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Bohlen J, Zhou Q, Philippot Q, Ogishi M, Rinchai D, Nieminen T, Seyedpour S, Parvaneh N, Rezaei N, Yazdanpanah N, Momenilandi M, Conil C, Neehus AL, Schmidt C, Arango-Franco CA, Voyer TL, Khan T, Yang R, Puchan J, Erazo L, Roiuk M, Vatovec T, Janda Z, Bagarić I, Materna M, Gervais A, Li H, Rosain J, Peel JN, Seeleuthner Y, Han JE, L'Honneur AS, Moncada-Vélez M, Martin-Fernandez M, Horesh ME, Kochetkov T, Schmidt M, AlShehri MA, Salo E, Saxen H, ElGhazali G, Yatim A, Soudée C, Sallusto F, Ensser A, Marr N, Zhang P, Bogunovic D, Cobat A, Shahrooei M, Béziat V, Abel L, Wang X, Boisson-Dupuis S, Teleman AA, Bustamante J, Zhang Q, Casanova JL. Human MCTS1-dependent translation of JAK2 is essential for IFN-γ immunity to mycobacteria. Cell 2023; 186:5114-5134.e27. [PMID: 37875108 PMCID: PMC10841658 DOI: 10.1016/j.cell.2023.09.024] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 08/11/2023] [Accepted: 09/22/2023] [Indexed: 10/26/2023]
Abstract
Human inherited disorders of interferon-gamma (IFN-γ) immunity underlie severe mycobacterial diseases. We report X-linked recessive MCTS1 deficiency in men with mycobacterial disease from kindreds of different ancestries (from China, Finland, Iran, and Saudi Arabia). Complete deficiency of this translation re-initiation factor impairs the translation of a subset of proteins, including the kinase JAK2 in all cell types tested, including T lymphocytes and phagocytes. JAK2 expression is sufficiently low to impair cellular responses to interleukin-23 (IL-23) and partially IL-12, but not other JAK2-dependent cytokines. Defective responses to IL-23 preferentially impair the production of IFN-γ by innate-like adaptive mucosal-associated invariant T cells (MAIT) and γδ T lymphocytes upon mycobacterial challenge. Surprisingly, the lack of MCTS1-dependent translation re-initiation and ribosome recycling seems to be otherwise physiologically redundant in these patients. These findings suggest that X-linked recessive human MCTS1 deficiency underlies isolated mycobacterial disease by impairing JAK2 translation in innate-like adaptive T lymphocytes, thereby impairing the IL-23-dependent induction of IFN-γ.
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Affiliation(s)
- Jonathan Bohlen
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France; German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Heidelberg University, 69120 Heidelberg, Germany.
| | - Qinhua Zhou
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA; Children's Hospital of Fudan University, 201102 Shanghai, China
| | - Quentin Philippot
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France
| | - Masato Ogishi
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA
| | - Darawan Rinchai
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA
| | - Tea Nieminen
- New Children's Hospital, 00290 Helsinki, Finland
| | - Simin Seyedpour
- Research Center for Immunodeficiencies, Tehran University of Medical Sciences, P94V+8MF Tehran, Iran; Nanomedicine Research Association (NRA), P94V+8MF Tehran, Iran
| | - Nima Parvaneh
- Research Center for Immunodeficiencies, Tehran University of Medical Sciences, P94V+8MF Tehran, Iran; Department of Pediatrics, Tehran University of Medical Sciences, P94V+8MF Tehran, Iran; Children's Medical Center, P94V+8MF Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Tehran University of Medical Sciences, P94V+8MF Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), 1419733151 Tehran, Iran
| | - Niloufar Yazdanpanah
- Research Center for Immunodeficiencies, Tehran University of Medical Sciences, P94V+8MF Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), 1419733151 Tehran, Iran
| | - Mana Momenilandi
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France
| | - Clément Conil
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France
| | - Anna-Lena Neehus
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France
| | - Carltin Schmidt
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA; Faculty of Medicine, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Carlos A Arango-Franco
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France; Primary Immunodeficiencies Group, Department of Microbiology and Parasitology, School of Medicine, University of Antioquia, Medellín, Colombia
| | - Tom Le Voyer
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France
| | - Taushif Khan
- College of Health and Life Sciences, Hamad Bin Khalifa University, 8C8M+6Q Doha, Qatar; Department of Immunology, Sidra Medicine, 8C8M+6Q Doha, Qatar; The Jackson Laboratory, Farmington, CT, USA
| | - Rui Yang
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA
| | - Julia Puchan
- Institute of Microbiology, ETH Zürich, 8049 Zürich, Switzerland
| | - Lucia Erazo
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France
| | - Mykola Roiuk
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Heidelberg University, 69120 Heidelberg, Germany
| | - Taja Vatovec
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France; Heidelberg University, 69120 Heidelberg, Germany
| | - Zarah Janda
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France; Heidelberg University, 69120 Heidelberg, Germany
| | - Ivan Bagarić
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France; Heidelberg University, 69120 Heidelberg, Germany
| | - Marie Materna
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France
| | - Adrian Gervais
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France
| | - Hailun Li
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France
| | - Jérémie Rosain
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France
| | - Jessica N Peel
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA
| | - Yoann Seeleuthner
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France
| | - Ji Eun Han
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA
| | | | - Marcela Moncada-Vélez
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA
| | - Marta Martin-Fernandez
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Precision Immunology Institute, Icahn School, New York, NY 10029, USA; Mindich Child Health and Development Institute, Icahn School, New York, NY 10029, USA; Department of Pediatrics, Icahn School, New York, NY 10029, USA; Department of Microbiology, Icahn School, New York, NY 10029, USA
| | - Michael E Horesh
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Precision Immunology Institute, Icahn School, New York, NY 10029, USA; Mindich Child Health and Development Institute, Icahn School, New York, NY 10029, USA; Department of Pediatrics, Icahn School, New York, NY 10029, USA; Department of Microbiology, Icahn School, New York, NY 10029, USA
| | - Tatiana Kochetkov
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA
| | - Monika Schmidt
- University Hospital Erlangen, Institute of Clinical and Molecular Virology, Friedrich-Alexander Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Mohammed A AlShehri
- King Fahad Medical City, Children's Specialized Hospital, 12231 Riyadh, Saudi Arabia
| | - Eeva Salo
- New Children's Hospital, 00290 Helsinki, Finland
| | - Harri Saxen
- New Children's Hospital, 00290 Helsinki, Finland
| | - Gehad ElGhazali
- Sheikh Khalifa Medical City- Union71, Purehealth, Abu Dhabi, United Arab Emirates, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ahmad Yatim
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA
| | - Camille Soudée
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France
| | - Federica Sallusto
- Institute of Microbiology, ETH Zürich, 8049 Zürich, Switzerland; Institute for Research in Biomedicine, Università della Svizzera Italiana, 6500 Bellinzona, Switzerland
| | - Armin Ensser
- University Hospital Erlangen, Institute of Clinical and Molecular Virology, Friedrich-Alexander Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Nico Marr
- College of Health and Life Sciences, Hamad Bin Khalifa University, 8C8M+6Q Doha, Qatar; Department of Immunology, Sidra Medicine, 8C8M+6Q Doha, Qatar
| | - Peng Zhang
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA
| | - Dusan Bogunovic
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Precision Immunology Institute, Icahn School, New York, NY 10029, USA; Mindich Child Health and Development Institute, Icahn School, New York, NY 10029, USA; Department of Pediatrics, Icahn School, New York, NY 10029, USA; Department of Microbiology, Icahn School, New York, NY 10029, USA
| | - Aurélie Cobat
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France
| | - Mohammad Shahrooei
- Clinical and Diagnostic Immunology, KU Leuven, 3000 Leuven, Belgium; Dr. Shahrooei Laboratory, 22 Bahman St., Ashrafi Esfahani Blvd, Tehran, Iran
| | - Vivien Béziat
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France; St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA
| | - Laurent Abel
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France; St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA
| | - Xiaochuan Wang
- Children's Hospital of Fudan University, 201102 Shanghai, China
| | - Stéphanie Boisson-Dupuis
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France; St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA
| | - Aurelio A Teleman
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Heidelberg University, 69120 Heidelberg, Germany
| | - Jacinta Bustamante
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France; St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA; Study Center for Primary Immunodeficiencies, AP-HP, Necker Hospital for Sick Children, 75015 Paris, France.
| | - Qian Zhang
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France; St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, INSERM UMR1163, Necker hospital for sick children, 75015 Paris, France; Paris Cité University, Imagine Institute, 75015 Paris, France; St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, NY 10065, USA; Howard Hughes Medical Institute, New York, NY 10032, USA; Department of Pediatrics, Necker Hospital for Sick Children, AP-HP, 75015 Paris, France.
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Puhakka L, Lappalainen M, Lönnqvist T, Nieminen T, Boppana S, Saxen H, Niemensivu R. Hearing outcome in congenitally CMV infected children in Finland - Results from follow-up after three years age. Int J Pediatr Otorhinolaryngol 2022; 156:111099. [PMID: 35276528 DOI: 10.1016/j.ijporl.2022.111099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 11/12/2021] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Cytomegalovirus (CMV) is the most common congenital infection affecting about 0.6% of all newborns in developed countries. Vertical transmission to fetus can take place either after maternal primary or non-primary CMV infection during pregnancy. It is the most common infectious agent for sensorineural hearing loss (SNHL) in young children. The hearing loss after congenital CMV (cCMV) may be present at birth, or may develop after months or even years. In this study, we evaluated hearing outcome at 3-4 years of age in children (n 32) with cCMV identified in universal saliva CMV-PCR-based screening. METHODS Study population consisted of mainly asymptomatic children (median age 3.1 years) with cCMV identified in newborn CMV screening. The type of maternal CMV infection (primary or non-primary) was determined by analyzing CMV antibodies (IgM, IgG and IgG avidity) from preserved maternal serum samples drawn in the end of first trimester of pregnancy. Hearing was evaluated with pure tone audiometry (PTA), or transient-evoked otoacoustic emission (TEOAE) and sound field audiometry (SF). RESULTS Unilateral hearing loss occurred in 5/32 (16%) of the children with cCMV. None of the subjects in our cohort had bilateral hearing loss. Hearing loss occurred in 3/15 (20%) of children who were born to mothers with non-primary CMV infection during pregnancy, and in 2/10 (20%) of children whose mother had had a primary CMV infection during the 2-3 trimester. None of the additional 6 children, whose mother had primary infection in the first trimester, had hearing loss by age of 3-4 years. Two children with normal hearing at 1 years age had developed unilateral hearing loss by the age of three. CONCLUSIONS Unilateral hearing loss was relatively common among the mainly asymptomatic children with cCMV identified in screening. Long-term follow up of children with cCMV is essential to identify the children with late-onset hearing loss.
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Affiliation(s)
- Laura Puhakka
- Department of Pediatric Infectious Diseases, New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Maija Lappalainen
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Finland
| | - Tuula Lönnqvist
- Department of Child Neurology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tea Nieminen
- Department of Pediatric Infectious Diseases, New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Suresh Boppana
- Pediatrics and Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harri Saxen
- Department of Pediatric Infectious Diseases, New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riina Niemensivu
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Puhakka L, Pati S, Lappalainen M, Lönnqvist T, Niemensivu R, Lindahl P, Nieminen T, Seuri R, Nupponen I, Boppana S, Saxen H. Viral shedding, and distribution of cytomegalovirus glycoprotein H (UL75), glycoprotein B (UL55), and glycoprotein N (UL73) genotypes in congenital cytomegalovirus infection. J Clin Virol 2020; 125:104287. [PMID: 32086150 DOI: 10.1016/j.jcv.2020.104287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/07/2019] [Revised: 10/13/2019] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Children with congenital CMV infection (cCMV) shed virus in urine and saliva for prolonged periods of time. Outcome of cCMV varies from asymptomatic infection with no sequelae in most cases, to severe longterm morbidity. The factors associated with asymptomatic cCMV are not well defined. We evaluated the viral shedding in a cohort of infants with cCMV identified on newborn screening. In addition, we describe the distribution of viral genotypes in our cohort of asymptomatic infants and previous cohorts of cCMV children in the literature. METHODS Study population consisted of 40 children with cCMV identified in screening of 19,868 infants, a prevalence of 2/1000. The viral shedding was evaluated at 3 and 18 months of age by real-time CMV-PCR of saliva and plasma, and CMV culture of urine. CMV positive saliva samples were analyzed for genotypes for CMV envelope glycoproteins gB (UL55), and gH (UL75) by genotype specific real-time PCR, and gN (UL73) by cloning and sequencing RESULTS: At 3 months age 40/40 saliva and urine samples, and 19/40 plasma samples were positive for CMV. At 18 months age all urine samples tested (33/33), 9/37 of saliva samples, and 2/34 plasma samples were positive for CMV. The genotype distribution did not differ from the published data CONCLUSIONS: The urinary virus shedding is more persistent than salivary shedding in children with cCMV. The genotype distribution was similar to previous literature and does not explain the low disease burden of cCMV in our population.
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Affiliation(s)
- Laura Puhakka
- Department of Pediatric Infectious Diseases, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Sunil Pati
- Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maija Lappalainen
- Laboratory Services (HUSLAB), Division of Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Finland
| | - Tuula Lönnqvist
- Department of Child Neurology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riina Niemensivu
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Päivi Lindahl
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tea Nieminen
- Department of Pediatric Infectious Diseases, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Raija Seuri
- Department of Pediatric Radiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Irmeli Nupponen
- Department of Neonatology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Suresh Boppana
- Pediatrics and Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harri Saxen
- Department of Pediatric Infectious Diseases, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Puhakka L, Lappalainen M, Lönnqvist T, Niemensivu R, Lindahl P, Nieminen T, Seuri R, Nupponen I, Pati S, Boppana S, Saxen H. The Burden of Congenital Cytomegalovirus Infection: A Prospective Cohort Study of 20 000 Infants in Finland. J Pediatric Infect Dis Soc 2019; 8:205-212. [PMID: 29554325 DOI: 10.1093/jpids/piy027] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Congenital cytomegalovirus (cCMV) infection is the most common congenital infection and causes significant morbidity. This study was undertaken to evaluate the benefits of screening newborns for cCMV and to understand the cCMV disease burden in Finland. METHODS Infants born in Helsinki area hospitals were screened for CMV by testing their saliva with a real-time polymerase chain reaction assay. The CMV-positive infants and matched controls were monitored to determine their neurodevelopmental, audiological, and ophthalmological outcomes at 18 months of age. Griffiths Mental Development Scales, otoacoustic emission and sound field audiometry, and ophthalmologic examination were performed. RESULTS Of the 19868 infants screened, 40 had confirmed cCMV infection (prevalence, 2 in 1000 [95% confidence interval, 1.4-2.6 in 1000]). Four (10%) infants had symptomatic cCMV. Griffiths general quotients did not differ significantly between the CMV-positive (mean, 101.0) and control (mean, 101.6) infants (P = .557), nor did quotients for any of the Griffiths subscales (locomotion, personal-social, hearing and language, eye and hand, performance) (P = .173-.721). Four of 54 CMV-positive ears and 6 of 80 CMV-negative ears failed otoacoustic emission testing (P = 1.000). The mean minimal response levels over the frequencies 500 Hz to 4 kHz in the sound field audiometry did not differ between CMV-positive (mean, 34.31-dB hearing level) and control (mean, 32.73-dB hearing level) infants (P = .338). No CMV-related ophthalmologic findings were observed. CONCLUSIONS The prevalence of cCMV was low, and outcomes at 18 months of age did not differ between the infected infants and healthy control infants. With such a low burden in Finland, universal newborn screening for cCMV seems unwarranted.
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Affiliation(s)
- Laura Puhakka
- Department of Pediatric Infectious Diseases, Childrens Hospital
| | | | | | - Riina Niemensivu
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Päivi Lindahl
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tea Nieminen
- Department of Pediatric Infectious Diseases, Childrens Hospital
| | - Raija Seuri
- Department of Pediatric Radiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Sunil Pati
- Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suresh Boppana
- Pediatrics and Microbiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Harri Saxen
- Department of Pediatric Infectious Diseases, Childrens Hospital
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Kurkela S, Puolakkainen M, Hokynar K, Nieminen T, Saxen H, Mannonen L, Pietikäinen R. Mycoplasma pneumoniae outbreak, Southeastern Finland, 2017-2018: molecular epidemiology and laboratory diagnostic lessons. Eur J Clin Microbiol Infect Dis 2019; 38:1867-1871. [PMID: 31263967 PMCID: PMC6778538 DOI: 10.1007/s10096-019-03619-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 04/09/2019] [Accepted: 06/18/2019] [Indexed: 01/09/2023]
Abstract
This study characterizes a large Mycoplasma pneumoniae outbreak observed in Kymenlaakso in Southeastern Finland during August 2017–January 2018. The first part of the investigation included 327 patients, who sought healthcare consultation at local GPs or hospitals due to clinical symptoms, and were tested for M. pneumoniae antibodies (Patient cohort). The second part of the investigation, conducted approximately 4 weeks after the peak of the outbreak, consisted of school screening of pupils (N = 239) in three different school buildings by PCR on respiratory specimens and questionnaires (Screening cohort). PCR positive respiratory specimens were subsequently utilized for molecular typing. The outbreak peaked in late October 2017. Of the Patient cohort, 9/106 (8.5%) respiratory specimens were PCR positive. In contrast, 3/182 (1.6%) of the Screening cohort were PCR positive. Asymptomatic carriage was observed. Multiple-locus variable-number tandem-repeat analysis (MLVA) identified two distinct MLVA types. All typed M. pneumoniae strains belonged to P1 type 1. No mutations leading to macrolide resistance were observed. In total, 61/327 (19%) of the Patient cohort had a serological indication of recent infection. The IgM test reactivity at the time of a negative PCR test result varied from a completely non-reactive value up to very strong reactivity, highlighting the difficulty in a single specimen serodiagnosis.
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Affiliation(s)
- Satu Kurkela
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Mirja Puolakkainen
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kati Hokynar
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tea Nieminen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Saxen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura Mannonen
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Hokynar K, Kurkela S, Nieminen T, Saxen H, Vesterinen EJ, Mannonen L, Pietikäinen R, Puolakkainen M. Parachlamydia acanthamoebae Detected during a Pneumonia Outbreak in Southeastern Finland, in 2017⁻2018. Microorganisms 2019; 7:E141. [PMID: 31108956 PMCID: PMC6560421 DOI: 10.3390/microorganisms7050141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 12/23/2022] Open
Abstract
Community-acquired pneumonia (CAP) is a common disease responsible for significant morbidity and mortality. However, the definite etiology of CAP often remains unresolved, suggesting that unknown agents of pneumonia remain to be identified. The recently discovered members of the order Chlamydiales, Chlamydia-related bacteria (CRB), are considered as possible emerging agents of CAP. Parachlamydia acanthamoebae is the most studied candidate. It survives and replicates inside free-living amoeba, which it might potentially use as a vehicle to infect animals and humans. A Mycoplasma pneumoniae outbreak was observed in Kymenlaakso region in Southeastern Finland during August 2017-January 2018. We determined the occurrence of Chlamydiales bacteria and their natural host, free-living amoeba in respiratory specimens collected during this outbreak with molecular methods. Altogether, 22/278 (7.9%) of the samples contained Chlamydiales DNA. By sequence analysis, majority of the CRBs detected were members of the Parachlamydiaceae family. Amoebal DNA was not detected within the sample material. Our study further proposes that Parachlamydiaceae could be a potential agent causing atypical CAP in children and adolescents.
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Affiliation(s)
- Kati Hokynar
- Department of Virology, University of Helsinki and Helsinki University Hospital, FI-00014 Helsinki, Finland.
| | - Satu Kurkela
- Department of Virology, University of Helsinki and Helsinki University Hospital, FI-00014 Helsinki, Finland.
| | - Tea Nieminen
- Children's Hospital, University of Helsinki, FI-00029 Helsinki, Finland.
| | - Harri Saxen
- Children's Hospital, University of Helsinki, FI-00029 Helsinki, Finland.
| | - Eero J Vesterinen
- Department of Ecology, Swedish University of Agricultural Sciences, SE-75007 Uppsala, Sweden.
- Biodiversity Unit, University of Turku, FI-20014 Turku, Finland.
| | - Laura Mannonen
- Department of Virology, University of Helsinki and Helsinki University Hospital, FI-00014 Helsinki, Finland.
| | - Risto Pietikäinen
- Department of Internal Medicine, Kymenlaakso Central Hospital, FI-48210 Kotka, Finland.
| | - Mirja Puolakkainen
- Department of Virology, University of Helsinki and Helsinki University Hospital, FI-00014 Helsinki, Finland.
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Kortela E, Hytönen J, Numminen J, Overmyer M, Saxen H, Oksi J. Cerebral vasculitis and intracranial multiple aneurysms in a child with Lyme neuroborreliosis. JMM Case Rep 2017; 4:e005090. [PMID: 29026617 PMCID: PMC5630958 DOI: 10.1099/jmmcr.0.005090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/16/2017] [Accepted: 03/20/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction. Lyme borreliosis is a multisystem tick-borne disease caused by Borrelia burgdorferi. Neurological manifestations are reported in up to 15 % of adult patients with Lyme disease, while the frequency among children is higher. The most common manifestations are painful radiculopathy, facial nerve paresis and lymphocytic meningitis. Epileptic seizures and cerebral vasculitis with stroke or aneurysms are very rare complications. Case presentation. We describe a paediatric patient with sensorineural auditory dysfunction, headache, fatigue and epileptic seizures as sequelae of meningoencephalitis/Lyme neuroborreliosis (LNB) caused by B. burgdorferi. Brain magnetic resonance imaging revealed widespread enhancement of the leptomeninges, cranial nerves and artery walls compatible with vasculitis and disturbances in cerebrospinal fluid (CSF) circulation. The patient was treated with ceftriaxone for 2 weeks. Two years later, the patient had an ischemic stroke. Brain magnetic resonance angiography revealed multiple aneurysms, which were not present previously. The largest aneurysm was operated rapidly. The patient was treated with another course of intravenous ceftriaxone for 4 weeks and pulse therapy with corticosteroids. He recovered well.
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Affiliation(s)
- Elisa Kortela
- Division of Infectious Diseases, Faculty of Medicine, University of Turku, University of Helsinki, Helsinki University Hospital, P.O. Box 348, 00029 HUS, Finland
| | - Jukka Hytönen
- Department of Medical Microbiology and Immunology and Microbiology and Genetics Department, University of Turku, Turku University Hospital, Turku, Finland
| | - Jussi Numminen
- Helsinki Medical Imaging Centre, University of Helsinki, Helsinki, Finland
| | - Margit Overmyer
- Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Harri Saxen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Division of Medicine, Faculty of Medicine, University of Turku, Turku University Hospital, P.O. Box 52, 20521 Turku, Finland
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Hannula-Jouppi K, Kostjukovitch S, Puhakka L, Saxen H, Ranki A. 124 Desmoplakin mutation in neonatal erythroderma. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.434] [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: 11/25/2022]
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Affiliation(s)
- Anni Koskinen
- a Department of Otorhinolaryngology - Head and Neck Surgery , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| | - Heli Koskinen
- a Department of Otorhinolaryngology - Head and Neck Surgery , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| | - Leif Bäck
- a Department of Otorhinolaryngology - Head and Neck Surgery , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| | - Harri Saxen
- b Children's Hospital, Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| | - Tuomas Klockars
- a Department of Otorhinolaryngology - Head and Neck Surgery , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
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Puhakka L, Renko M, Helminen M, Peltola V, Heiskanen-Kosma T, Lappalainen M, Surcel HM, Lönnqvist T, Saxen H. Primary versus non-primary maternal cytomegalovirus infection as a cause of symptomatic congenital infection - register-based study from Finland. Infect Dis (Lond) 2017; 49:445-453. [PMID: 28116961 DOI: 10.1080/23744235.2017.1279344] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Both primary and non-primary maternal cytomegalovirus (CMV) infection during pregnancy can lead to vertical transmission. We evaluated the proportion of maternal primary/non-primary infections among 26 babies with symptomatic congenital CMV infection born in Finland from 2000 to 2012. METHODS We executed a database search on hospital records from all five university hospitals in Finland to identify infants with congenital CMV infection. The preserved maternal serum samples drawn at the end of the first trimester were analysed for CMV antibodies. Maternal infection was classified to be non-primary, if there was high avidity CMV immunoglobulin G (IgG) in the early pregnancy samples. Infection was considered primary in the case of either low avidity IgG (primary infection in the first trimester or near conception) or absent CMV IgG at the end of the first trimester (primary infection in the second or third trimester). RESULTS The majority of the symptomatic congenital CMV infections (54%) were due to maternal non-primary infection, 27% due to maternal primary infection in the first trimester or near conception, and 19% during the second or third trimester. Long-term sequelae occurred in 59% of patients: in 6/7 after primary infection in the first trimester, in 0/5 after primary infection in the second or third trimester, and in 9/14 after non-primary infection. CONCLUSIONS In this register-based cohort, non-primary infections caused the majority of symptomatic congenital CMV infections, and resulted in significant morbidity.
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Affiliation(s)
- Laura Puhakka
- a Pediatrics , Children's Hospital, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Marjo Renko
- b Pediatrics, PEDEGO Research Unit , University of Oulu and Oulu University Hospital , Oulu , Finland
| | - Merja Helminen
- c Pediatrics , Tampere University and University Hospital , Tampere , Finland
| | - Ville Peltola
- d Department of Pediatrics and Adolescent Medicine , Turku University Hospital and University of Turku , Turku , Finland
| | | | - Maija Lappalainen
- f Laboratory Services (HUSLAB), Division of Clinical Microbiology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | | | - Tuula Lönnqvist
- h Pediatric Neurology , Children's Hospital, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Harri Saxen
- i Infectious Diseases , Children's Hospital, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
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Laine N, Kaukonen AM, Hoppu K, Airaksinen M, Saxen H. Off-label use of antimicrobials in neonates in a tertiary children's hospital. Eur J Clin Pharmacol 2017; 73:609-614. [PMID: 28101656 DOI: 10.1007/s00228-017-2200-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 08/20/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Off-label (OL) use of drugs for hospitalized children is very common. OL use occurs especially in the youngest patients, neonates. This study focused on the OL use of antimicrobials in neonates. To our knowledge, only few studies have focused on the prevalence of OL use of antimicrobials in neonates. METHODS We investigated the OL use of antimicrobials in neonates in a tertiary children's hospital. First, we investigated what were the most consumed OL antimicrobials in defined daily doses according to hospital's registry data from neonatal intensive care unit (NICU) during 2009-2014. Second, we conducted a targeted retrospective study of premature neonates (400-2000 g) with blood culture-positive infections and receiving antimicrobial therapy between 2005 and 2014 (N = 282). The data were obtained from the electronic patient records and from the hospital's electronic infection registry. Statistical analysis was conducted by using a univariate logistic regression model fitted for OL usage. RESULTS In NICU, 35% (7/20) of antimicrobials used were OL. Eighteen percent (51/282) of premature neonates with blood culture-positive infections received at least one antimicrobial OL. The most commonly used OL antimicrobials in neonates were meropenem 88% (45/51), rifampicin 18% (9/51), and ciprofloxacin 8% (4/51). The odds for OL use were significantly higher the smaller the neonate birth weight was. An increase in birth weight was found to statistically significantly decrease the probability of OL usage (odds ratio = 0.85 for 100 g increase in birth weight, p value <0.001). CONCLUSION More studies in neonates on especially dosing and pharmacokinetics of antimicrobials are urgently needed.
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Affiliation(s)
- Niina Laine
- Children's Hospital, Helsinki University Hospital, Stenbäckinkatu 11, 00029 HUS, Helsinki, PL 281, Finland. .,Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 9, 00014, Helsinki, Finland.
| | - Ann Marie Kaukonen
- Formulation and Industrial Pharmacy Unit, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.,Current address: Finnish Medicines Agency (FIMEA), P.O. Box 55, 00034, Helsinki, Finland
| | - Kalle Hoppu
- Children's Hospital, Helsinki University Hospital, Stenbäckinkatu 11, 00029 HUS, Helsinki, PL 281, Finland.,Poison Information Centre, Helsinki University Hospital, Helsinki, Finland
| | - Marja Airaksinen
- Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 9, 00014, Helsinki, Finland
| | - Harri Saxen
- Children's Hospital, Helsinki University Hospital, Stenbäckinkatu 11, 00029 HUS, Helsinki, PL 281, Finland
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Laine N, Hoppu K, Airaksinen M, Saxen H. Antimicrobial consumption in a tertiary children's hospital in Finland (2003-2013). Eur J Hosp Pharm 2016; 23:266-271. [PMID: 31156863 DOI: 10.1136/ejhpharm-2015-000766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/04/2015] [Revised: 12/21/2015] [Accepted: 01/06/2016] [Indexed: 11/03/2022] Open
Abstract
Background Numbers of resistant pathogens are constantly increasing, and prudent use of antimicrobials is of paramount importance. In order to see whether any changes in the use of antimicrobials in recent years have occurred, we decided to monitor the consumption of these drugs at a single tertiary paediatric hospital. Materials and methods This single-centre retrospective study investigated the consumption of antimicrobials in defined daily doses (DDDs according to the Anatomical Therapeutical Chemical /DDD index) in a 130-bed paediatric tertiary hospital. The data on the consumption of antimicrobials were collected from years 2003-2013 by using electronic surveillance records provided by the local pharmacy. The consumption was related to days of hospital care. Results During 2003-2013, the use of penicillins, cephalosporins and carbapenems increased by 28%, 46% and 110%, respectively. The consumption of both aminoglycosides and vancomycin decreased by 61% and 41%, respectively. Amphotericin B use clearly decreased by 39% while the use of novel azoles and echinocandins increased. Conclusions Increased use of carbapenems was the most significant finding of our study. The year-to-year consumption of antibacterials was in general relatively stable and new antibacterials were taken into use conservatively. In contrast to antibacterials, novel antifungals were rapidly adopted into use despite scarce evidence on their safety in children.
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Affiliation(s)
- Niina Laine
- Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland.,Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Kalle Hoppu
- Poison Information Centre, Helsinki University Central Hospital, Helsinki, Finland
| | - Marja Airaksinen
- Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Harri Saxen
- Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
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Puhakka L, Sarvikivi E, Lappalainen M, Surcel HM, Saxen H. Decrease in seroprevalence for herpesviruses among pregnant women in Finland: cross-sectional study of three time points 1992, 2002 and 2012. Infect Dis (Lond) 2015; 48:406-10. [DOI: 10.3109/23744235.2015.1123290] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Laine N, Vaara M, Anttila VJ, Hoppu K, Laaksonen R, Airaksinen M, Saxen H. Evaluation of Antimicrobial Therapy of Blood Culture Positive Healthcare-Associated Infections in Children. PLoS One 2015; 10:e0141555. [PMID: 26539831 PMCID: PMC4635017 DOI: 10.1371/journal.pone.0141555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 03/04/2015] [Accepted: 10/09/2015] [Indexed: 11/18/2022] Open
Abstract
Aim Knowledge of the quality of antimicrobial therapy (AMT) used for invasive healthcare-associated infections (HAIs) in paediatrics is scarce. Influence of the final information about the isolated pathogen on the subsequent targeted AMT was investigated in our study. Methods Data on 149 children (0–17 years) with blood culture positive HAIs were collected. The causative microbes under investigation were Staphylococcus aureus, Staphylococcus epidermidis, streptococci, Gram negative rods, and mixed infections were likewise included. For adjusting the antimicrobial regimen, an expert panel evaluated the quality of the targeted AMT and the delay of 72 hours after final microbiology results. AMT was regarded as inappropriate if the pathogen was totally resistant to the used antimicrobials (i) or if the chosen therapy was of not optimal efficacy against the pathogen (ii). Results 17% of the patients received inappropriate AMT. Half of these infections 13/26 (50%) were treated with an antimicrobial to which the isolate was resistant. Three (3/13, 23%) of these patients received antimicrobials which were totally ineffective according to in vitro data. Suboptimal or too broad spectrum AMT was administered to 13/26 (50%) patients. The most common causes of inappropriate use were the use of beta-lactams in oxacillin-resistant Staphylococcus epidermidis infections and vancomycin given in oxacillin-sensitive Staphylococcus aureus infections. Conclusion Approximately 17% of the selected cohort received inappropriate AMT. More attention should be paid to the appropriate use of antimicrobials, and training of prescribers should be urgently provided.
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Affiliation(s)
- Niina Laine
- Children´s Hospital, Helsinki University Central Hospital (HUCH), Helsinki, Finland
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Martti Vaara
- Division of Clinical Microbiology, HUSLAB, Helsinki University Central (HUCH) Hospital, Helsinki, Finland
| | - Veli-Jukka Anttila
- Department of Infectious Diseases, Helsinki University Central Hospital (HUCH), Helsinki, Finland
| | - Kalle Hoppu
- Poison Information Centre, Helsinki University Central Hospital (HUCH), Helsinki, Finland
| | - Raisa Laaksonen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Marja Airaksinen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Harri Saxen
- Children´s Hospital, Helsinki University Central Hospital (HUCH), Helsinki, Finland
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Abstract
OBJECTIVE Antibiotics have direct effects on the human intestinal microbiota, particularly in infancy. Antibacterial agents promote growth in farm animals by unknown mechanisms, but little is known about their effects on human weight gain. Our aim was to evaluate the impact of antibiotic exposure during infancy on weight and height in healthy Finnish children. METHODS The population-based cohort comprised 6114 healthy boys and 5948 healthy girls having primary care weight and height measurements and drug purchase data from birth to 24 months. BMI and height, expressed as z-scores at the median age of 24 months (interquartile range 24 to 26 months), were compared between children exposed and unexposed to antibiotics using analysis of covariance with perinatal factors as covariates. RESULTS Exposed children were on average heavier than unexposed children (adjusted BMI-for-age z-score difference in boys 0.13 SD [95% confidence interval 0.07 to 0.19, P < .001] and in girls 0.07 SD [0.01 to 0.13, P < .05]). The effect was most pronounced after exposure to macrolides before 6 months of age (boys 0.28 [0.11 to 0.46]; girls 0.23 [0.04 to 0.42]) or >1 exposure (boys 0.20 [0.10 to 0.30]; girls 0.13 [0.03 to 0.22]). CONCLUSIONS Antibiotic exposure before 6 months of age, or repeatedly during infancy, was associated with increased body mass in healthy children. Such effects may play a role in the worldwide childhood obesity epidemic and highlight the importance of judicious use of antibiotics during infancy, favoring narrow-spectrum antibiotics.
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Affiliation(s)
- Antti Saari
- Department of Pediatrics, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland;
| | - Lauri J Virta
- Department of Research, Social Insurance Institution, Turku, Finland
| | - Ulla Sankilampi
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Leo Dunkel
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; and
| | - Harri Saxen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Laine N, Vaara M, Anttila VJ, Laaksonen R, Airaksinen M, Saxen H. CP-089 The effect of the blood culture result on subsequent antimicrobial treatment in paediatric hospital-acquired infections. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000436.87] [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: 11/04/2022] Open
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Frisch M, Aigrain Y, Barauskas V, Bjarnason R, Boddy SA, Czauderna P, de Gier RPE, de Jong TPVM, Fasching G, Fetter W, Gahr M, Graugaard C, Greisen G, Gunnarsdottir A, Hartmann W, Havranek P, Hitchcock R, Huddart S, Janson S, Jaszczak P, Kupferschmid C, Lahdes-Vasama T, Lindahl H, MacDonald N, Markestad T, Märtson M, Nordhov SM, Pälve H, Petersons A, Quinn F, Qvist N, Rosmundsson T, Saxen H, Söder O, Stehr M, von Loewenich VCH, Wallander J, Wijnen R. Cultural bias in the AAP's 2012 Technical Report and Policy Statement on male circumcision. Pediatrics 2013; 131:796-800. [PMID: 23509170 DOI: 10.1542/peds.2012-2896] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report's conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non-US-based physicians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.
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Affiliation(s)
- Morten Frisch
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen and Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Mattila PS, Hammarén-Malmi S, Saxen H, Kaijalainen T, Käyhty H, Tarkkanen J. Adenoidectomy in young children and serum IgG antibodies to pneumococcal surface protein A and choline binding protein A. Int J Pediatr Otorhinolaryngol 2012; 76:1569-74. [PMID: 22835927 DOI: 10.1016/j.ijporl.2012.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 07/05/2012] [Accepted: 07/06/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE We have previously reported that surgical removal of the nasopharyngeal adenoid in young children resulted in increased risk of nasopharyngeal colonization by pneumococci. We now investigated whether adenoidectomy influences the development of serum IgG antibodies to pneumococcal choline-binding protein A (CbpA) and pneumococcal surface protein A (PspA). METHODS Altogether 217 children aged 12-48 months who had recurrent or persistent otitis media were randomized to undergo or not to undergo adenoidectomy. All the children underwent insertion of tympanostomy tubes. 166 children were followed-up for 3 years. The main outcome measures were concentrations of serum IgG antibodies to CbpA and PspA three years after randomization. Nasopharyngeal colonization by pneumococci was assessed 1, 2, and 3 years after randomization. RESULTS Adenoidectomy decreased concentrations of CbpA antibodies by ca. 25% independently of the observed increase in pneumococcal carriage (OR of log(10) transformed concentrations 0.74, 95% CI 0.58-0.94, P=0.016). Concentrations of PspA antibodies were lower and they seemed not to be influenced by adenoidectomy. CONCLUSIONS Adenoidectomy in young children causes a small but detectable impairment in the development of serum IgG antibodies to pneumococcal CbpA. The adenoid seems to have a role in augmenting systemic immunity against pneumococci.
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Affiliation(s)
- Petri S Mattila
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Finland.
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Pelkonen T, Aarnisalo A, Markkola A, Eskola J, Saxen H, Salo E. Prolonged otorrhea and mastoiditis caused by Mycobacterium abscessus. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.pedex.2011.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Siikala E, Bowyer P, Richardson M, Saxen H, Sanglard D, Rautemaa R. ADH1 expression inversely correlates with CDR1 and CDR2 in Candida albicans from chronic oral candidosis in APECED (APS-I) patients. FEMS Yeast Res 2011; 11:494-8. [DOI: 10.1111/j.1567-1364.2011.00739.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Siikala E, Rautemaa R, Richardson M, Saxen H, Bowyer P, Sanglard D. Persistent Candida albicans colonization and molecular mechanisms of azole resistance in autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) patients. J Antimicrob Chemother 2010; 65:2505-13. [PMID: 20876623 DOI: 10.1093/jac/dkq354] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED, APS-I) suffer from chronic candidosis caused mainly by Candida albicans, and repeated courses of azole antifungals have led to the development of resistance in the APECED patient population in Finland. The aim of our study was to address whether the patients are persistently colonized with the same or genetically closely related strains, whether epidemic strains are present and which molecular mechanisms account for azole resistance. METHODS Sets of C. albicans (n = 19) isolates from nine APECED patients reported with decreased susceptibility to fluconazole isolated up to 9 years apart were included. The strains were typed by multilocus sequence typing. CDR1/2, MDR1 and ERG11 mRNA expression was analysed by northern blotting and Cdr1, Cdr2 and Mdr1 protein expression by western blotting, and TAC1 and ERG11 genes were sequenced. RESULTS All seven patients with multiple C. albicans isolates analysed were persistently colonized with the same or a genetically closely related strain for a mean of 5 years. All patients were colonized with different strains and no epidemic strains were found. The major molecular mechanisms behind the azole resistance were mutations in TAC1 contributing to overexpression of CDR1 and CDR2. Six new TAC1 mutations were found, one of which (N740S) is likely to be a gain-of-function mutation. Most isolates were found to have gained multiple TAC1 and ERG11 point mutations. CONCLUSIONS Despite clinically successful treatment leading to relief of symptoms, colonization by C. albicans strains is persistent within APECED patients. Microevolution and point mutations occur within strains, leading to the development of azole-resistant isolates.
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Affiliation(s)
- Emilia Siikala
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki, Finland.
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Mattila PS, Hammarén-Malmi S, Saxen H, Kaijalainen T, Käyhty H, Tarkkanen J. Adenoidectomy and nasopharyngeal carriage of Streptococcus pneumoniae in young children. Arch Dis Child 2010; 95:696-702. [PMID: 20504840 DOI: 10.1136/adc.2009.165654] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The effect of adenoidectomy on nasopharyngeal colonisation of pathogens has not previously been evaluated. The authors studied the effect of adenoidectomy on nasopharyngeal colonisation by bacteria causing otitis media and the effect of adenoidectomy on the development of pneumococcal capsular polysaccharide antibodies. DESIGN Randomised controlled study. SETTING Tertiary care centre. PATIENTS 217 children aged 12-48 months who had recurrent or persistent otitis media were randomised. 166 children were followed up for 3 years. INTERVENTION Random allocation to undergo adenoidectomy or not to undergo adenoidectomy. All the children underwent insertion of tympanostomy tubes. MAIN OUTCOME MEASURES Nasopharyngeal colonisation by pneumococci, Haemophilus influenzae and Moraxella catarrhalis 1, 2 and 3 years after randomisation. Serum IgG antibodies against pneumococcal capsular polysaccharide serotypes 6B, 14, 19F and 23F 3 years after randomisation. RESULTS After the first year of randomisation adenoidectomy increased nasopharyngeal carriage of pneumococci (RR, 1.47; 95% CI 1.04 to 2.07) but it did not influence the carriage of H influenzae or M catarrhalis. Among carriers of serotype 6B pneumococci, adenoidectomy resulted in lower concentrations of pneumococcal serotype 6B polysaccharide antibodies (ratio of geometric means of antibody concentrations, 0.37; 95% CI 0.16 to 0.85). Concentrations of serotype 14, 19F and 23F antibodies seemed not to be influenced by adenoidectomy. Despite this, adenoidectomy resulted in a significant increase in nasopharyngeal carriage of serotype 19F pneumococci. CONCLUSIONS Adenoidectomy increases the risk of nasopharyngeal carriage of pneumococci in children younger than 4 years of age. This may be independent of the development of serum IgG capsular polysaccharide antibodies.
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Affiliation(s)
- Petri S Mattila
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Finland.
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23
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Mattila PS, Hammarén-Malmi S, Pelkonen AS, Malmberg LP, Mäkelä MJ, Saxen H, Tarkkanen J. Effect of adenoidectomy on respiratory function: a randomised prospective study. Arch Dis Child 2009; 94:366-70. [PMID: 19131420 DOI: 10.1136/adc.2008.145664] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Risk of childhood asthma is increased in children with recurrent otitis media. This may be associated with recurrent respiratory tract infections in these children, but the role of adenoidectomy, a frequent operation during childhood, is unknown. Therefore, the role of adenoidectomy in the development of atopy and respiratory function changes characteristic of asthma was evaluated. DESIGN Randomised controlled study. SETTING Tertiary care centre. PATIENTS 166 children aged 12-48 months who had recurrent or persistent otitis media and who were followed-up for 3 years after randomisation. INTERVENTION Randomisation to undergo insertion of tympanostomy tubes with or without adenoidectomy. MAIN OUTCOME MEASURES The primary outcome measure was exercise-induced bronchoconstriction as evaluated by impulse oscillometry. The secondary outcome measures were bronchial inflammation as evaluated by exhaled nitric oxide and atopy as evaluated by skin prick tests. During the 3-year follow-up period otitis media episodes were documented in patient diaries. RESULTS Adenoidectomy did not significantly influence baseline lung function, exercise-induced bronchoconstriction, exhaled nitric oxide concentration, the development of positive skin prick tests, or doctor-diagnosed asthma. Adenoidectomy did not significantly prevent otitis media. Recurrent otitis media (>or=4 episodes) during the first follow-up year was associated with an abnormal exercise-induced bronchoconstriction (OR 6.62, 95% CI 1.27 to 34) and an elevated exhaled nitric oxide concentration (OR 3.26, 95% CI 0.98 to 10.8) regardless of adenoidectomy. CONCLUSIONS Adenoidectomy did not promote asthma or allergy. Recurrent respiratory tract infections during early childhood are associated with the risk of bronchial hyper-reactivity.
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Affiliation(s)
- P S Mattila
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland.
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24
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Rihkanen H, Rönkkö E, Nieminen T, Komsi KL, Räty R, Saxen H, Ziegler T, Roivainen M, Söderlund-Venermo M, Anne L, Hovi T, Pitkäranta A, Pitkäranta A. Respiratory viruses in laryngeal croup of young children. J Pediatr 2008; 152:661-5. [PMID: 18410770 PMCID: PMC7094409 DOI: 10.1016/j.jpeds.2007.10.043] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 08/07/2007] [Accepted: 10/25/2007] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To determine the viral cause of laryngeal croup by use of highly sensitive methods, and including recently recognized viruses in the analysis. STUDY DESIGN One hundred forty-four consecutive children with hoarse voice and inspiratory stridor attending the emergency department were enrolled. Age- and season-matched children presenting with a wheezing illness served as control subjects (n = 76). Nasopharyngeal swabs were analyzed by polymerase chain reaction for rhinovirus and enterovirus, coronavirus, respiratory syncytial virus (RSV), parainfluenza virus (PIV), influenza A and B virus, human bocavirus, human metapneumovirus, adenovirus, and Mycoplasma pneumoniae. RESULTS Virus infection was documented in 80% of patients with croup and 71% of control subjects. Children with croup had significantly more positive test results for PIV 1 and 2 (31% vs 4% and 6% vs 0%, respectively) and significantly fewer positive test results for RSV (15% vs 28%) than wheezing children. Rhinoviruses and enteroviruses were present equally in both groups (21% vs 25%). There was no significant difference in the frequency of influenza A virus or human bocavirus. Few subjects with adenovirus or M. pneumoniae were detected. CONCLUSION Acute laryngeal croup is most often associated with PIV, RSV, rhinovirus, and enterovirus. Rhinovirus and enterovirus appeared equally often in croup and in wheezing illness. During late fall, they were found in 39% and 40%, respectively, of the tested samples.
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Affiliation(s)
- Heikki Rihkanen
- Department of Otorhinolaryngology, Head & Neck Surgery, Helsinki University Central Hospital, Helsinki, Finland.
| | - Esa Rönkkö
- Department of Viral Diseases and Immunology, National Public Health Institute, Helsinki, Finland
| | - Tea Nieminen
- Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland
| | - Kaija-Leena Komsi
- Department of Pediatrics, Jorvi Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Riitta Räty
- Department of Pediatrics, Jorvi Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Harri Saxen
- Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland
| | - Thedi Ziegler
- Department of Viral Diseases and Immunology, National Public Health Institute, Helsinki, Finland
| | - Merja Roivainen
- Department of Viral Diseases and Immunology, National Public Health Institute, Helsinki, Finland
| | | | - Lahtinen Anne
- Department of Virology, Haartman Institute, Helsinki University, Helsinki, Finland
| | - Tapani Hovi
- Department of Virology, Haartman Institute, Helsinki University, Helsinki, Finland
| | - Anne Pitkäranta
- Department of Otorhinolaryngology, Head & Neck Surgery, Helsinki University Central Hospital, Helsinki, Finland
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25
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Renko M, Salo E, Putto-Laurila A, Saxen H, Mattila PS, Luotonen J, Ruuskanen O, Uhari M. A randomized, controlled trial of tonsillectomy in periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome. J Pediatr 2007; 151:289-92. [PMID: 17719940 DOI: 10.1016/j.jpeds.2007.03.015] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Revised: 12/29/2006] [Accepted: 03/06/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We carried out a prospective, randomized, controlled trial to clarify the effect of tonsillectomy on the clinical course of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome. STUDY DESIGN Twenty-six consecutive children (mean age 4.1 years) with at least 5 PFAPA attacks were recruited from 3 tertiary care pediatric hospitals during 1999-2003 and randomly allocated to tonsillectomy or follow-up alone. They were all followed up with symptom diaries for 12 months. Tonsillectomy was allowed after 6 months in the control group if the attacks recurred. RESULTS Six months after randomization all 14 children in the tonsillectomy group and 6/12 children in the control group (50%) were free of symptoms (difference 50%, 95% confidence interval 23% to 75%, P < .001). Tonsillectomy was performed on 5/6 of the patients in the control group who still had symptoms after 6 months. The remaining unoperated child in the control group had recurrences of the fever episodes throughout the follow-up, but the symptoms became less severe, and the parents did not choose tonsillectomy. CONCLUSION Tonsillectomy appeared to be effective for treating PFAPA syndrome. The fever episodes ceased without any intervention in half of the control subjects. We conclude that although the mechanisms behind this syndrome are unknown, tonsillectomy can be offered as an effective intervention for children with PFAPA.
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Affiliation(s)
- M Renko
- Department of Pediatrics, University of Oulu, Finland.
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26
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Hammarén-Malmi S, Saxen H, Tarkkanen J, Mattila PS. Passive smoking after tympanostomy and risk of recurrent acute otitis media. Int J Pediatr Otorhinolaryngol 2007; 71:1305-10. [PMID: 17582514 DOI: 10.1016/j.ijporl.2007.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 05/09/2007] [Accepted: 05/14/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Exposure to environmental tobacco smoke has been reported to be a risk factor for childhood otitis media. The effect of parental smoking on the risk of otitis media after the insertion of tympanostomy tubes is unknown. We evaluated the effect of parental smoking on the risk of recurrent otitis media in children who had received tympanostomy tubes. METHODS We enrolled 217 children aged 1-4 years who underwent insertion of tympanostomy tubes because of middle ear disease. The children were followed-up for 12 months. Otitis media episodes were recorded in patient diaries by primary care physicians. Parental smoking habits were assessed by a questionnaire at the start of the trial and after the 12 month follow-up had ended. The main outcome measure was risk of recurrent otitis media as defined by four or more otitis media episodes after tympanostomy. Altogether 198 children completed the follow-up. RESULTS Maternal smoking was associated with a highly increased risk of recurrent acute otitis media (OR 4.15, 95% CI 1.45-11.9) after the insertion of tympanostomy tubes. CONCLUSION Exposure to passive smoking is associated with four-fold risk of recurrent otitis media after tympanostomy. This finding should be used to encourage parents to stop smoking even after the insertion of tympanostomy tubes to their children.
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Affiliation(s)
- Sari Hammarén-Malmi
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland
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27
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Rautemaa-Richardson R, Richardson M, Pfaller M, Koukila-Kähkölä P, Perheentupa J, Saxen H. P1273 Activity of posaconazole against clinical isolates of Candida albicans with decreased sensitivity tofiuconazole from autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy patients. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71113-5] [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: 10/23/2022]
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28
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Hovi L, Saxen H, Saarinen-Pihkala UM, Vettenranta K, Meri T, Richardson M. Prevention and monitoring of invasive fungal infections in pediatric patients with cancer and hematologic disorders. Pediatr Blood Cancer 2007; 48:28-34. [PMID: 16395687 DOI: 10.1002/pbc.20717] [Citation(s) in RCA: 55] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The occurrence of invasive fungal infection (IFIs) in a pediatric hematology/oncology unit after renovation of the ventilation system, and initiating routine azole antifungal prophylaxis was monitored. In addition, the value of serial screening for Aspergillus galactomannan (GM) for diagnosing invasive aspergillosis was assessed. PROCEDURE A total of 98 consecutive high-risk pediatric patients were prospectively surveyed for signs of IFI and weekly monitored for serum GM. The data was not made available to treating physicians. RESULTS Only 2 patients had proven and 27 possible IFI based on the European Organization for Research and Treatment of Cancer/Mycoses Study Group definitions. The incidence of proven IFI was 1/31 (3.2%) in the allogeneic stem cell transplant (SCT) (Aspergillus spp), 0/26 in the autologous SCT, and 1/60 (1.6%) in the induction therapy group (C. krusei). GM was detected at least in one tested sample in 12/98 patients (12.2%), in five patients in two or more sequential samples. In the latter group, IFI was proven in one patient and could not be excluded in the others. Four of the five patients belonged to the 31 allogeneic and one to the 26 autologous SCT patients. In patients with only one positive GM test none developed signs of IFI and only one received empirical amphotericin B. CONCLUSIONS With the currently used preventative and prophylactic measures, IFI is uncommon in children with high-risk for infection. Regular screening for GM could be useful among allogeneic SCT patients and two positive samples should prompt further investigative procedures and pre-emptive antifungal therapy.
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MESH Headings
- Adolescent
- Antifungal Agents/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Aspergillosis/blood
- Aspergillosis/diagnosis
- Aspergillosis/etiology
- Aspergillosis/mortality
- Aspergillosis/prevention & control
- Child
- Child, Preschool
- Female
- Galactose/analogs & derivatives
- Humans
- Infant
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Male
- Mannans/blood
- Monitoring, Physiologic
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/blood
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Remission Induction
- Retrospective Studies
- Risk Factors
- Stem Cell Transplantation/adverse effects
- Transplantation, Autologous
- Transplantation, Homologous
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Affiliation(s)
- Liisa Hovi
- Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
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29
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Abstract
OBJECTIVE To evaluate serology with novel Borrelia-specific protein or peptide antigens in the laboratory diagnosis of neuroborreliosis (NB) in children. METHODS The performance of enzyme-linked immunosorbent assays with several recombinant borrelial protein antigens and invariable region 6 synthetic peptide antigen and of a commercial enzyme-linked immunosorbent assay with the flagella antigen were evaluated in the serodiagnosis and follow-up of children with clinical suspicion of NB. Serum samples were obtained from 20 children with neurologic symptoms indicative of NB. The patients were retrospectively divided into 2 groups based on the laboratory tests at presentation indicating definite (n = 7) or probable (n = 13) NB. RESULTS In addition to cerebrospinal fluid (CSF) lymphocytic pleocytosis and CSF antiflagella antibodies, all 7 patients with definite NB had serum IgG antibodies to at least 2 of the 3 novel antigens at presentation. The 13 patients with probable NB had variable laboratory findings: CSF pleocytosis (n = 7), CSF antiflagella IgM antibodies (n = 4), serum antiflagella IgM and/or IgG antibodies (n = 10). Of these 13 patients, 7 had serum IgG antibodies to 2 of the 3 novel antigens at presentation. During long term follow-up, serum anti-invariable region 6 antibodies disappeared. CONCLUSIONS The present study suggests that assessment of serum antibodies to a panel of Borrelia-specific antigens could improve the laboratory diagnosis of NB at presentation.
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Affiliation(s)
- Tero Heikkilä
- Hospital for Children and Adolescents, University of Helsinki, Finland
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30
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Hammarén-Malmi S, Saxen H, Tarkkanen J, Mattila PS. Adenoidectomy does not significantly reduce the incidence of otitis media in conjunction with the insertion of tympanostomy tubes in children who are younger than 4 years: a randomized trial. Pediatrics 2005; 116:185-9. [PMID: 15995051 DOI: 10.1542/peds.2004-2253] [Citation(s) in RCA: 53] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of adenoidectomy in reducing the incidence of otitis media among children who are younger than 4 years and receive tympanostomy tubes. METHODS A randomized trial was conducted at a tertiary center clinic. A total of 217 children who were aged 12 to 48 months and had recurrent acute otitis media (>3 episodes during the past 6 months) or chronic otitis media with effusion, no obstructive symptoms as a result of adenoid enlargement, and no previous surgical intervention were enrolled in the study. Adenoidectomy in conjunction with the insertion of tympanostomy tubes or insertion of tympanostomy tubes without adenoidectomy was studied. The number of otitis media episodes during the follow-up period of 12 months was measured. RESULTS During the follow-up, the mean number of otitis media episodes was 1.7 among children who underwent adenoidectomy with concurrent insertion of tympanostomy tubes and 1.4 among children who received tympanostomy tubes only. The risk for recurrent otitis media (>or=3 episodes) could not be reduced by adenoidectomy (odds ratio: 1.66; 95% confidence interval: 0.80-3.46). CONCLUSION Adenoidectomy does not significantly reduce the incidence of acute otitis media in otitis prone children who are younger than 4 years and receive tympanostomy tubes.
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Affiliation(s)
- Sari Hammarén-Malmi
- Department of Otorhinolaryngology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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31
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Abstract
The objective of the study was to evaluate the risk of asthma in children who had undergone an adenoidectomy, an operation frequently performed on children with glue ear or recurrent otitis media. Two surveys were carried out, a nation-wide questionnaire returned by 483 individuals (survey A) and a survey of hospital discharge records involving 1616 children who had undergone an adenoidectomy and 161 control children who had undergone probing of the nasolacrimal duct due to congenital obstruction (survey B). The questionnaire (survey A) showed that an adenoidectomy before the age of 4 years was associated with asthma (OR 3.19, 95% CI 1.25; 8.13) and with allergy to animal dust (OR 2.50, 95% CI 1.27; 4.95). In survey B, asthma diagnosis was retrieved from the national asthma register. It showed also that adenoidectomy at an early age was associated with an increased risk of asthma (OR 6.74, 95% CI 2.99; 15.2). There was an association between asthma and adenoidectomy, even before adenoidectomy had actually been performed. The risk of asthma was highest among children who had had adenoidectomy because of recurrent otitis media. The observed association between an adenoidectomy and asthma may be explained by an underlying factor predisposing to both recurrent otitis media and asthma.
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Affiliation(s)
- Petri S Mattila
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland.
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32
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Lahdenne P, Panelius J, Saxen H, Heikkilä T, Sillanpää H, Peltomaa M, Arnez M, Huppertz HI, Seppälä IJT. Improved serodiagnosis of erythema migrans using novel recombinant borrelial BBK32 antigens. J Med Microbiol 2003; 52:563-567. [PMID: 12808077 DOI: 10.1099/jmm.0.05095-0] [Citation(s) in RCA: 27] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The performances of recombinant borrelial BBK32 proteins as antigens in the serology of erythema migrans (EM) were evaluated in an ELISA. Serum samples were obtained from 75 patients from different geographic areas where three borrelial species, Borrelia burgdorferi sensu stricto, Borrelia afzelii or Borrelia garinii, cause Lyme borreliosis. Antibodies to variant BBK32 proteins were compared with anti-flagella or with anti-IR(6) peptide antibodies. In IgG ELISA at presentation of EM, 65/75 (87 %) patients had antibodies to one or more variants of BBK32, 29/75 (39 %) had antibodies to flagella and 29/75 (39 %) had antibodies to the VlsE IR(6) peptide antigen. The immunoreactivity against variant BBK32 proteins differed in patients from different geographic regions. The present results suggest that the BBK32 proteins used in combination or in parallel may improve the laboratory diagnosis of EM.
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Affiliation(s)
- Pekka Lahdenne
- Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, 00290 Helsinki, Finland 2Department of Bacteriology and Immunology, Haartman Institute, Haartmaninkatu 3, 00014 Helsinki, Finland 3,7Department of Otolaryngology3 and Laboratory Diagnostics7, Helsinki University Central Hospital, 00290 Helsinki, Finland 4Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA 5Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia 6Professor-Hess-Children's Hospital Bremen and Children's Hospital of the University of Würzburg, Germany
| | - Jaana Panelius
- Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, 00290 Helsinki, Finland 2Department of Bacteriology and Immunology, Haartman Institute, Haartmaninkatu 3, 00014 Helsinki, Finland 3,7Department of Otolaryngology3 and Laboratory Diagnostics7, Helsinki University Central Hospital, 00290 Helsinki, Finland 4Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA 5Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia 6Professor-Hess-Children's Hospital Bremen and Children's Hospital of the University of Würzburg, Germany
| | - Harri Saxen
- Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, 00290 Helsinki, Finland 2Department of Bacteriology and Immunology, Haartman Institute, Haartmaninkatu 3, 00014 Helsinki, Finland 3,7Department of Otolaryngology3 and Laboratory Diagnostics7, Helsinki University Central Hospital, 00290 Helsinki, Finland 4Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA 5Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia 6Professor-Hess-Children's Hospital Bremen and Children's Hospital of the University of Würzburg, Germany
| | - Tero Heikkilä
- Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, 00290 Helsinki, Finland 2Department of Bacteriology and Immunology, Haartman Institute, Haartmaninkatu 3, 00014 Helsinki, Finland 3,7Department of Otolaryngology3 and Laboratory Diagnostics7, Helsinki University Central Hospital, 00290 Helsinki, Finland 4Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA 5Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia 6Professor-Hess-Children's Hospital Bremen and Children's Hospital of the University of Würzburg, Germany
| | - Heidi Sillanpää
- Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, 00290 Helsinki, Finland 2Department of Bacteriology and Immunology, Haartman Institute, Haartmaninkatu 3, 00014 Helsinki, Finland 3,7Department of Otolaryngology3 and Laboratory Diagnostics7, Helsinki University Central Hospital, 00290 Helsinki, Finland 4Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA 5Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia 6Professor-Hess-Children's Hospital Bremen and Children's Hospital of the University of Würzburg, Germany
| | - Miikka Peltomaa
- Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, 00290 Helsinki, Finland 2Department of Bacteriology and Immunology, Haartman Institute, Haartmaninkatu 3, 00014 Helsinki, Finland 3,7Department of Otolaryngology3 and Laboratory Diagnostics7, Helsinki University Central Hospital, 00290 Helsinki, Finland 4Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA 5Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia 6Professor-Hess-Children's Hospital Bremen and Children's Hospital of the University of Würzburg, Germany
| | - Maja Arnez
- Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, 00290 Helsinki, Finland 2Department of Bacteriology and Immunology, Haartman Institute, Haartmaninkatu 3, 00014 Helsinki, Finland 3,7Department of Otolaryngology3 and Laboratory Diagnostics7, Helsinki University Central Hospital, 00290 Helsinki, Finland 4Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA 5Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia 6Professor-Hess-Children's Hospital Bremen and Children's Hospital of the University of Würzburg, Germany
| | - Hans-Iko Huppertz
- Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, 00290 Helsinki, Finland 2Department of Bacteriology and Immunology, Haartman Institute, Haartmaninkatu 3, 00014 Helsinki, Finland 3,7Department of Otolaryngology3 and Laboratory Diagnostics7, Helsinki University Central Hospital, 00290 Helsinki, Finland 4Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA 5Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia 6Professor-Hess-Children's Hospital Bremen and Children's Hospital of the University of Würzburg, Germany
| | - Ilkka J T Seppälä
- Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, 00290 Helsinki, Finland 2Department of Bacteriology and Immunology, Haartman Institute, Haartmaninkatu 3, 00014 Helsinki, Finland 3,7Department of Otolaryngology3 and Laboratory Diagnostics7, Helsinki University Central Hospital, 00290 Helsinki, Finland 4Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA 5Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia 6Professor-Hess-Children's Hospital Bremen and Children's Hospital of the University of Würzburg, Germany
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33
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Heikkilä T, Huppertz HI, Seppälä I, Sillanpää H, Saxen H, Lahdenne P. Recombinant or peptide antigens in the serology of Lyme arthritis in children. J Infect Dis 2003; 187:1888-94. [PMID: 12792865 DOI: 10.1086/375371] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [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: 09/27/2002] [Accepted: 01/27/2003] [Indexed: 11/03/2022] Open
Abstract
The performance of ELISAs with the recombinant antigens decorin-binding protein A (DbpA), DbpB, and BBK32 (from Borrelia afzelii, B. garinii, and B. burgdorferi sensu stricto) and VlsE peptide antigen invariable region 6 (IR(6)) were evaluated in the serodiagnosis and follow-up of children with Lyme arthritis (LA). Serum samples were obtained from 52 children with clinically typical and serologically confirmed LA. In IgG ELISAs, at diagnosis, 50 samples were positive for BBK32, 51 for DbpA, 40 for DbpB, and 51 for IR(6). In the posttreatment follow-up, the rate of decline of the antibodies to the recombinant protein antigens or to IR(6) did not appear useful in the prediction of the treatment response or the clinical course of LA. Yet, IR(6) seems to have the greatest potential to be used universally in the diagnostic serology of Lyme borreliosis (LB). Alternate to that, the use of several specific borrelial antigens, in parallel, might improve the accuracy of serology for LB.
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Affiliation(s)
- Tero Heikkilä
- Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
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Skogberg K, Nuorti JP, Saxen H, Kusnetsov J, Mentula S, Fellman V, Mäki-Petäys N, Jousimies-Somer H. A newborn with domestically acquired legionnaires disease confirmed by molecular typing. Clin Infect Dis 2002; 35:e82-5. [PMID: 12355396 DOI: 10.1086/342886] [Citation(s) in RCA: 13] [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: 01/29/2002] [Revised: 06/10/2002] [Indexed: 11/03/2022] Open
Abstract
Legionella pneumophila serogroup 6 was recovered from a bronchoalveolar lavage specimen from a 1-week-old, full-term newborn with pneumonia, as well as from water samples from the maternity hospital and the newborn's home (an apartment). Amplified fragment-length polymorphism typing revealed that the strains isolated from the newborn and her home were indistinguishable from each other but were clearly different from the hospital and control strains. To our knowledge, this is the first report of domestic acquisition of legionnaires disease in a newborn to have been confirmed by molecular typing.
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Affiliation(s)
- Kirsi Skogberg
- Department of Infectious Disease Epidemiology, National Public Health Institute, Helsinki, Finland
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Heikkilä T, Seppälä I, Saxen H, Panelius J, Peltomaa M, Huppertz HI, Lahdenne P. Cloning of the gene encoding the decorin-binding protein B (DbpB) in Borrelia burgdorferi sensu lato and characterisation of the antibody responses to DbpB in Lyme borreliosis. J Med Microbiol 2002; 51:641-648. [PMID: 12171294 DOI: 10.1099/0022-1317-51-8-641] [Citation(s) in RCA: 13] [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: 11/18/2022] Open
Abstract
A genome walking technique was applied to borrelial DNA to clone the gene encoding decorin-binding protein B (DbpB) in Borrelia garinii and B. afzelii. Sequence analysis showed 62-67% identity of the predicted amino acid sequences of DbpB between the B. afzelii and B. garinii strains and B. burgdorferi sensu stricto. Within subspecies, the sequences were 99-100% identical. The respective recombinant DbpBs (rDbpBs) were produced and tested as antigens in an enzyme-linked immunosorbent assay (ELISA) for Lyme borreliosis (LB). In IgG ELISA, with rDbpBs as antigens, 11 (73%) of 15 adult patients with Lyme arthritis and 9 (64%) of 14 with neuroborreliosis were positive. Of children with Lyme arthritis, 40 (77%) of 52 were positive. All adult and paediatric patients with disseminated LB had high titres of anti-flagellin IgG antibodies. Seropositivity against rDbpB from B. garinii predominated, 39 (65%) of 60 of the positive samples reacting with rDbpB from B. garinii. In patients with erythema migrans, IgM antibodies to rDbpB were detected in 1 (4%) of 23 and IgG antibodies in 6 (26%) of 23. These results indicate that DbpB may be a useful antigen in the IgG serology for disseminated LB. The high inter-species sequence heterogeneity observed indicates that a combination of the variant DbpBs should be included in the antigen set to cover all the relevant borrelial subspecies in the serodiagnosis of LB.
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Affiliation(s)
- Tero Heikkilä
- *Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, FIN-00290 Helsinki, †Department of Bacteriology and Immunology, Haartman Institute, Haartmaninkatu 3, FIN-00290 Helsinki, ‡Laboratory Diagnostics, Helsinki University Central Hospital, Haartmaninkatu 3, FIN-00290 Helsinki, §Department of Otorhinolaryngology, University of Helsinki, 00290 Helsinki, Finland and Professor- Hess-Children's Hospital, Bremen Central Hospital, 28205 Bremen, Germany
| | - Ilkka Seppälä
- *Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, FIN-00290 Helsinki, †Department of Bacteriology and Immunology, Haartman Institute, Haartmaninkatu 3, FIN-00290 Helsinki, ‡Laboratory Diagnostics, Helsinki University Central Hospital, Haartmaninkatu 3, FIN-00290 Helsinki, §Department of Otorhinolaryngology, University of Helsinki, 00290 Helsinki, Finland and Professor- Hess-Children's Hospital, Bremen Central Hospital, 28205 Bremen, Germany
| | - Harri Saxen
- *Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, FIN-00290 Helsinki, †Department of Bacteriology and Immunology, Haartman Institute, Haartmaninkatu 3, FIN-00290 Helsinki, ‡Laboratory Diagnostics, Helsinki University Central Hospital, Haartmaninkatu 3, FIN-00290 Helsinki, §Department of Otorhinolaryngology, University of Helsinki, 00290 Helsinki, Finland and Professor- Hess-Children's Hospital, Bremen Central Hospital, 28205 Bremen, Germany
| | - Jaana Panelius
- *Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, FIN-00290 Helsinki, †Department of Bacteriology and Immunology, Haartman Institute, Haartmaninkatu 3, FIN-00290 Helsinki, ‡Laboratory Diagnostics, Helsinki University Central Hospital, Haartmaninkatu 3, FIN-00290 Helsinki, §Department of Otorhinolaryngology, University of Helsinki, 00290 Helsinki, Finland and Professor- Hess-Children's Hospital, Bremen Central Hospital, 28205 Bremen, Germany
| | - Miikka Peltomaa
- *Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, FIN-00290 Helsinki, †Department of Bacteriology and Immunology, Haartman Institute, Haartmaninkatu 3, FIN-00290 Helsinki, ‡Laboratory Diagnostics, Helsinki University Central Hospital, Haartmaninkatu 3, FIN-00290 Helsinki, §Department of Otorhinolaryngology, University of Helsinki, 00290 Helsinki, Finland and Professor- Hess-Children's Hospital, Bremen Central Hospital, 28205 Bremen, Germany
| | | | - Pekka Lahdenne
- *Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, FIN-00290 Helsinki, †Department of Bacteriology and Immunology, Haartman Institute, Haartmaninkatu 3, FIN-00290 Helsinki, ‡Laboratory Diagnostics, Helsinki University Central Hospital, Haartmaninkatu 3, FIN-00290 Helsinki, §Department of Otorhinolaryngology, University of Helsinki, 00290 Helsinki, Finland and Professor- Hess-Children's Hospital, Bremen Central Hospital, 28205 Bremen, Germany
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Bauer RJ, Zhang L, Foxman B, Siitonen A, Jantunen ME, Saxen H, Marrs CF. Molecular epidemiology of 3 putative virulence genes for Escherichia coli urinary tract infection-usp, iha, and iroN(E. coli). J Infect Dis 2002; 185:1521-4. [PMID: 11992291 DOI: 10.1086/340206] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2001] [Revised: 01/10/2002] [Indexed: 01/08/2023] Open
Abstract
This study describes the epidemiological association of 3 putative genes for virulence of uropathogenic Escherichia coli; uropathogenic specific protein (usp), a Vibrio cholerae zot gene homologue; IrgA homologue adhesin (iha), a nonhemagglutinating adhesin; and iroN(E. coli), a catechole siderophore receptor homologue. We compared the relative frequency in urinary tract infection (UTI) isolates (n=508), compared with non-UTI isolates (n=416). iroN(E. coli) occurred 2.1-3.6 times more frequently in UTI isolates than in rectal isolates (P=1.1x10-18 to P=2.7x10-5) and was associated with several uropathogenic virulence genes found on pathogenicity islands. usp occurred more frequently in isolates from patients with pyelonephritis (P=3.6x10-9), in periurethral isolates (P=.001), and in isolates from patients with UTI who were aged 40-65 years (P=.004), when compared with the rectal isolates; iha was not associated with UTI in this study.
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Affiliation(s)
- Richard J Bauer
- Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, MI 48109, USA
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Mattila PS, Tarkkanen J, Saxen H, Pitkäniemi J, Karvonen M, Tuomilehto J. Predisposition to atopic symptoms to inhaled antigens may protect from childhood type 1 diabetes. Diabetes Care 2002; 25:865-8. [PMID: 11978682 DOI: 10.2337/diacare.25.5.865] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the inverse association between type 1 diabetes and asthma to establish whether environmental and/or genetic factors predisposing to asthma or to atopic symptoms to inhaled antigens protect from diabetes. RESEACH DESIGN AND METHODS: Questionnaires were returned by 306 probands with childhood type 1 diabetes, their 506 nonaffected siblings, and 406 age- and sex-matched unaffected population control subjects. The main outcome measures were self-reported physician-diagnosed asthma and atopic symptoms to animal dust and pollen. RESULTS Risk of diabetes was inversely associated with asthma (odds ratio 0.49 [95% CI 0.24-1.00]), allergy to animal dust (0.67 [0.45-0.99]), and to a lesser degree to pollen (0.74 [0.51-1.07]) when the probands were compared with the population control subjects. Among the children of the families of an affected proband, the risk of diabetes appeared to be inversely associated with asthma (0.54 [0.27-1.09]) but not with allergy to animal dust (0.99 [0.66-1.47]) nor allergy to pollen (0.88 [0.62-1.27]). CONCLUSIONS The frequency of asthma and atopic symptoms to some inhaled antigens is decreased in individuals with childhood type 1 diabetes. Factors predisposing to atopic symptoms to inhaled antigens may protect from childhood type 1 diabetes.
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Affiliation(s)
- Petri S Mattila
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland.
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Vuori-Holopainen E, Salo E, Saxen H, Vaara M, Tarkka E, Peltola H. Clinical "pneumococcal pneumonia" due to Moraxella osloensis: case report and a review. Scand J Infect Dis 2002; 33:625-7. [PMID: 11525360 DOI: 10.1080/00365540110026737] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A previously healthy 6-y-old girl presented with a disease very similar to pneumococcal pneumonia. However, Moraxella osloensis was isolated by lung tap. The patient responded well to a course of parenteral penicillin. This is probably the first documented case of community-acquired pneumonia associated with this agent. Clinical isolates of M. osloensis are rare and its pathogenesis has not been delineated; however, a literature review suggests that the organism is more common than is generally recognized.
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Affiliation(s)
- E Vuori-Holopainen
- Hospital for Children and Adolescents, Helsinki University Central Hospital, Finland
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Marrs CF, Zhang L, Tallman P, Manning SD, Somsel P, Raz P, Colodner R, Jantunen ME, Siitonen A, Saxen H, Foxman B. Variations in 10 putative uropathogen virulence genes among urinary, faecal and peri-urethral Escherichia coli. J Med Microbiol 2002; 51:138-142. [PMID: 11863265 DOI: 10.1099/0022-1317-51-2-138] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A total of 868 isolates was screened from seven different collections of organisms from previous studies - pyelonephritis in children aged 1-24 months; first, second and recurring urinary tract infection (UTI) in women aged 18-39 years; UTI in women aged 40-65 years and peri-urethral and faecal isolates from women aged 18-39 years - for the presence of 10 potential Escherichia coli UTI virulence genes. Previously reported differences between the frequency of these genes in UTI compared with faecal isolates were confirmed and extended. A single virulence signature (strains containing aer, kpsMT, ompT, fim and papGAD) occurred in 29% of the pyelonephritic isolates, but in no more than 11% of the other collections. Peri-urethral isolates were found to have frequencies of these 10 genes that differed from those found for both UTI and faecal isolates.
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Affiliation(s)
| | | | | | | | - Patricia Somsel
- Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory Street, Ann Arbor, MI 48109, *Bureau of Laboratories, Michigan Department of Community Health, 3350 N. Martin Luther King Jr Blvd, PO Box 30035, Lansing, MI 48909, †Infectious Disease Unit and ‡Microbiology Laboratory, Ha'Emek Medical Center, 18101 Afula, Israel and †Faculty of Medicine, Technion, Haifa, Israel, §Hospital for Children and Adolescents, University of Helsinki and ∥Laboratory of Enteric Pathogens, National Public Health Institute, Mannerheimintie 166, FIN-00300, Helsinki, Finland
| | - Paul Raz
- Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory Street, Ann Arbor, MI 48109, *Bureau of Laboratories, Michigan Department of Community Health, 3350 N. Martin Luther King Jr Blvd, PO Box 30035, Lansing, MI 48909, †Infectious Disease Unit and ‡Microbiology Laboratory, Ha'Emek Medical Center, 18101 Afula, Israel and †Faculty of Medicine, Technion, Haifa, Israel, §Hospital for Children and Adolescents, University of Helsinki and ∥Laboratory of Enteric Pathogens, National Public Health Institute, Mannerheimintie 166, FIN-00300, Helsinki, Finland
| | - Raul Colodner
- Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory Street, Ann Arbor, MI 48109, *Bureau of Laboratories, Michigan Department of Community Health, 3350 N. Martin Luther King Jr Blvd, PO Box 30035, Lansing, MI 48909, †Infectious Disease Unit and ‡Microbiology Laboratory, Ha'Emek Medical Center, 18101 Afula, Israel and †Faculty of Medicine, Technion, Haifa, Israel, §Hospital for Children and Adolescents, University of Helsinki and ∥Laboratory of Enteric Pathogens, National Public Health Institute, Mannerheimintie 166, FIN-00300, Helsinki, Finland
| | - Maria E Jantunen
- Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory Street, Ann Arbor, MI 48109, *Bureau of Laboratories, Michigan Department of Community Health, 3350 N. Martin Luther King Jr Blvd, PO Box 30035, Lansing, MI 48909, †Infectious Disease Unit and ‡Microbiology Laboratory, Ha'Emek Medical Center, 18101 Afula, Israel and †Faculty of Medicine, Technion, Haifa, Israel, §Hospital for Children and Adolescents, University of Helsinki and ∥Laboratory of Enteric Pathogens, National Public Health Institute, Mannerheimintie 166, FIN-00300, Helsinki, Finland
| | - Anja Siitonen
- Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory Street, Ann Arbor, MI 48109, *Bureau of Laboratories, Michigan Department of Community Health, 3350 N. Martin Luther King Jr Blvd, PO Box 30035, Lansing, MI 48909, †Infectious Disease Unit and ‡Microbiology Laboratory, Ha'Emek Medical Center, 18101 Afula, Israel and †Faculty of Medicine, Technion, Haifa, Israel, §Hospital for Children and Adolescents, University of Helsinki and ∥Laboratory of Enteric Pathogens, National Public Health Institute, Mannerheimintie 166, FIN-00300, Helsinki, Finland
| | - Harri Saxen
- Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory Street, Ann Arbor, MI 48109, *Bureau of Laboratories, Michigan Department of Community Health, 3350 N. Martin Luther King Jr Blvd, PO Box 30035, Lansing, MI 48909, †Infectious Disease Unit and ‡Microbiology Laboratory, Ha'Emek Medical Center, 18101 Afula, Israel and †Faculty of Medicine, Technion, Haifa, Israel, §Hospital for Children and Adolescents, University of Helsinki and ∥Laboratory of Enteric Pathogens, National Public Health Institute, Mannerheimintie 166, FIN-00300, Helsinki, Finland
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Heikkilä T, Seppälä I, Saxen H, Panelius J, Yrjänäinen H, Lahdenne P. Species-specific serodiagnosis of Lyme arthritis and neuroborreliosis due to Borrelia burgdorferi sensu stricto, B. afzelii, and B. garinii by using decorin binding protein A. J Clin Microbiol 2002; 40:453-60. [PMID: 11825956 PMCID: PMC153353 DOI: 10.1128/jcm.40.02.453-460.2002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [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: 11/20/2022] Open
Abstract
The antigenic potential of decorin binding protein A (DbpA) was evaluated in serodiagnosis of human Lyme borreliosis (LB). The dbpA was cloned and sequenced from the three pathogenic Borrelia species common in Europe. Sequence analysis revealed high interspecies heterogeneity. The identity of the predicted amino acid sequences was 43 to 62% among Borrelia burgdorferi sensu stricto, B. afzelii, and B. garinii. The respective recombinant DbpAs (rDbpAs) were produced and tested as antigens by Western blotting and enzyme-linked immunosorbent assay (ELISA). One hundred percent of patients with neuroborreliosis (NB) and 93% of patients with Lyme arthritis (LA) reacted positively. Sera from the majority of patients reacted with one rDbpA only and had no or low cross-reactivity to other two variant proteins. In patients with culture-positive erythema migrans (EM), the sensitivity of rDbpA immunoglobulin G (IgG) or IgM ELISA was low. The DbpA seems to be a sensitive and specific antigen for the serodiagnosis of LA or NB, but not of EM, provided that variants from all three pathogenic borrelial species are included in the combined set of antigens.
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Affiliation(s)
- Tero Heikkilä
- Hospital for Children and Adolescents, University of Helsinki, Finland.
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41
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Panelius J, Lahdenne P, Saxen H, Heikkilä T, Seppälä I. Recombinant flagellin A proteins from Borrelia burgdorferi sensu stricto, B. afzelii, and B. garinii in serodiagnosis of Lyme borreliosis. J Clin Microbiol 2001; 39:4013-9. [PMID: 11682523 PMCID: PMC88480 DOI: 10.1128/jcm.39.11.4013-4019.2001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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: 11/20/2022] Open
Abstract
Genes for flagellin A (FlaA) proteins from European borrelial strains of Borrelia burgdorferi sensu stricto, B. afzelii, and B. garinii were cloned and sequenced. An identity of 92 to 93% was observed in the flaA sequences of the different species. Polyhistidine-tagged recombinant FlaA (rFlaA) proteins were produced in Escherichia coli and used as antigens in Western blotting (WB) and enzyme-linked immunosorbent assay (ELISA). In immunoglobulin G (IgG) WB, 71% (10 of 14) of the sera from neuroborreliosis and 86% (12 of 14) of those from Lyme arthritis patients reacted with one to three rFlaAs. In IgG ELISA, 74% (14 of 19) and 79% (15 of 19) of patients with neuroborreliosis and arthritis, respectively, were positive. The immunoreactivity in local European patient sera was stronger against rFlaA from B. garinii and B. afzelii than against rFlaA from B. burgdorferi sensu stricto. Neither IgG nor IgM ELISA was sensitive in the serodiagnosis of erythema migrans. Serum samples from patients with syphilis and systemic lupus erythematosus showed mild cross-reactivity in IgG tests. Sera from Yersinia enterocolitica or beta-hemolytic Streptococcus infections showed only occasional responses. With IgM ELISA, 58% (11 of 19) and 37% (7 of 19) of patients with neuroborreliosis and arthritis, respectively, were positive. Cross-reactive antibodies to FlaA, especially in serum samples from patients with rheumatoid factor positivity and Epstein-Barr virus infection, reduced the specificity of IgM serodiagnosis. Therefore, rFlaA seems to have a limited role for IgM serodiagnosis, yet rFlaA might be useful in the IgG serodiagnosis of disseminated Lyme borreliosis.
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Affiliation(s)
- J Panelius
- Haartman Institute, Department of Bacteriology and Immunology, Helsinki, Finland.
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Hovi L, Saarinen-Pihkala UM, Vettenranta K, Saxen H. Invasive fungal infections in pediatric bone marrow transplant recipients: single center experience of 10 years. Bone Marrow Transplant 2000; 26:999-1004. [PMID: 11100280 DOI: 10.1038/sj.bmt.1702654] [Citation(s) in RCA: 137] [Impact Index Per Article: 5.7] [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: 11/09/2022]
Abstract
Invasive fungal infections (IFI) with substantial mortality constitute an increasing problem among BMT patients. From 1986 to 1996 148 children underwent BMT, and are included in a retrospective analysis of the incidence, risk factors and outcome of IFI. By histopathology or culture-proven IFI (Candida, 10; Aspergillus, 8) was documented in 12/73 (16%) allogeneic and in 6/75 (8%) autologous BMT patients. Of these 18 patients, 15 subsequently died, and in 12 (66%) IFI was regarded as the main cause of death. In addition to the patients with documented IFI, 48 had suspected and 82 no fungal infection. Invasive candidal infections were more frequent in patients with semiquantitatively estimated abundant candidal colonization as compared with those with no colonization (18% vs 3%, P = 0.015). In the allogeneic group, 50% of those with severe (grades III-IV) aGVHD had IFI as opposed to 8% of those with no or mild aGVHD (P < 0.001). Regarding cGVHD, 57% of those with extensive cGVHD vs 5% of those with absent or limited cGVHD had IFI (P < 0.001). The dose of steroids was associated with IFI: 77% of those who received high-dose steroids (methylprednisolone 0.25-1 g/day for 5 days) vs 5% of those with conventional-dose (prednisone 2 mg/kg/day) had IFI (P < 0.001). Particularly for BMT patients at risk, new, quicker and better diagnostic tests and more effective anti-fungal agents, both for prophylaxis and treatment, are needed.
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Affiliation(s)
- L Hovi
- Hospital for Children and Adolescents, University of Helsinki, Finland
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43
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Pitkäranta A, Atula T, Lindahl P, Saxen H, Malmberg H. Unilateral blindness in a child with acute sinusitis. Rhinology 2000; 38:43-4. [PMID: 10780047] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Orbital infection in association with sinusitis is an emergency. It may cause visual disturbances, and in rare cases even permanent blindness by affecting the optic nerve. We report an unusual case of acute sinusitis that was complicated by irreversible visual loss in a young patient. As there is increasing evidence that respiratory viruses play an important role in the pathogenesis of acute community acquired sinusitis and spontaneous healing with only symptomatic treatment is common, the use of antibiotics in the treatment of acute sinusitis may not be needed in all cases. If the general policy to use antibiotics in acute sinusitis will be changed to more restrained and expectant, we have to be even more aware of these nowadays rare complications.
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Affiliation(s)
- A Pitkäranta
- Department of Otorhinolaryngology, Helsinki University Hospital, Finland
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Peltomaa M, Saxen H, Seppälä I, Viljanen M, Pyykkö I. Paediatric facial paralysis caused by Lyme borreliosis: a prospective and retrospective analysis. Scand J Infect Dis 1998; 30:269-75. [PMID: 9790136 DOI: 10.1080/00365549850160927] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [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
The incidence of Lyme borreliosis (LB) was studied prospectively in 49 children (< 17 years of age) with 50 episodes of acute FP. In addition, 43 children with a history of FP (average follow-up of 5.2 y) were studied retrospectively for the outcome of FP and for the symptoms and signs of late LB. In the prospective study, 17 (34%) patients with FP proved to have acute LB. They all received antibiotic treatment and their FP had a favourable outcome. In the retrospective study the patients had had FP before the diagnostic tests for LB were available. Thus, none of the 43 patients had been diagnosed to have, or treated for, LB. The outcome of their FP had generally been favourable. None of them had any signs of late LB at the follow-up visit. Our results indicate that LB is a frequent cause of acute paediatric FP in an endemic area. In addition our data suggests that FP caused by LB in children has a favourable prognosis, even when left untreated.
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Affiliation(s)
- M Peltomaa
- Department of Otolaryngology, Helsinki University Central Hospital, Finland
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45
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Hynninen M, Valtonen M, Vaara M, Markkanen H, Kuusela P, Saxen H, Takkunen O. Plasma interleukin-8, interleukin-10, and E-selectin levels in neutropenic and non-neutropenic bacteremic patients. Eur J Clin Microbiol Infect Dis 1997; 16:587-91. [PMID: 9323470 DOI: 10.1007/bf02447921] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Plasma interleukin-8 (IL-8) interleukin-10 (IL-10), and E-selectin concentrations were studied in 39 neutropenic and 30 non-neutropenic bacteremic patients; 54 nonbacteremic patients were analyzed as controls. Interleukin-8 concentrations were significantly higher in neutropenic than in non-neutropenic bacteremic patients (median 475 vs. 0 pg/ml, p < 0.0001). Median IL-8 and IL-10 levels were higher in bacteremic than in non-bacteremic patients (330 vs. 0 pg/ml, p < 0.0001 and 20 vs. 0 pg/ml, p = 0.04, respectively). In contrast, concentrations of IL-10 were similar in neutropenic and non-neutropenic patients. Median levels of E-selectin were not increased in any of the patient groups. Neutropenic bacteremic patients showed significantly lower concentrations of E-selectin than did non-neutropenic bacteremic patients (p < 0.0001). In conclusion, neutropenic bacteremic patients had significantly higher concentrations of IL-8 than non-neutropenic bacteremic patients. Levels of IL-10 were higher in bacteremic than in nonbacteremic patients, but neutropenic and non-neutropenic patients had similar levels of IL-10. Increased levels of E-selectin were not found in any of the patient groups, although neutropenic patients with bacteremia had lower concentrations than did non-neutropenic patients.
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Affiliation(s)
- M Hynninen
- Department of Surgery/Intensive Care Unit, Helsinki University Central Hospital, Finland
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Mäki-Ikola O, Mertsola J, Granfors K, Kuusela P, Lehtinen K, Von Essen R, Saxen H. No endotoxin detected in plasma of patients with ankylosing spondylitis. Ann Rheum Dis 1997; 56:279. [PMID: 9166006 PMCID: PMC1752363 DOI: 10.1136/ard.56.4.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
The aim of the study was to investigate the possible signs of chronic spirochetal infection in 27 children with a history of facial paralysis with onset of symptoms during May-October 1985-1993. These children had not been studied at the time of facial paralysis for possible Lyme borreliosis and none of these children had received antimicrobial therapy at that time. The patients were interviewed with special reference to symptoms and signs of Lyme borreliosis and thereafter examined clinically and with laboratory tests. None of the patients showed signs or symptoms of chronic Lyme borreliosis. One child-now a 14-year old girl-had a 4-fold rise in serum Borrelia burgdorferi antibodies as a sign of a recent infection. According to our prospective studies on pediatric facial paralysis in Finland (over 50% of children presenting with facial paralysis during May-October have Lyme borreliosis), we have a reason to assume that at least some in our study group had a facial paralysis caused by Borrelia burgdorferi infection. The results of our study indicate that facial paralysis has a favorable prognosis and in short-term follow-up the children do not have symptoms or signs of chronic Lyme borreliosis.
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Affiliation(s)
- M Peltomaa
- Department of Otolaryngology, Helsinki University Hospital, Sweden
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Hynninen M, Valtonen M, Vaara M, Markkanen H, Kuusela P, Saxen H, Takkunen O. Plasma endotoxin and cytokine levels in neutropenic and non-neutropenic bacteremic patients. Eur J Clin Microbiol Infect Dis 1995; 14:1039-45. [PMID: 8681977 DOI: 10.1007/bf01590936] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [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: 02/01/2023]
Abstract
Plasma endotoxin, tumor necrosis factor-alpha (TNF-alpha), interleukin 1 beta (IL-1 beta), interleukin 1 receptor antagonist (IL-1ra), and interleukin 6 (IL-6) concentrations in 69 bacteremic patients were compared with those in 54 nonbacteremic patients suffering from suspected bacterial infections. Only three (11%) of the 27 patients with gram-negative bacteremia showed detectable levels of endotoxin. TNF-alpha was detected in 6% of the bacteremic patients and in none of the nonbacteremic patients. Median IL-6 levels were significantly higher in bacteremic than in nonbacteremic patients (55 vs. 0 pg/ml, p = 0.0008). IL-6 concentrations were similar in neutropenic and non-neutropenic bacteremic patients (median 55 vs. 74 pg/ml). In contrast, neutropenic bacteremic patients had significantly lower concentrations of IL-1ra than non-neutropenic bacteremic patients (250 vs. 1,950 pg/ml, p < 0.0001). Patients with fatal bacteremia had significantly higher concentrations of IL-6 and IL-1ra than the survivors (median, 450 vs. 40, p = 0.012 and 7,600 vs. 420 pg/ml, p = 0.0075, respectively). Determinations of endotoxin or TNF-alpha in patients with suspected bacteremia failed to offer clinically relevant data on the prognosis of these patients. IL-6 levels correlated with both the presence of bacteremia and the risk of death. Granulocytopenic patients with bacteremia had lower levels of circulating IL-1ra than patients with normal granulocyte counts, and these levels correlated with poor outcome.
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Affiliation(s)
- M Hynninen
- Department of Anesthesia, Helsinki University Central Hospital, Finland
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Hansen EJ, Lumbley SR, Saxen H, Kern K, Cope LD, Radolf JD. Detection of Haemophilus ducreyi lipooligosaccharide by means of an immunolimulus assay. J Immunol Methods 1995; 185:225-35. [PMID: 7561133 DOI: 10.1016/0022-1759(95)00118-t] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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: 01/25/2023]
Abstract
A murine monoclonal antibody (MAb) directed against a surface-exposed epitope of the lipooligosaccharide (LOS) of Haemophilus ducreyi strain 35000 was shown to be reactive with all 37 strains of this pathogen tested in a colony blot-radioimmunoassay. The LOS epitope bound by this MAb appeared to be stably expressed by H. ducreyi growing in vitro. The use of this MAb in the immunolimulus system revealed that it could detect purified H. ducreyi LOS at a level of 25 pg/ml. Similarly, this immunolimulus system could detect as few as 1000 colony forming units of in vitro-grown H. ducreyi cells per ml of buffer. When this MAb was utilized in the immunolimulus system together with lesion material from rabbits infected with two different H. ducreyi strains, a positive reaction was obtained with every sample tested, even when no viable organisms were present in the lesion material. In contrast, this MAb yielded consistently negative results when used in the immunolimulus system with lesion material from animals infected with Staphylococcus aureus.
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Affiliation(s)
- E J Hansen
- Department of Microbiology, University of Texas Southwestern Medical Center, Dallas 75235-9048, USA
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Saxen H, Virtanen M, Carlson P, Hoppu K, Pohjavuori M, Vaara M, Vuopio-Varkila J, Peltola H. Neonatal Candida parapsilosis outbreak with a high case fatality rate. Pediatr Infect Dis J 1995; 14:776-81. [PMID: 8559627 DOI: 10.1097/00006454-199509000-00009] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A Candida parapsilosis outbreak of 58 cases in a neonatal intensive care unit lasted for 55 months. Patients infected by or colonized with C. parapsilosis were mainly very low birth weight infants (birth weight < 1500 g). Their mean birth weight was 817 g and their mean gestational age was 28 weeks. Statistical analysis including logistic regression confirmed that prematurity was the main risk factor. The analysis also suggested that C. parapsilosis infection (or colonization) was associated with a poor prognosis. In infants with gestational age < 29 weeks the risk for death in C. parapsilosis-infected patients was 16-fold greater than in those with no C. parapsilosis infection. The case fatality rate of C. parapsilosis patients was higher than that of the controls (9 of 23 vs. 1 of 40; P < 0.0001). The outbreak was most likely a result of cross-infection because C. parapsilosis could be isolated only from the patients and from the hands of four nurses immediately after they had cared for a colonized patient. Cessation of the outbreak was temporally associated with long term parenteral fluconazole (6 mg/kg/day) prophylaxis.
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Affiliation(s)
- H Saxen
- Children's Hospital, University of Helsinki, Finland
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