Borrelia, Department of Clinical Microbiology in Jönköping, Region Jönköping County, Linköping University, Linköping, Sweden
| | - Guro Furset Jensen
- National Reference Laboratory for Borrelia, Department of Clinical Microbiology, Sørlandet Hospital Trust, Kristiansand, Norway
- Department of Clinical Microbiology, Sørlandet Hospital Health Enterprise, Kristiansand, Norway
| | - Randi Eikeland
- National Advisory Unit on Tick Borne Diseases, Sørlandet Hospital Trust, Kristiansand, Norway
- Faculty of Health and Sports Science, University of Agder, Grimstad, Norway
- ESCMID Study Group for Lyme Borreliosis-ESGBOR, Part of the European Society for Clinical Microbiology and Infectious Diseases, Basel, Switzerland
| | - Dag Nyman
- ESCMID Study Group for Lyme Borreliosis-ESGBOR, Part of the European Society for Clinical Microbiology and Infectious Diseases, Basel, Switzerland
- The Åland Group for Borrelia Research, Mariehamn, Finland
| | - Lars Brudin
- Department of Clinical Physiology, Region Kalmar County, Kalmar, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna J Henningsson
- ESCMID Study Group for Lyme Borreliosis-ESGBOR, Part of the European Society for Clinical Microbiology and Infectious Diseases, Basel, Switzerland
- National Reference Laboratory for Borrelia and Other Tick-Borne Bacteria, Department of Clinical Microbiology in Jönköping, Region Jönköping County, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Carlströmer Berthén N, Tompa E, Olausson S, Nyberg C, Nyman D, Ringbom M, Perander L, Svärd J, Lindgren PE, Forsberg P, Wilhelmsson P, Sjöwall J, Nordberg M. The AxBioTick Study: Borrelia Species and Tick-Borne Encephalitis Virus in Ticks, and Clinical Responses in Tick-Bitten Individuals on the Aland Islands, Finland. Microorganisms 2023; 11:1100. [PMID: 37317075 DOI: 10.3390/microorganisms11051100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 06/16/2023] Open
Abstract
The AxBioTick study was initiated to investigate the prevalence of ticks and tick-borne pathogens and their impact on antibody and clinical responses in tick-bitten individuals on the Aland Islands. This geographical area is hyperendemic for both Lyme borreliosis (LB) and Tick-borne encephalitis (TBE). Blood samples and ticks were collected from 100 tick-bitten volunteers. A total of 425 ticks was collected, all determined to Ixodes ricinus using molecular tools. Of them 20% contained Borrelia species, of which B. garinii and B. afzelii were most common. None contained the TBE virus (TBEV). Blood samples were drawn in conjunction with the tick bite, and eight weeks later. Sera were analyzed for Borrelia- and TBEV-specific antibodies using an ELISA and a semiquantitative antibody assay. In total 14% seroconverted in Borrelia C6IgG1, 3% in TBEV IgG, and 2% in TBEV IgM. Five participants developed clinical manifestations of LB. The high seroprevalence of both Borrelia (57%) and TBEV (52%) antibodies are likely attributed to the endemic status of the corresponding infections as well as the TBE vaccination program. Despite the similar prevalence of Borrelia spp. detected in ticks in other parts of Europe, the infection rate in this population is high. The AxBioTick study is continuing to investigate more participants and ticks for co-infections, and to characterize the dermal immune response following a tick bite.
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Affiliation(s)
- Nellie Carlströmer Berthén
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- Bimelix AB, 22100 Mariehamn, The Aland Islands, Finland
| | - Eszter Tompa
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
| | - Susanne Olausson
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- Bimelix AB, 22100 Mariehamn, The Aland Islands, Finland
| | - Clara Nyberg
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
| | - Dag Nyman
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- Bimelix AB, 22100 Mariehamn, The Aland Islands, Finland
| | - Malin Ringbom
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- The Aland Islands Healthcare Services, 22100 Mariehamn, The Aland Islands, Finland
| | - Linda Perander
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- The Aland Islands Healthcare Services, 22100 Mariehamn, The Aland Islands, Finland
| | - Joel Svärd
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
| | - Per-Eric Lindgren
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
- Clinical Microbiology, Laboratory Medicine, County Hospital Ryhov, 551 85 Jonkoping, Sweden
| | - Pia Forsberg
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
| | - Peter Wilhelmsson
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
- Clinical Microbiology, Laboratory Medicine, County Hospital Ryhov, 551 85 Jonkoping, Sweden
| | - Johanna Sjöwall
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
- Department of Infectious Diseases, Vrinnevi Hospital, 603 79 Norrkoping, Sweden
| | - Marika Nordberg
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- The Aland Islands Healthcare Services, 22100 Mariehamn, The Aland Islands, Finland
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Donadio V, Incensi A, Rizzo G, Westermark GT, Devigili G, De Micco R, Tessitore A, Nyholm D, Parisini S, Nyman D, Tedeschi G, Eleopra R, Ingelsson M, Liguori R. Phosphorylated α-synuclein in skin Schwann cells: a new biomarker for multiple system atrophy. Brain 2023; 146:1065-1074. [PMID: 35552610 DOI: 10.1093/brain/awac124] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 11/14/2022] Open
Abstract
Multiple system atrophy (MSA) is characterized by accumulation of phosphorylated α-synuclein (p-syn) as glial cytoplasmic inclusions in the brain and a specific biomarker for this disorder is urgently needed. We aimed at investigating if p-syn can also be detected in skin Remak non-myelinating Schwann cells (RSCs) as Schwann cell cytoplasmic inclusions (SCCi) and may represent a reliable clinical biomarker for MSA. This cross-sectional diagnostic study evaluated skin p-syn in 96 patients: 46 with probable MSA (29 with parkinsonism type MSA and 17 with cerebellar type MSA), 34 with Parkinson's disease (PD) and 16 with dementia with Lewy bodies (DLB). We also included 50 healthy control subjects. Patients were recruited from five different medical centres. P-syn aggregates in skin sections were stained by immunofluorescence, followed by analyses with confocal microscopy and immuno-electron microscopy. All analyses were performed in a blinded fashion. Overall, p-syn aggregates were found in 78% of MSA patients and 100% of patients with PD/DLB, whereas they could not be detected in controls. As for neuronal aggregates 78% of MSA patients were positive for p-syn in somatic neurons, whereas all PD/DLB patients were positive in autonomic neurons. When analysing the presence of p-syn in RSCs, 74% of MSA patients were positive, whereas no such SCCi could be observed in PD/DLB patients. Analyses by immuno-electron microscopy confirmed that SCCi were only found in cases with MSA and thus absent in those with PD/DLB. In conclusion, our findings demonstrate that (i) fibrillar p-syn in RSCs is a pathological hallmark of MSA and may be used as a specific and sensitive disease biomarker; (ii) in Lewy body synucleinopathies (PD/DLB) only neurons contain p-syn deposits; and (iii) the cell-specific deposition of p-syn in the skin thus mirrors that of the brain in many aspects and suggests that non-myelinated glial cells are also involved in the MSA pathogenesis.
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Affiliation(s)
- Vincenzo Donadio
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Alex Incensi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Giovanni Rizzo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | | | - Grazia Devigili
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Rosa De Micco
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Alessandro Tessitore
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Sara Parisini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Dag Nyman
- Åland University of Applied Sciences Mariehamn, Åland, Finland
| | - Gioacchino Tedeschi
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Roberto Eleopra
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences, Section of Geriatrics, Uppsala University, Sweden.,Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.,Department of Medicine and Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada
| | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
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5
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Henningsson AJ, Aase A, Bavelaar H, Flottorp S, Forsberg P, Kirkehei I, Lövmar M, Nilsson K, Nyman D, Ornstein K, Sjöwall J, Skogman BH, Tjernberg I, Aaberge I. Laboratory Methods for Detection of Infectious Agents and Serological Response in Humans With Tick-Borne Infections: A Systematic Review of Evaluations Based on Clinical Patient Samples. Front Public Health 2021; 9:580102. [PMID: 34616701 PMCID: PMC8488432 DOI: 10.3389/fpubh.2021.580102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/20/2021] [Indexed: 01/08/2023] Open
Abstract
Background: For the most important and well-known infections spread by Ixodes ticks, Lyme borreliosis (LB) and tick-borne encephalitis (TBE), there are recommendations for diagnosis and management available from several health authorities and professional medical networks. However, other tick-borne microorganisms with potential to cause human disease are less known and clear recommendations on diagnosis and management are scarce. Therefore, we performed a systematic review of published studies and reviews focusing on evaluation of laboratory methods for clinical diagnosis of human tick-borne diseases (TBDs), other than acute LB and TBE. The specific aim was to evaluate the scientific support for laboratory diagnosis of human granulocytic anaplasmosis, rickettsiosis, neoehrlichiosis, babesiosis, hard tick relapsing fever, tularemia and bartonellosis, as well as tick-borne co-infections and persistent LB in spite of recommended standard antibiotic treatment. Methods: We performed a systematic literature search in 11 databases for research published from 2007 through 2017, and categorized potentially relevant references according to the predefined infections and study design. An expert group assessed the relevance and eligibility and reviewed the articles according to the QUADAS (diagnostic studies) or AMSTAR (systematic reviews) protocols, respectively. Clinical evaluations of one or several diagnostic tests and systematic reviews were included. Case reports, non-human studies and articles published in other languages than English were excluded. Results: A total of 48 studies fulfilled the inclusion criteria for evaluation. The majority of these studies were based on small sample sizes. There were no eligible studies for evaluation of tick-borne co-infections or for persistent LB after antibiotic treatment. Conclusions: Our findings highlight the need for larger evaluations of laboratory tests using clinical samples from well-defined cases taken at different time-points during the course of the diseases. Since the diseases occur at a relatively low frequency, single-center cross-sectional studies are practically not feasible, but multi-center case control studies could be a way forward.
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Affiliation(s)
- Anna J Henningsson
- Division of Clinical Microbiology, Laboratory Medicine, Region Jönköping County, Jönköping, Sweden.,Division of Clinical Microbiology, Region Östergötland, Linköping, Sweden.,Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Audun Aase
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Herjan Bavelaar
- Division of Clinical Microbiology, Laboratory Medicine, Region Jönköping County, Jönköping, Sweden
| | - Signe Flottorp
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Pia Forsberg
- Division of Infectious Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Matilda Lövmar
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kenneth Nilsson
- Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University, Uppsala, Sweden
| | - Dag Nyman
- The Åland Group for Borrelia Research, Mariehamn, Finland
| | | | - Johanna Sjöwall
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Infectious Diseases, Region Östergötland, Norrköping, Sweden
| | - Barbro H Skogman
- Department of Pediatrics and Center for Clinical Research, Dalarna-Uppsala University, Falun, Sweden.,Faculty of Medical and Health Sciences, Örebro University, Örebro, Sweden
| | - Ivar Tjernberg
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Chemistry and Transfusion Medicine, Region Kalmar County, Kalmar, Sweden
| | - Ingeborg Aaberge
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
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Appelgren D, Enocsson H, Skogman BH, Nordberg M, Perander L, Nyman D, Nyberg C, Knopf J, Muñoz LE, Sjöwall C, Sjöwall J. Neutrophil Extracellular Traps (NETs) in the Cerebrospinal Fluid Samples from Children and Adults with Central Nervous System Infections. Cells 2019; 9:cells9010043. [PMID: 31877982 PMCID: PMC7016761 DOI: 10.3390/cells9010043] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/05/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023] Open
Abstract
Neutrophils operate as part of the innate defence in the skin and may eliminate the Borrelia spirochaete via phagocytosis, oxidative bursts, and hydrolytic enzymes. However, their importance in Lyme neuroborreliosis (LNB) is unclear. Neutrophil extracellular trap (NET) formation, which is associated with the production of reactive oxygen species, involves the extrusion of the neutrophil DNA to form traps that incapacitate bacteria and immobilise viruses. Meanwhile, NET formation has recently been studied in pneumococcal meningitis, the role of NETs in other central nervous system (CNS) infections has previously not been studied. Here, cerebrospinal fluid (CSF) samples from clinically well-characterised children (N = 111) and adults (N = 64) with LNB and other CNS infections were analysed for NETs (DNA/myeloperoxidase complexes) and elastase activity. NETs were detected more frequently in the children than the adults (p = 0.01). NET presence was associated with higher CSF levels of CXCL1 (p < 0.001), CXCL6 (p = 0.007), CXCL8 (p = 0.003), CXCL10 (p < 0.001), MMP-9 (p = 0.002), TNF (p = 0.02), IL-6 (p < 0.001), and IL-17A (p = 0.03). NETs were associated with fever (p = 0.002) and correlated with polynuclear pleocytosis (rs = 0.53, p < 0.0001). We show that neutrophil activation and active NET formation occur in the CSF samples of children and adults with CNS infections, mainly caused by Borrelia and neurotropic viruses. The role of NETs in the early phase of viral/bacterial CNS infections warrants further investigation.
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Affiliation(s)
- Daniel Appelgren
- Division of Drug Research, Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden;
| | - Helena Enocsson
- Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, SE-581 85 Linköping, Sweden; (H.E.); (C.S.)
| | - Barbro H. Skogman
- Center for Clinical Research Dalarna-Uppsala University, Region Dalarna and Faculty of Medicine and Health Sciences, Örebro University, SE-702 81 Örebro, Sweden;
| | - Marika Nordberg
- Åland Central Hospital, Department of Infectious Diseases, AX-22 100 Mariehamn, Åland, Finland; (M.N.); (L.P.); (C.N.)
| | - Linda Perander
- Åland Central Hospital, Department of Infectious Diseases, AX-22 100 Mariehamn, Åland, Finland; (M.N.); (L.P.); (C.N.)
| | - Dag Nyman
- Bimelix AB, AX-22 100 Mariehamn, Åland, Finland;
| | - Clara Nyberg
- Åland Central Hospital, Department of Infectious Diseases, AX-22 100 Mariehamn, Åland, Finland; (M.N.); (L.P.); (C.N.)
| | - Jasmin Knopf
- Department of Internal Medicine 3-Rheumatology and Immunology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), DE-91 054 Erlangen, Germany; (J.K.); (L.E.M.)
| | - Luis E. Muñoz
- Department of Internal Medicine 3-Rheumatology and Immunology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), DE-91 054 Erlangen, Germany; (J.K.); (L.E.M.)
| | - Christopher Sjöwall
- Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, SE-581 85 Linköping, Sweden; (H.E.); (C.S.)
| | - Johanna Sjöwall
- Clinic of Infectious Diseases, Linköping University Hospital, SE-581 85 Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, SE-581 85 Linköping, Sweden
- Correspondence:
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7
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Lager M, Dessau RB, Wilhelmsson P, Nyman D, Jensen GF, Matussek A, Lindgren PE, Henningsson AJ, Baqir H, Serrander L, Johansson M, Tjernberg I, Skarstein I, Ulvestad E, Grude N, Pedersen AB, Bredberg A, Veflingstad R, Wass L, Aleke J, Nordberg M, Nyberg C, Perander L, Bojesson C, Sjöberg E, Lorentzen ÅR, Eikeland R, Noraas S, Henriksson GA, Petrányi G. Serological diagnostics of Lyme borreliosis: comparison of assays in twelve clinical laboratories in Northern Europe. Eur J Clin Microbiol Infect Dis 2019; 38:1933-1945. [PMID: 31399914 PMCID: PMC6778534 DOI: 10.1007/s10096-019-03631-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/04/2019] [Indexed: 11/30/2022]
Abstract
Lyme borreliosis (LB), caused by spirochetes belonging to the Borrelia burgdorferi sensu lato complex, is the most common tick-borne infection in Europe. Laboratory diagnosis of LB is mainly based on the patients’ medical history, clinical signs and symptoms in combination with detection of Borrelia-specific antibodies where indirect enzyme-linked-immunosorbent assay (ELISA) is the most widely used technique. The objective of the study was to evaluate and compare the diagnostic accuracy (sensitivities and specificities) of serological tests that are currently in use for diagnosis of LB in clinical laboratories in Northern Europe, by use of a large serum panel. The panel consisted of 195 serum samples from well-characterized and classified patients under investigation for clinically suspected LB (n = 59) including patients with Lyme neuroborreliosis, Lyme arthritis, acrodermatitis chronica atrophicans, erythema migrans or other diseases (n = 112). A total of 201 serum samples from healthy blood donors were also included. The panel (396 serum samples altogether) was sent to 12 clinical laboratories (using five different ELISA methods) as blinded for group affiliation and the laboratories were asked to perform serological analysis according to their routine procedure. The results from the study demonstrated high diagnostic concordance between the laboratories using the same diagnostic assay and lower diagnostic concordance between laboratories using different diagnostic assays. For IgG, the results were in general rather homogenous and showed an average sensitivity of 88% (range 85–91%) compared to IgM which showed lower average sensitivity of 59% (range 50–67%) and more heterogeneous results between assays and laboratories.
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Affiliation(s)
- Malin Lager
- Division of Clinical Microbiology, Laboratory Medicine, Jönköping Region Jönköping County, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Ryhov County Hospital, SE-551 85, Jönköping, Sweden. .,Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Ram B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Peter Wilhelmsson
- Division of Clinical Microbiology, Laboratory Medicine, Jönköping Region Jönköping County, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Ryhov County Hospital, SE-551 85, Jönköping, Sweden.,Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Dag Nyman
- The Åland Group for Borrelia Research, Åland, Mariehamn, Finland
| | - Guro F Jensen
- Department of Medical Microbiology, Sørlandet Hospital, Kristiansand, Norway
| | - Andreas Matussek
- Division of Clinical Microbiology, Laboratory Medicine, Jönköping Region Jönköping County, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Ryhov County Hospital, SE-551 85, Jönköping, Sweden.,Karolinska University Laboratory, Stockholm, Sweden.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Per-Eric Lindgren
- Division of Clinical Microbiology, Laboratory Medicine, Jönköping Region Jönköping County, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Ryhov County Hospital, SE-551 85, Jönköping, Sweden.,Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anna J Henningsson
- Division of Clinical Microbiology, Laboratory Medicine, Jönköping Region Jönköping County, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Ryhov County Hospital, SE-551 85, Jönköping, Sweden.,Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Division of Clinical Microbiology, Department of Clinical and Experimental Medicine, Linköping University Hospital, Linköping, Sweden
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8
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Sandholm K, Persson B, Skattum L, Eggertsen G, Nyman D, Gunnarsson I, Svenungson E, Nilsson B, Ekdahl KN. Evaluation of a Novel Immunoassay for Quantification of C1q for Clinical Diagnostic Use. Front Immunol 2019; 10:7. [PMID: 30740097 PMCID: PMC6357986 DOI: 10.3389/fimmu.2019.00007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/03/2019] [Indexed: 01/28/2023] Open
Abstract
Objectives: C1q is a valuable biomarker of disease activity in systemic lupus erythematosus (SLE). The “gold standard” assay, rocket immunoelectrophoresis (RIE), is time-consuming, and thus a shift to soluble immune precipitation techniques such as nephelometry has occurred. However, quantification of C1q with these techniques has been questioned as a result of the antibody binding properties of C1q. In the present work, we have compared results using various techniques (RIE, nephelometry, and ELISA) and have developed and validated a new magnetic bead-based sandwich immunoassay (MBSI). Methods: C1q was quantified by nephelometry and the new sandwich immunoassay in 45 serum samples analyzed using RIE. C1q was also assessed in plasma using RIE and sandwich immunoassay in samples from SLE patients with nephritis (n = 69), SLE patients without nephritis (n = 310) as classified by BILAG score, and matched controls (n = 322). In addition, cerebrospinal fluid (CSF) samples from 31 patients, previously analyzed with ELISA, were also analyzed with the MBSI to test the behavior of this new assay in the lower detection range. Results: We found a strong correlation between the new MBSI, RIE, and ELISA, but not with nephelometry. The MBSI demonstrated lower levels of C1q in SLE patients than in matched controls (p < 0.0001), and patients with nephritis had lower levels than patients without nephritis (p < 0.01). Similarily, RIE showed significant differences between the patient groups (p < 0.0001). An association was also found between the levels of C1q and the SLE disease activity index (SLEDAI). Furthermore, there was good correlation between the values obtained by MBSI and ELISA, in both serum (r = 0.960) and CSF (r = 0.786), underscoring the ability of both techniques to measure low concentrations of C1q with high accuracy. Conclusion: The sandwich immunoassay correlated well with RIE, but soluble immune precipitation techniques, such as nephelometry, did not appear suitable alternatives, since C1q itself, and possibly anti-C1q antibodies, interfered with the measurements. The new sandwich immunoassay is therefore a good replacement for RIE in monitoring SLE disease activity.
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Affiliation(s)
- Kerstin Sandholm
- Linnaeus Center of Biomaterials Chemistry, Linnaeus University, Kalmar, Sweden
| | - Barbro Persson
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Lillemor Skattum
- Section of Microbiology, Department of Laboratory Medicine, Immunology and Glycobiology, Lund University, and Clinical Immunology and Transfusion Medicine, Lund, Sweden
| | - Gösta Eggertsen
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Laboratory, Clinical Chemistry, Stockholm, Sweden
| | - Dag Nyman
- Åland Borrelia Group, Åland Central Hospital, Mariehamn, Finland
| | - Iva Gunnarsson
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabet Svenungson
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Bo Nilsson
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Kristina N Ekdahl
- Linnaeus Center of Biomaterials Chemistry, Linnaeus University, Kalmar, Sweden.,Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
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Schulman S, Lockner D, Granqvist S, Bratt G, Paul C, Nyman D. A Comparative Randomized Trial of Low-Dose Versus High-Dose Streptokinase in Deep Vein Thrombosis of the Thigh. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661072] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryFibrinolytic treatment of acute deep vein thrombosis (DVT) of the leg with high-dose streptokinase (SK) (100,000 U/h) in 39 cases, or low-dose SK (approx 10,000 U/h) in combination with low-dose heparin in 41 cases, was studied in a prospective randomized trial. The degree of thrombolysis was similar in both groups and did not correlate with age or size of the thrombus or with fibrinogen level. The degree of late recanalization was also similar in both groups. There were however significantly more patients with postthrombotic changes in the low-dose group than in the high-dose group after a mean follow-up time of 31 and 38 months respectively. In the low-dose group 2 intracranial hemorrhages occurred (one was fatal) and one patient died of pulmonary embolism, but there were significantly less allergic side effects to SK. There were no cases of such serious side effects in the highdose group. Although low-dose SK has equal thrombolytic effect it seems inferior to high-dose SK, since it probably causes more severe hemorrhagic side-effects.
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Affiliation(s)
- Sam Schulman
- The Thrombosis Unit, Department of Medicine, Huddinge University Hospital, Huddinge, Sweden
| | - Dieter Lockner
- The Thrombosis Unit, Department of Medicine, Huddinge University Hospital, Huddinge, Sweden
| | - Staffan Granqvist
- The Department of Radiology, Huddinge University Hospital, Huddinge, Sweden
| | - Göran Bratt
- The Thrombosis Unit, Department of Medicine, Huddinge University Hospital, Huddinge, Sweden
| | - Christer Paul
- The Thrombosis Unit, Department of Medicine, Huddinge University Hospital, Huddinge, Sweden
| | - Dag Nyman
- The Thrombosis Unit, Department of Medicine, Huddinge University Hospital, Huddinge, Sweden
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10
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Biland L, Duckert F, Prisender S, Nyman D. Quantitative Estimation of Coagulation Factors in Liver Disease. The Diagnostic and Prognostic Value of Factor XIII, Factor V and Plasminogen. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1646739] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Summary20 coagulation parameters were investigated in 144 patients with different liver diseases. The groups of acute hepatitis, chronic active hepatitis and liver cirrhosis were compared and the prognostic value of the coagulation analyses investigated. It is clear that the determination of the factor V activity is a good and easy test for detection of actual liver function. Repeated controls over several weeks revealed with a statistical significance (p <0.0005) that all patients with a factor XIII below 35& and a plasminogen below 19& will die in liver coma, if they have not died beforehand from acute gastrointestinal haemorrhage, acute infection or cardiac arrest.Plasminogen is also lower in the group of non-survivors but the values of the two groups are overlapping and of no prognostic help in a single case. The possible causes of the diminution of factor XIII activity are discussed.
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Affiliation(s)
- L Biland
- The Department of Internal Medicine, Coagulation and Fibrinolysis Laboratories, Kantonsspital, Basle, Switzerland
| | - F Duckert
- The Department of Internal Medicine, Coagulation and Fibrinolysis Laboratories, Kantonsspital, Basle, Switzerland
| | - S Prisender
- The Department of Internal Medicine, Coagulation and Fibrinolysis Laboratories, Kantonsspital, Basle, Switzerland
| | - D Nyman
- The Department of Internal Medicine, Coagulation and Fibrinolysis Laboratories, Kantonsspital, Basle, Switzerland
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11
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Abstract
Summary161 consecutively admitted medical patients with the clinical suspicion of acute deep venous thrombosis (DVT) were thermographed and phlebographed in order to study the congruence of these methods. The sensitivity of thermography in the detection of DVT was found to be 99%, whereas the specificity was only 49%.The low specificity is explained by the fact that all thermographs suggestive of DVT were classified as pathologic to keep the sensitivity of the method as high as possible. Patients with dilated veins which may closely resemble DVT on thermography may in these cases give false positive results.Of 76 patients with phlebographically verified DVT, 22% became thermographically normal within 22 days, whereas 78% did not normalize within the mean observation time of 31 days.In another part of the study all medical patients (101) who were residing in our wards during a period of a week were screened by means of thermography. From this unselected group 17 patients were found to have thermographs suggestive of DVT. In 5 of these patients no reason for pathological thermography could be found.Thermography is a cheap and highly sensitive screening method for DVT, but findings of false positives caused by older thromboses and dilated veins are not unusual. The frequency of such false positives may be minimized by performing thermography after exercise.
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Affiliation(s)
- Dieter Lockner
- The Thrombosis Unit, Department of Medicine and Department of Radiology, Huddinge University Hospital, Huddinge, Sweden
| | - Christer Paul
- The Thrombosis Unit, Department of Medicine and Department of Radiology, Huddinge University Hospital, Huddinge, Sweden
| | - Birger Hedlund
- The Thrombosis Unit, Department of Medicine and Department of Radiology, Huddinge University Hospital, Huddinge, Sweden
| | - Sam Schulman
- The Thrombosis Unit, Department of Medicine and Department of Radiology, Huddinge University Hospital, Huddinge, Sweden
| | - Dag Nyman
- The Thrombosis Unit, Department of Medicine and Department of Radiology, Huddinge University Hospital, Huddinge, Sweden
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Walter M, Nyman D, Krajnc V, Duckert F. The Activation of Plasma Factor XIII with the Snake Venom Enzymes Ancrod and Batroxobin Marajoensis. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1651479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe snake venom enzymes Ancrod and Batroxobin marajoensis are able to activate human plasma factor XIII as shown by the formation of the γ-dimers. The concentration of γ-dimers increases with the concentration of the activating enzymes. Factor XIII activated by Ancrod or Batroxobin marajoensis is, however, unable to catalyse the incorporation of the amine dansylcadaverine into casein. The partially activated factor XIII is therefore not demonstrable by means of the artificial test system. This factor XIII loses little activity and remains activable by thrombin.
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13
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Nyman D, Eriksson AW, Blombäck M, Frants RR, Wahlberg P. Recent Investigations of the First Bleeder Family in Åland (Finland) Described by von Willebrand. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1650132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe still living members of the original bleeder family on the Åland Islands described by von Willebrand in 1926 have been reinvestigated by using modem laboratory techniques for the measurement of the Factor VIII complex and with regard to platelet aggregation. The low level of F VIII: C activity demonstrated in 1957 could be confirmed in some of the family members, who however all had only mild bleeding symptoms. More consistently, in 6 out of 10, a low F VIIIR: Ag was found; all of those also had a low F VIII: RCoF. In none of the members were excessively low values for any of the parameters found. However, the spectrum of the whole F VIII complex indicates that the original family described by von Willebrand belongs to von Willebrand’s disease, type I.
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Affiliation(s)
- D Nyman
- Department of Blood Coagulation Disorders, Karolinska Hospital, 104 01 Stockholm, Sweden
| | - A W Eriksson
- Institute of Human Genetics, Free University, 1007 MC Amsterdam, The Netherlands
| | - M Blombäck
- Department of Blood Coagulation Disorders, Karolinska Hospital, 104 01 Stockholm, Sweden
| | - R R Frants
- Institute of Human Genetics, Free University, 1007 MC Amsterdam, The Netherlands
| | - P Wahlberg
- Folkhälsan Institute of Genetics Unit, Helsiniki, Finland and Åland Central Hospital, Marieham, Åland, Finland
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Abstract
SummaryBrinase was administered intra-arterially in 16 patients with thrombotic or embolic arterial occlusions. Angiography could be performed before and after treatment in 13 patients. Thrombolysis was obtained in 3 of 9 patients with thrombotic and in 3 of 4 patients with embolic occlusions. In 3 patients severe local side effects occurred.
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Abstract
SummaryTwo methods for the assay of brinase inhibitors are compared. Neither provided a reliable means of brinase dose prediction. Overdosage can, however, be avoided by preinfusion inhibitor assay.
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Abstract
SummaryBrinase infusions in man cause, without excessive lowering of the inhibitor capacity, a slowing of the fibrin polymerization. This is combined with a degradation of the A α chain into two major fragments. Both fragments carry crosslinking sites. Brinase infusion also causes positive ethanol gelation. Evidence for the formation of γ dimers was found.
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18
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Abstract
SummaryA method for preparation of an artificial substrate for the one-stage factor VIII assay is described. Standardization of the test is given. The method is specific and reproducible.
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19
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Thilo D, Nyman D, Duckert F. A Study of the Effects of the Anti-Rheumatic Drug Ibuprofen (Brufen®) on Patients Being Treated with the Oral Anti-Coagulant Phenprocoumon (Marcoumar®). J Int Med Res 2016. [DOI: 10.1177/030006057400200404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The effects of ibuprofen on various parameters relating to blood coagulation were studied in nineteen patients adequately anti-coagulated on a fixed dose of phenprocoumon. The patients were studied for a five-week period and they received a fixed dose of phenprocoumon throughout the whole five weeks. Ibuprofen, 200 mg three times daily was added during weeks three and four. The following tests were performed at weekly intervals; Prothrombin time (Quick), Factor II, Factor VII, Factor X, Ivy bleeding time and serum concentration of phenprocoumon. The results showed that in the dosage given, ibuprofen had no significant effect on any of the above tests. It is suggested that the administration of the anti-rheumatic drug, ibuprofen is safe during long-term oral anticoagulation therapy with phenprocoumon.
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Affiliation(s)
- D Thilo
- Department of Internal Medicine, First Medical University Clinic, Coagulation and Fibrinolysis Laboratories, Kantonsspital, Basle, Switzerland
| | - D Nyman
- Department of Internal Medicine, First Medical University Clinic, Coagulation and Fibrinolysis Laboratories, Kantonsspital, Basle, Switzerland
| | - F Duckert
- Department of Internal Medicine, Kantonsspital, Basle, Switzerland
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Henningsson AJ, Wilhelmsson P, Gyllemark P, Kozak M, Matussek A, Nyman D, Ekerfelt C, Lindgren PE, Forsberg P. Low risk of seroconversion or clinical disease in humans after a bite by an Anaplasma phagocytophilum-infected tick. Ticks Tick Borne Dis 2015; 6:787-92. [PMID: 26187418 DOI: 10.1016/j.ttbdis.2015.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 07/06/2015] [Accepted: 07/06/2015] [Indexed: 01/24/2023]
Abstract
The risk of contracting human granulocytic anaplasmosis (HGA) after a tick bite is mainly unknown. In this study we investigated the clinical and serological response in 30 humans bitten by ticks positive for Anaplasma phagocytophilum (Group A), 30 humans bitten by Borrelia burgdorferi sensu lato (s.l.)-positive ticks (Group B), and 30 humans bitten by ticks negative for both A. phagocytophilum and B. burgdorferi s.l. (Group C). Ticks, blood samples and questionnaires were collected from tick-bitten humans at 34 primary healthcare centres in Sweden and in the Åland Islands, Finland, at the time of the tick bite and after three months. A total of 2553 ticks detached from humans in 2007-2009 were analyzed by polymerase chain reaction, and 31 (1.2%) were positive for A. phagocytophilum, 556 (21.8%) were positive for B. burgdorferi s.l., and eight (0.3%) were co-infected by A. phagocytophilum and B. burgdorferi s.l. The overall prevalence of Anaplasma IgG antibodies in the included participants (n=90) was 17%, and there was no significant difference between the groups A-C. Only one of the participants (in Group C) showed a four-fold increase of IgG antibodies against A. phagocytophilum at the three-month follow-up, but reported no symptoms. The frequency of reported symptoms did not differ between groups A-C, and was unrelated to the findings of A. phagocytophilum and B. burgdorferi s.l. in the detached ticks. We conclude that the risk for HGA or asymptomatic seroconversion after a tick bite in Sweden or in the Åland Islands is low, even if the tick is infected by A. phagocytophilum.
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Affiliation(s)
- Anna J Henningsson
- Department of Clinical Microbiology, Ryhov County Hospital, S-551 85 Jönköping, Sweden.
| | - Peter Wilhelmsson
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, S-581 85 Linköping, Sweden
| | - Paula Gyllemark
- Department of Infectious Diseases, Ryhov County Hospital, S-551 85 Jönköping, Sweden
| | - Monika Kozak
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, S-581 85 Linköping, Sweden
| | - Andreas Matussek
- Department of Clinical Microbiology, Ryhov County Hospital, S-551 85 Jönköping, Sweden
| | - Dag Nyman
- The Åland Group for Borrelia Research, Bimelix Biomedical Laboratory, Torggatan 10, AX-22100 Mariehamn, Åland, Finland
| | - Christina Ekerfelt
- Division of Clinical Immunology, Department of Clinical and Experimental Medicine, Linköping University, S-551 85 Jönköping, Sweden
| | - Per-Eric Lindgren
- Department of Clinical Microbiology, Ryhov County Hospital, S-551 85 Jönköping, Sweden; Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, S-581 85 Linköping, Sweden
| | - Pia Forsberg
- Clinic of Infectious Diseases, Linköping University Hospital, and Department of Clinical and Experimental Medicine, Linköping University, S-551 85 Jönköping, Sweden
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Lindblom P, Wilhelmsson P, Fryland L, Matussek A, Haglund M, Sjöwall J, Vene S, Nyman D, Forsberg P, Lindgren PE. Factors determining immunological response to vaccination against tick-borne encephalitis virus in older individuals. PLoS One 2014; 9:e100860. [PMID: 24967619 PMCID: PMC4072701 DOI: 10.1371/journal.pone.0100860] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 05/30/2014] [Indexed: 12/30/2022] Open
Abstract
We performed a cross-sectional study including 533 individuals (median age 61) from the highly TBE endemic Åland Islands in the archipelago between Sweden and Finland. Blood samples, questionnaires and vaccination records were obtained from all study participants. The aim was to investigate if there was any association between TBEV antibody titer and 12 health-related factors. Measurement of TBEV IgG antibodies was performed using two commercial ELISA assays (Enzygnost and Immunozym), and a third in-house rapid fluorescent focus inhibition test was used to measure TBEV neutralizing antibodies. The age of the individual and the number of vaccine doses were the two most important factors determining the immunological response to vaccination. The response to each vaccine dose declined linearly with increased age. A 35 year age difference corresponds to a vaccine dose increment from 3 to 4 to achieve the same immunological response. Participants previously vaccinated against other flaviviruses had lower odds of being seropositive for neutralizing TBEV antibodies on average, while participants with self-reported asthma had higher odds of being seropositive. By comparing the 3 serological assays we show that the Enzygnost and Immunozym assay differ due to choice of cutoffs, but not in overall accuracy.
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Affiliation(s)
- Pontus Lindblom
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- * E-mail:
| | - Peter Wilhelmsson
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Linda Fryland
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Andreas Matussek
- Division of Medical Services, Department of Microbiology, County Hospital Ryhov, Jönköping, Sweden
| | - Mats Haglund
- Department of Infectious Diseases, County Hospital Kalmar, Kalmar, Sweden
| | - Johanna Sjöwall
- Clinic of Infectious Diseases, Linköping University Hospital, Linköping, Sweden
| | - Sirkka Vene
- Public Health Agency of Sweden, Stockholm, Sweden
| | - Dag Nyman
- Åland Central Hospital, Mariehamn, Åland, Finland
| | - Pia Forsberg
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Clinic of Infectious Diseases, Linköping University Hospital, Linköping, Sweden
| | - Per-Eric Lindgren
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Division of Medical Services, Department of Microbiology, County Hospital Ryhov, Jönköping, Sweden
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Wilhelmsson P, Lindblom P, Fryland L, Nyman D, Jaenson TGT, Forsberg P, Lindgren PE. Ixodes ricinus ticks removed from humans in Northern Europe: seasonal pattern of infestation, attachment sites and duration of feeding. Parasit Vectors 2013; 6:362. [PMID: 24360096 PMCID: PMC3880168 DOI: 10.1186/1756-3305-6-362] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 12/16/2013] [Indexed: 11/28/2022] Open
Abstract
Background The common tick Ixodes ricinus is the main vector in Europe of the tick-borne encephalitis virus and of several species of the Borrelia burgdorferi sensu lato complex, which are the etiological agents of Lyme borreliosis. The risk to contract bites of I. ricinus is dependent on many factors including the behaviour of both ticks and people. The tick’s site of attachment on the human body and the duration of tick attachment may be of clinical importance. Data on I. ricinus ticks, which were found attached to the skin of people, were analysed regarding potentially stage-specific differences in location of attachment sites, duration of tick attachment (= feeding duration), seasonal and geographical distribution of tick infestation in relation to age and gender of the tick-infested hosts. Methods During 2008–2009, 1770 tick-bitten persons from Sweden and the Åland Islands removed 2110 I. ricinus ticks. Participants provided information about the date of tick detection and location on their body of each attached tick. Ticks were identified to species and developmental stage. The feeding duration of each nymph and adult female tick was microscopically estimated based on the scutal and the coxal index. Results In 2008, participants were tick-bitten from mid-May to mid-October and in 2009 from early April to early November. The infestation pattern of the nymphs was bimodal whereas that of the adult female ticks was unimodal with a peak in late summer. Tick attachment site on the human body was associated with stage of the tick and gender of the human host. Site of attachment seemed to influence the duration of tick feeding. Overall, 63% of nymphs and adult female ticks were detected and removed more than 24 hours after attachment. Older persons, compared to younger ones, and men, compared to women, removed “their” ticks after a longer period of tick attachment. Conclusions The infestation behaviour of the different tick stages concerning where on the host’s body the ticks generally will attach and when such ticks generally will be detected and removed in relation to host age and gender, should be of value for the development of prophylactic methods against tick infestation and to provide relevant advice to people on how to avoid or reduce the risk of tick infestation.
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Affiliation(s)
- Peter Wilhelmsson
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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23
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Lindblom P, Wilhelmsson P, Fryland L, Sjöwall J, Haglund M, Matussek A, Ernerudh J, Vene S, Nyman D, Andreassen A, Forsberg P, Lindgren PE. Tick-borne encephalitis virus in ticks detached from humans and follow-up of serological and clinical response. Ticks Tick Borne Dis 2013; 5:21-8. [PMID: 24275477 DOI: 10.1016/j.ttbdis.2013.07.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 07/14/2013] [Indexed: 12/20/2022]
Abstract
The risk of tick-borne encephalitis virus (TBEV) infection after a tick bite remains largely unknown. To address this, we investigated the presence of TBEV in ticks detached from humans in an attempt to relate viral copy number, TBEV subtype, and tick feeding time with the serological and clinical response of the tick-bitten participants. Ticks, blood samples, and questionnaires were collected from tick-bitten humans at 34 primary health care centers in Sweden and in the Åland Islands (Finland). A total of 2167 ticks was received from 1886 persons in 2008-2009. Using a multiplex quantitative real-time PCR, 5 TBEV-infected ticks were found (overall prevalence 0.23%, copy range <4×10(2)-7.7×10(6)per tick). One unvaccinated person bitten by a tick containing 7.7×10(6) TBEV copies experienced symptoms. Another unvaccinated person bitten by a tick containing 1.8×10(3) TBEV copies developed neither symptoms nor TBEV antibodies. The remaining 3 persons were protected by vaccination. In contrast, despite lack of TBEV in the detached ticks, 2 persons developed antibodies against TBEV, one of whom reported symptoms. Overall, a low risk of TBEV infection was observed, and too few persons got bitten by TBEV-infected ticks to draw certain conclusions regarding the clinical outcome in relation to the duration of the blood meal and virus copy number. However, this study indicates that an antibody response may develop without clinical symptoms, that a bite by an infected tick not always leads to an antibody response or clinical symptoms, and a possible correlation between virus load and tick feeding time.
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Affiliation(s)
- Pontus Lindblom
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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Sjöwall J, Fryland L, Nordberg M, Sjögren F, Garpmo U, Jansson C, Carlsson SA, Bergström S, Ernerudh J, Nyman D, Forsberg P, Ekerfelt C. Decreased Th1-type inflammatory cytokine expression in the skin is associated with persisting symptoms after treatment of erythema migrans. PLoS One 2011; 6:e18220. [PMID: 21483819 PMCID: PMC3069060 DOI: 10.1371/journal.pone.0018220] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 02/25/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the good prognosis of erythema migrans (EM), some patients have persisting symptoms of various character and duration post-treatment. Several factors may affect the clinical outcome of EM, e.g. the early interaction between Borrelia (B.) burgdorferi and the host immune response, the B. burgdorferi genotype, antibiotic treatment as well as other clinical circumstances. Our study was designed to determine whether early cytokine expression in the skin and in peripheral blood in patients with EM is associated with the clinical outcome. METHODS A prospective follow-up study of 109 patients with EM was conducted at the Åland Islands, Finland. Symptoms were evaluated at 3, 6, 12 and 24 months post-treatment. Skin biopsies from the EM and healthy skin were immunohistochemically analysed for expression of interleukin (IL)-4, IL-10, IL-12p70 and interferon (IFN)-γ, as well as for B. burgdorferi DNA. Blood samples were analysed for B. burgdorferi antibodies, allergic predisposition and levels of systemic cytokines. FINDINGS None of the patients developed late manifestations of Lyme borreliosis. However, at the 6-month follow-up, 7 of 88 patients reported persisting symptoms of diverse character. Compared to asymptomatic patients, these 7 patients showed decreased expression of the Th1-associated cytokine IFN-γ in the EM biopsies (p=0.003). B. afzelii DNA was found in 48%, B. garinii in 15% and B. burgdorferi sensu stricto in 1% of the EM biopsies, and species distribution was the same in patients with and without post-treatment symptoms. The two groups did not differ regarding baseline patient characteristics, B. burgdorferi antibodies, allergic predisposition or systemic cytokine levels. CONCLUSION Patients with persisting symptoms following an EM show a decreased Th1-type inflammatory response in infected skin early during the infection, which might reflect a dysregulation of the early immune response. This finding supports the importance of an early, local Th1-type response for optimal resolution of LB.
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Affiliation(s)
- Johanna Sjöwall
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Linköping, Linköping, Sweden
- Division of Clinical Immunology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Linköping, Linköping, Sweden
| | - Linda Fryland
- Division of Clinical Immunology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Linköping, Linköping, Sweden
- * E-mail:
| | - Marika Nordberg
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Linköping, Linköping, Sweden
- The Åland Borrelia group, the Åland Islands, Finland
| | - Florence Sjögren
- Division of Dermatology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Linköping, Linköping, Sweden
| | - Ulf Garpmo
- Department of Clinical Microbiology, Kalmar Hospital, Kalmar, Sweden
| | | | | | - Sven Bergström
- Department of Microbiology, University of Umeå, Umeå, Sweden
| | - Jan Ernerudh
- Division of Clinical Immunology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Linköping, Linköping, Sweden
| | - Dag Nyman
- The Åland Borrelia group, the Åland Islands, Finland
| | - Pia Forsberg
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Linköping, Linköping, Sweden
| | - Christina Ekerfelt
- Division of Clinical Immunology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Linköping, Linköping, Sweden
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Fryland L, Wilhelmsson P, Lindgren PE, Nyman D, Ekerfelt C, Forsberg P. Low risk of developing Borrelia burgdorferi infection in the south-east of Sweden after being bitten by a Borrelia burgdorferi-infected tick. Int J Infect Dis 2010; 15:e174-81. [PMID: 21168354 DOI: 10.1016/j.ijid.2010.10.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 10/19/2010] [Accepted: 10/21/2010] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The risk of developing Lyme borreliosis (LB) from Borrelia burgdorferi sensu lato (Bb)-infected ticks in Sweden is largely unknown. In the current study, we investigated the prevalence of Bb in ticks that had bitten humans and the risk of developing LB from Bb-infected ticks. METHODS Health questionnaires, blood samples, and ticks were collected from 394 tick-bitten study subjects in the County of Östergötland, Sweden, at the time of the tick bite. Questionnaires and blood samples were also collected 3 months later. Ticks were screened for Bb DNA with PCR, while sera were analyzed for antibodies against Bb using two ELISA assays. Seroconversion, i.e., an at least two-fold increase in anti-Bb antibodies after 3 months, was confirmed using a Strip-Immunoassay. RESULTS Seventy-five of 397 ticks collected from the study subjects were determined to be Bb-positive. Sixty-four of the tick-bitten subjects had been bitten by Bb-infected ticks. Four of them showed seroconversion and were therefore considered to have an active Bb infection. None of these four subjects had sought health care due to symptoms, but one reported symptoms. CONCLUSIONS Our data suggest that the risk of developing LB after being bitten by a Bb-infected tick is low, and asymptomatic Bb infections appear to be more frequent than symptomatic infections.
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Affiliation(s)
- Linda Fryland
- Division of Clinical Immunology, Department of Clinical and Experimental Medicine, Linköping University, S-581 85 Linköping, Sweden
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26
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Nordberg M, Forsberg P, Johansson A, Nyman D, Jansson C, Ernerudh J, Ekerfelt C. Cytotoxic mechanisms may play a role in the local immune response in the central nervous system in neuroborreliosis. J Neuroimmunol 2010; 232:186-93. [PMID: 21056912 DOI: 10.1016/j.jneuroim.2010.09.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 09/06/2010] [Accepted: 09/28/2010] [Indexed: 11/26/2022]
Abstract
Aiming to investigate the role of cytotoxic mechanisms in neuroborreliosis (NB), the cytokines IL-2, IL-7, IL-10, IL-12p70, IL-15, GM-CSF and the Th17-cytokine IL-17 were analyzed in cerebrospinal fluid (CSF) and plasma from NB-patients. NB-patients showed increased levels in CSF compared to controls of all analyzed cytokines except IL-15 but not in plasma. Blood lymphocytes from three NB-patients showed functional cytotoxicity in response to autologous Borrelia-infected macrophages. The findings support a role for cytotoxic mechanisms in the local immune response in NB and in addition suggest an increase of IL-17.
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Affiliation(s)
- Marika Nordberg
- Linköping University, Dept. of Clinical and Experimental Medicine, Division of Infectious Medicine, Linköping, Sweden.
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Abstract
Tick-borne encephalitis, TBE, has been observed in Aland Islands (population 26,500) for more than 60 years. Because of the small population, the relative incidence is high. Antibodies to TBE virus have been found in ca. 5% of healthy blood donors, indicating that subclinical infection must be common. This study is a review of the symptoms and signs of all the 301 serologically verified cases of TBE seen in Aland during 1959-2005. It also aims at analysing any possible changes in the symptoms and signs of TBE over time. The annual number of patients has been from 1 to 26, and has increased over time. The clinical picture has not undergone any conspicuous changes during these years. A few patients have had permanent neurological damage. There were no certain deaths from TBE. Simple practical measures may be taken to diminish, but not to eliminate, the risk of tick bites. Vaccination of exposed people is recommended, and general vaccination against TBE has commenced in Aland, beginning 2006. This is expected to reduce the incidence of TBE among the population to almost nil, provided that new inhabitants are vaccinated and that booster vaccinations are carried out as required.
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Gunnarsson R, Nyman D, Wålinder O, Ostman J. Fibrinolytic activity and diabetes control--evidence for a relationship. A preliminary report. Acta Med Scand Suppl 2009; 639:23-4. [PMID: 6932810 DOI: 10.1111/j.0954-6820.1980.tb12859.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Palva IP, Ahrenberg P, Harja KA, Almqvist A, Elonen E, Hallman H, Hänninen A, Ilvonen M, Isomaa B, Jouppila J, Järvenpää E, Järventie G, Kilpi H, Koivunen E, Kätkä K, Kääriäinen M, Lahtinen R, Laitinen A, Lehtinen M, Mäkelä H, Nyländen P, Nyman D, Oivanen T, Pakkala S, Pelliniemi TT, Pulli T, Rajamäki A, Ruutu T, Savola J, Soininen K, Timonen T, Wasastjerna C, Vilpo J. Intensive chemotherapy with combinations containing anthracyclines for refractory and relapsing multiple myeloma. Eur J Haematol 2009. [DOI: 10.1111/j.1600-0609.1990.tb00362.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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30
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Wahlberg P, Nyman D. [Chronic Lyme borreliosis--fact or fiction?]. Duodecim 2009; 125:1269-1276. [PMID: 19711595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Persistent infection after proper antibiotic treatment in Lyme borreliosis is rare. Symptoms may sometimes continue, especially from the nervous and the articular systems. There are many possible mechanisms for persistence of inflammation even after successful treatment of the infection. The lack of indicators of active infection impedes diagnostics. Early diagnosis and treatment are the most important means for preventing prolonged symptoms and signs. The differential diagnostics are crucial. Repeated treatment with antibiotics is seldom needed, and overlong treatments should be avoided. Lyme borreliosis may sometimes cause permanent tissue damage for which there is no cure.
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31
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Du W, Ma X, Nyman D, Povlsen K, Akguen N, Schneider EM. Antigen biochips verify and extend the scope of antibody detection in Lyme borreliosis. Diagn Microbiol Infect Dis 2007; 59:355-63. [PMID: 17888607 DOI: 10.1016/j.diagmicrobio.2007.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Revised: 06/05/2007] [Accepted: 06/10/2007] [Indexed: 11/21/2022]
Abstract
The antibody response of serum IgM and IgG of patients with neuroborreliosis and erythema migrans of Lyme borreliosis (LB) was examined against a 41-kDa flagellar antigen and an 8-mer synthetic OspC8 peptide (VAESPKKP) derived from the C-terminus of outer surface protein C (OspC) from Borrelia garinii. We developed a streptavidin-modified biochip-based immunodiagnosis and compared it with conventional methods such as enzyme-linked immunosorbent assay (ELISA) and Western blot (WB). The diagnostic sensitivity of the coated biochips was demonstrated to be identical, and the results of conventional assays such as ELISA and WB were confirmed. Flagellar antigens lead to better diagnosis because of a higher discriminative value. By contrast, OspC8, a peptide derived from the outer surface antigen, is less sensitive to identify immunity in LB. The inferior antigenicity of OspC8 may be due to epitope masking. Overall, this system is open to simultaneously analyze a larger family of peptides differing in length. Thus, an array approach is generally more advantageous to extend the pattern of antigens to be tested for antigenicity in LB. Serial analysis during ongoing disease may be valuable to learn more about the course of the disease and intermittent reactivation of infection. Protein biochip as a potential substitution of ELISA and WB method offers the opportunity to study serum immunity in a multiplicity of patients simultaneously.
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Affiliation(s)
- Weidong Du
- Section Experimental Anesthesiology, University Clinic Ulm, D-89075 Ulm, Germany.
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32
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Oksi J, Nikoskelainen J, Hiekkanen H, Lauhio A, Peltomaa M, Pitkäranta A, Nyman D, Granlund H, Carlsson SA, Seppälä I, Valtonen V, Viljanen M. Duration of antibiotic treatment in disseminated Lyme borreliosis: a double-blind, randomized, placebo-controlled, multicenter clinical study. Eur J Clin Microbiol Infect Dis 2007; 26:571-81. [PMID: 17587070 DOI: 10.1007/s10096-007-0340-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Despite rather strict recommendations for antibiotic treatment of disseminated Lyme borreliosis (LB), evidence-based studies on the duration of antibiotic treatment are scarce. The aim of this multicenter study was to determine whether initial treatment with intravenous ceftriaxone (CRO) for 3 weeks should be extended with a period of adjunct oral antibiotic therapy. A total of 152 consecutive patients with LB were randomized in a double-blind fashion to receive either amoxicillin (AMOX) 1 g or placebo (PBO) twice daily for 100 days. Both groups received an initial treatment of intravenous CRO 2 g daily for 3 weeks, followed by the randomized drug or PBO. The outcome was evaluated using the visual analogue scale at the follow-up visits. The final analysis included 145 patients, of whom 73 received AMOX and 72 PBO. Diagnoses of LB were categorized as either definite or possible, on the basis of symptoms, signs, and laboratory results. The diagnosis was definite in 52 of the 73 (71.2%) AMOX-treated patients and in 54 of the 72 (75%) PBO patients. Of the patients with definite diagnoses, 62 had neuroborreliosis, 45 arthritis or other musculoskeletal manifestations, and 4 other manifestations of LB. As judged by the visual analogue scale and patient records, the outcome after a 1-year follow-up period was excellent or good in 114 (78.6%) patients, controversial in 14 (9.7%) patients, and poor in 17 (11.7%) patients. In patients with definite LB, the outcome was excellent or good in 49 (92.5%) AMOX-treated patients and 47 (87.0%) PBO patients and poor in 3 (5.7%) AMOX-treated patients and 6 (11.1%) PBO patients (difference nonsignificant, p = 0.49). Twelve months after the end of intravenous antibiotic therapy, the levels of antibodies against Borrelia burgdorferi were markedly decreased in 50% of the patients with definite LB in both groups. The results indicate that oral adjunct antibiotics are not justified in the treatment of patients with disseminated LB who initially receive intravenous CRO for 3 weeks. The clinical outcome cannot be evaluated at the completion of intravenous antibiotic treatment but rather 6-12 months afterwards. In patients with chronic post-treatment symptoms, persistent positive levels of antibodies do not seem to provide any useful information for further care of the patient.
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Affiliation(s)
- J Oksi
- Department of Medicine, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
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Henningsson AJ, Ernerudh J, Sandholm K, Carlsson SA, Granlund H, Jansson C, Nyman D, Forsberg P, Nilsson Ekdahl K. Complement activation in Lyme neuroborreliosis — Increased levels of C1q and C3a in cerebrospinal fluid indicate complement activation in the CNS. J Neuroimmunol 2007; 183:200-7. [PMID: 17157926 DOI: 10.1016/j.jneuroim.2006.10.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Revised: 10/30/2006] [Accepted: 10/31/2006] [Indexed: 11/25/2022]
Abstract
A strong initial inflammatory response is important in neuroborreliosis. Since complement is a main player in early inflammation, we monitored the concentration and activation of complement in plasma and cerebrospinal fluid from 298 patients, of whom 23 were diagnosed with neuroborreliosis. Using sandwich ELISAs, we found significantly elevated levels of C1q, C4, C3, and C3a in cerebrospinal fluid, but not in plasma, in patients with neuroborreliosis. This finding indicates that complement plays a role in the human immune response in neuroborreliosis, that the immunologic process is compartmentalized to the CNS, and that complement activation may occur via the classical pathway.
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Affiliation(s)
- Anna J Henningsson
- Department of Infectious Diseases, Ryhov County Hospital, 551 85, Jönköping, and Division of Clinical Immunology, Department of Molecular and Clinical Medicine, Linköping University, Sweden.
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34
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Ekdahl KN, Sandholm K, Ernerudh J, Carlsson SA, Granlund H, Jansson C, Nyman D, Forsberg P, Henningsson AJ. Raised intrathecal levels of complement components C1q and C3a in lyme neuroborreliosis. Mol Immunol 2007. [DOI: 10.1016/j.molimm.2006.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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Nyman D, Willén L, Jansson C, Carlsson SA, Granlund H, Wahlberg P. VlsE C6 peptide and IgG ELISA antibody analysis for clinical diagnosis of Lyme borreliosis in an endemic area. Clin Microbiol Infect 2006; 12:496-7. [PMID: 16643532 DOI: 10.1111/j.1469-0691.2006.01374.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Wahlberg P, Nyman D. [Penicillin V treatment in erythema migrans can give a false security]. Lakartidningen 2006; 103:668. [PMID: 16583549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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37
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Jansson C, Carlsson SA, Granlund H, Wahlberg P, Nyman D. Analysis of Borrelia burgdorferi IgG antibodies with a combination of IgG ELISA and VlsE C6 peptide ELISA. Clin Microbiol Infect 2005; 11:147-50. [PMID: 15679490 DOI: 10.1111/j.1469-0691.2004.01041.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Enzyme-linked immunosorbent assays (ELISAs) were used to detect antibodies to the C6 peptide of the Borrelia burgdorferi VlsE protein and a selection of B. burgdorferi IgG antigens, separately and as a combination, in 355 serum specimens from blood donors and patients. Western immunoblotting was used as the reference method. The sensitivity of the combined analysis of IgG antigen and C6 peptide analysis was markedly superior to those of the separate analyses. When the C6 peptide and IgG results were concordant, the customary confirmatory Western immunoblotting assay could be omitted, thus reducing the time and cost of analysis.
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Affiliation(s)
- C Jansson
- Laboratory Department, Aland Central Hospital, Aland, Finland
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38
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Andersson C, Nyberg C, Nyman D. [Rapid development of dementia of an elderly person, diagnosis and successful treatment]. Duodecim 2004; 120:1893-6. [PMID: 15508763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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39
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Carlsson SA, Granlund H, Jansson C, Nyman D, Wahlberg P. Characteristics of erythema migrans in Borrelia afzelii and Borrelia garinii infections. Scand J Infect Dis 2003; 35:31-3. [PMID: 12685881 DOI: 10.1080/0036554021000026978] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Erythema migrans is the most common manifestation of stage I Lyme borreliosis. This study investigated the relation between the subspecies of Borrelia burgdorferi involved, the time of development and the appearance of the manifestation. The study comprised 33 cases of erythema migrans yielding B. burgdorferi sensu lato by culture of skin biopsy. The species was determined by polymerase chain reaction analysis of the cultivated spirochaetes. In 22 of the cases, B. afzelii was demonstrated, whereas 11 yielded growth of B. garinii. All 11 erythemas associated with B. garinii were homogeneous, whereas 20 of the 22 associated with B. afzelii were annular. The garinii erythemas developed more rapidly, and were generally larger than the afzelii erythemas. The observations call for comparison with other geographical areas with similar, and with different, borrelial infection spectra.
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40
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Affiliation(s)
- P Wahlberg
- Aland Borrelia Group and Aland Central Hospital, Mariehamn, Aland Islands, Finland.
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41
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Abstract
Population isolates are increasingly being used in attempts to map genes underlying complex diseases. To further explore the utility of isolates for this purpose, we explore linkage disequilibrium patterns in polymorphisms from two regions (VWF and NF1) in three isolated populations from Finland. At the NF1 locus, the Finnish populations have greater pairwise disequilibrium than populations from Africa, Asia, or northern Europe. However, populations from 'New Finland' and 'Old Finland' do not differ in their disequilibrium levels at either the NF1 or the VWF locus. In addition, disequilibrium patterns and haplotype diversity do not differ between a sample from the Aland Islands, Finland, and a collection of outbred Centre d'Etude du Polymorphisme Humain families. These results show that linkage disequilibrium patterns sometimes differ among populations with different histories and founding dates, but some putative isolated populations may not significantly differ from larger admixed populations. We discuss factors that should be considered when using isolated populations in gene-mapping studies.
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Affiliation(s)
- L B Jorde
- Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, Utah 84112, USA
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Panelius J, Seppälä I, Granlund H, Nyman D, Wahlberg P. Evaluation of treatment responses in late Lyme borreliosis on the basis of antibody decrease during the follow-up period. Eur J Clin Microbiol Infect Dis 1999; 18:621-9. [PMID: 10534183 DOI: 10.1007/s100960050362] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The purpose of this study was to identify a serological marker of successful treatment as distinct from treatment failure in late Lyme borreliosis. Consecutive serum samples from 68 treated patients with late Lyme borreliosis were analyzed during a 1-2 year follow-up period after the start of treatment. End-point enzyme immunoassay titres of IgG1, IgG2, IgG3, and combined IgG1+3 subclasses against a sonicate antigen of Borrelia burgdorferi were determined and compared to the IgG antibody response against Borrelia burgdorferi flagella. Individual half-lives of the antibody levels were calculated for each patient. The half-life values were compared to the patients' clinical outcome in order to find a serological marker of remaining disease activity or relapse. The levels of combined IgG1+3 subclass antibodies against the sonicate antigen and the individual levels of IgG1, IgG2, and IgG3 antibodies did not change significantly after treatment. In contrast, antibodies to flagella decreased markedly after successful treatment, with a half-life of 112+/-92 days (arithmetic mean value +/- SD). This was significantly shorter than the half-life after unsuccessful treatment (271+/-151 days), (P<0.0001). The decrease was observed mainly in IgG1 and IgG4 responses to flagella, less so for IgG2 or IgG3. The results suggest that a rapid decrease in flagella antibodies can serve as a marker for a successful treatment of Lyme borreliosis.
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Affiliation(s)
- J Panelius
- Haartman Institute, Department of Bacteriology and Immunology, University of Helsinki, Finland
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Carlsson SA, Granlund H, Nyman D, Wahlberg P. IgG seroprevalence of Lyme borreliosis in the population of the Aland Islands in Finland. Scand J Infect Dis 1999; 30:501-3. [PMID: 10066053 DOI: 10.1080/00365549850161520] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This is a study of people living in Aland, a group of islands in the Baltic Sea between Finland and Sweden. 500 blood donors and 3,248 health service clients who did not have Lyme borreliosis were examined for Borrelia burgdorferi IgG antibodies. The method used was an ELISA containing a selection of diagnostic antigens to a Borrelia burgdorferi PKo strain. It was found that the distribution according to sex, age and titre values was identical in the 2 groups, which were therefore treated as one. 19.7% of all the sera was positive. The prevalence in men was 23.6%, and in women 16.7%. The prevalence rises with age, the highest prevalence being seen in men (44.7%) and women (37.0%) over 70 y of age. The data show that the Aland islands are strongly endemic for Lyme borreliosis compared with international levels of infection.
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Affiliation(s)
- S A Carlsson
- Department of Medicine, Aland Central Hospital, Mariehamn, Finland
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44
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Abstract
The aim of this study was to develop a treatment for late Lyme borreliosis and to compare the clinical results with serological findings before and after treatment. It was done in the Aland Islands (population 25,000), a region endemic for Lyme borreliosis. The patients were the first consecutive 100 patients from the Aland Islands with late Lyme borreliosis. They were followed for at least 1 year after treatment. The clinical results of treatment were compared with results of analyses of flagellar IgG antibodies to Borrelia burgdorferi done at the time of diagnosis before treatment and up to 12 months afterwards. Short periods of treatment were not generally effective. The outcome was successful in four of 13 treatments with 14 days of intravenous ceftriaxone alone, in 50 of 56 assessable treatments with ceftriaxone followed by 100 days of amoxycillin plus probenecid, and in 19 of 23 completed treatments with ceftriaxone followed by 100 days of cephadroxil. Titres of IgG antibodies to B. burgdorferi flagella declined significantly after 6 and 12 months in the patients who had successful treatments. All patients whose final titres were less than 30% of the initial titre were in the successful group. Their titres usually remained above the upper limit of normal for a long time but a decline to a value of less than 30% of that before treatment was always a sign of cure.
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Affiliation(s)
- P Wahlberg
- Department of Medicine, Aland Central Hospital, Mariehamn, Finland
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Watkins WS, Zenger R, O'Brien E, Nyman D, Eriksson AW, Renlund M, Jorde LB. Linkage disequilibrium patterns vary with chromosomal location: a case study from the von Willebrand factor region. Am J Hum Genet 1994; 55:348-55. [PMID: 7913583 PMCID: PMC1918364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Linkage disequilibrium analysis has been used as a tool for analyzing marker order and locating disease genes. Under appropriate circumstances, disequilibrium patterns reflect recombination events that have occurred throughout a population's history. As a result, disequilibrium mapping may be useful in genomic regions of < 1 cM where the number of informative meioses needed to detect recombinant individuals within pedigrees is exceptionally high. Its utility for refining target areas for candidate disease genes before initiating chromosomal walks and cloning experiments will be enhanced as the relationship between linkage disequilibrium and physical distance is better understood. To address this issue, we have characterized linkage disequilibrium in a 144-kb region of the von Willebrand factor gene on chromosome 12. Sixty CEPH and 12 von Willebrand disease families were genotyped for five PCR-based markers, which include two microsatellite repeats and three single-base-pair substitutions. Linkage disequilibrium and physical distance between polymorphisms are highly correlated (rm = -.76; P < .05) within this region. None of the five markers showed significant disequilibrium with the von Willebrand disease phenotype. The linkage disequilibrium/physical distance relationship was also analyzed as a function of chromosomal location for this and eight previously characterized regions. This analysis revealed a general trend in which linkage disequilibrium dissipates more rapidly with physical distance in telomeric regions than in centromeric regions. This trend is consistent with higher recombination rates near telomeres.
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Affiliation(s)
- W S Watkins
- Department of Human Genetics, University of Utah School of Medicine, Salt Lake City 84112
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46
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Halimi P, Kadari A, Dayan M, Nyman D, Braverman I, Sichel JY. Gastric bleeding complicating esophageal intubation with a Carden's tube. J Clin Anesth 1994; 6:168-9. [PMID: 8204241 DOI: 10.1016/0952-8180(94)90026-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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47
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Zhang ZP, Blombäck M, Nyman D, Anvret M. Mutations of von Willebrand factor gene in families with von Willebrand disease in the Aland Islands. Proc Natl Acad Sci U S A 1993; 90:7937-40. [PMID: 8367445 PMCID: PMC47262 DOI: 10.1073/pnas.90.17.7937] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Patients with von Willebrand disease in four families in the Aland Islands, including the original family that was described in 1926 by the Finnish physician von Willebrand, were screened for mutations in the Swedish "hot-spot" regions (exons 18, 28, 32, 43, and 45) of the von Willebrand factor gene. One cytosine deletion in exon 18 was detected in each of these families. Linkage analysis and genealogical studies suggest that the deletion present in these four families probably has an origin in common with the mutations in the Swedish patients. Apart from the deletion in exon 18, two close transitions (G-->A at S1263 and C-->T at P1266) in exon 28 on the same chromosome were identified in one individual who married into the original family and in his two children. The transitions could be due to a recombination between the von Willebrand factor gene and its pseudogene.
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Affiliation(s)
- Z P Zhang
- Department of Clinical Chemistry, Karolinska Hospital, Stockholm, Sweden
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48
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Abstract
Lyme borreliosis is endemic in the Aland Islands. Exposure of the inhabitants to bites of the tick Ixodes ricinus is heavy. The purpose of this study was to describe symptoms and signs of patients with late Lyme borreliosis in this area, and to correlate the findings with the epidemiological setting. The first 100 consecutive patients with late Lyme borreliosis found in the region since 1984 are included in this study. Neurological, articular and muscular symptoms and signs dominate. General screening for Lyme disease is not recommended in the area due to uncertainty about how to deal with seropositive healthy persons in this heavily exposed population. The recognition and prompt treatment of erythema migrans and other manifestations of primary Lyme borreliosis is important in order to avoid the late stages of the disease. Treatment of all those suffering tick-bites with an antibiotic would be an option in view of the incidence of infected ticks, but cannot be considered because tick-bites are extremely common among the inhabitants. The region would be suitable for general immunization against Borrelia burgdorferi if the means for doing this becomes available in the future.
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Affiliation(s)
- P Wahlberg
- Department of Medicine, Aland Central Hospital, Aland Islands, Finland
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49
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Schulman S, Lockner D, Granqvist S, Bratt G, Paul C, Nyman D. A comparative randomized trial of low-dose versus high-dose streptokinase in deep vein thrombosis of the thigh. Thromb Haemost 1984; 51:261-5. [PMID: 6377568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Fibrinolytic treatment of acute deep vein thrombosis (DVT) of the leg with high-dose streptokinase (SK) (100,000 U/h) in 39 cases, or low-dose SK (approx 10,000 U/h) in combination with low-dose heparin in 41 cases, was studied in a prospective randomized trial. The degree of thrombolysis was similar in both groups and did not correlate with age or size of the thrombus or with fibrinogen level. The degree of late recanalization was also similar in both groups. There were however significantly more patients with postthrombotic changes in the low-dose group than in the high-dose group after a mean follow-up time of 31 and 38 months respectively. In the low-dose group 2 intracranial hemorrhages occurred (one was fatal) and one patient died of pulmonary embolism, but there were significantly less allergic side effects to SK. There were no cases of such serious side effects in the highdose group. Although low-dose SK has equal thrombolytic effect it seems inferior to high-dose SK, since it probably causes more severe hemorrhagic side-effects.
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50
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Lockner D, Paul C, Hedlund B, Schulman S, Nyman D. Thermography in the diagnosis of DVT. Thromb Haemost 1981; 46:652-4. [PMID: 7314058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
161 consecutively admitted medical patients with the clinical suspicion of acute deep venous thrombosis (DVT) were thermographed and phlebographed in order to study the congruence of these methods. The sensitivity of thermography in the detection of DVT was found to be 99%, whereas the specificity was only 49%. The low specificity is explained by the fact that all thermographs suggestive of DVT were classified as pathologic to keep the sensitivity of the method as high as possible. Patients with dilated veins which may closely resemble DVT on thermography may in these cases give false positive results. Of 76 patients with phlebographically verified DVT, 22% became thermographically normal within 22 days, whereas 78% did not normalize within the mean observation time of 31 days. In another part of the study all medical patients (101) who were residing in our wards during a period of a week were screened by means of thermography. From this unselected group 17 patients were found to have thermographs suggestive of DVT. In 5 of these patients no reason for pathological thermography could be found. Thermography is a cheap and highly sensitive screening method for DVT, but findings of false positives caused by older thromboses and dilated veins are not unusual. The frequency of such false positives may be minimized by performing thermography after exercise.
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