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Tietäväinen J, Seiskari T, Aittoniemi J, Huhtala H, Mustonen J, Huttunen R, Syrjänen J, Rannikko J. Assessment of a novel BLOOMY score for predicting mortality in hospitalised adults with bloodstream infection. Infection 2024:10.1007/s15010-024-02254-5. [PMID: 38652226 DOI: 10.1007/s15010-024-02254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE A German multicentre study BLOOMY was the first to use machine learning approach to develop mortality prediction scores for bloodstream infection (BSI) patients, but the scores have not been assessed in other cohorts. Our aim was to assess how the BLOOMY 14-day and 6-month scores estimate mortality in our cohort of 497 cases with BSI. METHODS Clinical data, laboratory data, and patient outcome were gathered retrospectively from patient records. The scores were calculated as presented in the BLOOMY study with the exception in the day of the evaluation. RESULTS In our cohort, BLOOMY 14-day score estimated death by day 14 with an area under curve (AUC) of 0.87 (95% Confidence Interval 0.80-0.94). Using ≥ 6 points as a cutoff, sensitivity was 68.8%, specificity 88.1%, positive predictive value (PPV) 39.3%, and negative predictive value (NPV) 96.2%. These results were similar in the original BLOOMY cohort and outweighed both quick Sepsis-Related Organ Failure Assessment (AUC 0.76) and Pitt Bacteraemia Score (AUC 0.79) in our cohort. BLOOMY 6-month score to estimate 6-month mortality had an AUC of 0.79 (0.73-0.85). Using ≥ 6 points as a cutoff, sensitivity was 98.3%, specificity 10.7%, PPV 25.7%, and NPV 95.2%. AUCs of 6-month score to estimate 1-year and 5-year mortality were 0.80 (0.74-0.85) and 0.77 (0.73-0.82), respectively. CONCLUSION The BLOOMY 14-day and 6-month scores performed well in the estimations of mortality in our cohort and exceeded some established scores, but their adoption in clinical work remains to be seen.
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Affiliation(s)
- Johanna Tietäväinen
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520, Tampere, Finland
| | - Tapio Seiskari
- Department of Clinical Microbiology, Fimlab Laboratories Ltd, P.O. Box 66, 33013, Tampere, Finland
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories Ltd, P.O. Box 66, 33013, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Arvo Ylpön Katu 34, 33520, Tampere, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520, Tampere, Finland
| | - Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland
| | - Jaana Syrjänen
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland
| | - Juha Rannikko
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520, Tampere, Finland.
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Allonen S, Aittoniemi J, Vuorialho M, Närhi L, Panula K, Vuento R, Honkaniemi J. Streptococcus intermedius causing primary bacterial ventriculitis in a patient with severe periodontitis - a case report. BMC Neurol 2024; 24:112. [PMID: 38580923 PMCID: PMC10996266 DOI: 10.1186/s12883-024-03604-4] [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: 05/17/2023] [Accepted: 03/17/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Streptococcus intermedius is a member of the S. anginosus group and is part of the normal oral microbiota. It can cause pyogenic infections in various organs, primarily in the head and neck area, including brain abscesses and meningitis. However, ventriculitis due to periodontitis has not been reported previously. CASE PRESENTATION A 64-year-old male was admitted to the hospital with a headache, fever and later imbalance, blurred vision, and general slowness. Neurological examination revealed nuchal rigidity and general clumsiness. Meningitis was suspected, and the patient was treated with dexamethasone, ceftriaxone and acyclovir. A brain computer tomography (CT) scan was normal, and cerebrospinal fluid (CSF) Gram staining and bacterial cultures remained negative, so the antibacterial treatment was discontinued. Nine days after admission, the patient's condition deteriorated. The antibacterial treatment was restarted, and a brain magnetic resonance imaging revealed ventriculitis. A subsequent CT scan showed hydrocephalus, so a ventriculostomy was performed. In CSF Gram staining, chains of gram-positive cocci were observed. Bacterial cultures remained negative, but a bacterial PCR detected Streptococcus intermedius. An orthopantomography revealed advanced periodontal destruction in several teeth and periapical abscesses, which were subsequently operated on. The patient was discharged in good condition after one month. CONCLUSIONS Poor dental health can lead to life-threatening infections in the central nervous system, even in a completely healthy individual. Primary bacterial ventriculitis is a diagnostic challenge, which may result in delayed treatment and increased mortality.
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Affiliation(s)
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab laboratories, Arvo Ylpon katu 4, 33520, Tampere, Finland.
| | - Matti Vuorialho
- Department of Radiology, Vaasa Central Hospital, Vaasa, Finland
| | - Lassi Närhi
- Department of Physical and Rehabilitation Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Kari Panula
- Department of Oral and Maxillofacial Surgery, Vaasa Central Hospital, Vaasa, Finland
| | - Risto Vuento
- Department of Clinical Microbiology, Fimlab laboratories, Arvo Ylpon katu 4, 33520, Tampere, Finland
| | - Jari Honkaniemi
- Department of Neurology, Vaasa Central Hospital, Vaasa, Finland
- Tampere University Hospital, Tampere and Turku University, Turku, Finland
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Luukinen B, Antikainen J, Aittoniemi J, Miikkulainen-Lahti T, Hyyryläinen HL, Pätäri-Sampo A. Evaluation of the FluoroType Mycobacteria assay for identification of mycobacteria. J Clin Microbiol 2024; 62:e0105423. [PMID: 38350859 PMCID: PMC10935635 DOI: 10.1128/jcm.01054-23] [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: 08/19/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Abstract
Accurate species identification is a prerequisite for successful management of tuberculosis and non-tuberculous mycobacterial (NTM) diseases. The novel FluoroType Mycobacteria assay combines three established GenoType DNA strip assays (CM, AS, and NTM-DR), allowing detection of Mycobacterium tuberculosis and 32 NTM species/subspecies in a single assay with automatic detection and result analysis. We evaluated the clinical performance of the FluoroType assay and its feasibility in replacing the GenoType Mycobacterium CM assay as the initial method for mycobacterial identification. A total of 191 clinical mycobacterial cultures were analyzed in this study: 180 identified for one mycobacterial species, 6 for multiple, and 5 for no mycobacterial species. Positive percent agreement (PPA) for the FluoroType assay was 87.8% (n = 158), with full agreement for 23/29 species. Weakest PPA was observed for Mycobacterium gordonae (50%, n = 9/18), Mycobacterium interjectum (40%, n = 2/5), and Mycobacterium intracellulare (42%, n = 5/12). Clinical and mixed cultures containing multiple mycobacterial species gave equally single species and genus level identifications (n = 30). No cross-reactivity with non-mycobacterial species was observed (n = 22). In a separate in silico analysis of 2016-2022 HUS area (Finland) register data (n = 2,573), the FluoroType assay was estimated to produce 18.8% (n = 471) inadequate identifications (genus/false species) if used as the primary identification method compared to 14.2% (n = 366) with the GenoType CM assay. The FluoroType assay was significantly more convenient in terms of assay workflow and result interpretation compared to the entirely manual and subjective GenoType CM assay. However, the feasibility of the assay should be critically assessed with respect to the local NTM species distribution. IMPORTANCE This study is the first clinical evaluation report of the novel FluoroType Mycobacteria assay. The assay has the potential to replace the established GenoType NTM product family in identification of culture-enriched mycobacteria. However, our research results suggest that the assay performs suboptimally and may not be feasible for use in all clinical settings.
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Affiliation(s)
- Bruno Luukinen
- Department of Clinical Microbiology, HUSLAB, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jenni Antikainen
- Department of Clinical Microbiology, HUSLAB, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Terhi Miikkulainen-Lahti
- Department of Clinical Microbiology, HUSLAB, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Anu Pätäri-Sampo
- Department of Clinical Microbiology, HUSLAB, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Aronen A, Aittoniemi J, Huttunen R, Siiki A, Antila A, Sand J, Laukkarinen J. P-suPAR may reflect the inflammatory response after pancreatic surgery. Pancreatology 2024; 24:146-151. [PMID: 38000982 DOI: 10.1016/j.pan.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Several different scoring systems have been developed to predict post-pancreatectomy complications. Currently used inflammatory markers are of only limited value in predicting complications after pancreatic surgery. Plasma soluble urokinase plasminogen activator receptor (P-suPAR) is a prognostic biomarker associated with different inflammatory conditions. The aim of this study was to investigate P-suPAR levels before and after pancreatic surgery. METHODS One hundred and seventy-six patients evaluated for pancreatic surgery due to suspected malignant or premalignant lesion were recruited for this study at Tampere University Hospital between 2016 and 2021. P-suPAR was analyzed before the planned operation and on postoperative days (PODs) one and three. RESULTS One hundred and thirty-three patients [median age 67 (range 33-84) years, 50 % male] underwent a pancreatic surgery procedure. Compared to preoperative values [median 3.7 (IQR 3.1-4.7) ng/mL], P-suPAR was significantly lower on PODs 1 [3.2 (2.5-3.9) ng/mL; p < 0.001] and 3 [3.2 (2.7-4.1) ng/mL; p < 0.001]. P-suPAR on POD 1 was significantly lower in patients with postoperative pancreatic fistula (POPF) [2.6 (2.1-3.4) ng/mL] than in patients with no POPF [3.2 (2.6-3.8) ng/mL; p = 0.007]. Similar decreases in P-suPAR values were seen in patients with postoperative acute pancreatitis (POAP) and surgical site infection (SSI). CONCLUSIONS After pancreatic surgery, P-suPAR level on POD 1 is significantly lower in patients with POPF, POAP or SSI. P-suPAR is decreased after pancreatic resection in all patients. This type of postoperative P-suPAR profile has not previously been described, and may reflect the compensatory anti-inflammatory reaction following the initial systemic inflammatory reaction caused by surgical trauma.
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Affiliation(s)
- Anu Aronen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | | | - Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, Finland
| | - Antti Siiki
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Finland
| | - Anne Antila
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Finland
| | - Juhani Sand
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Finland
| | - Johanna Laukkarinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
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Flinck H, Aittoniemi J. Evaluation of the new 2.0 version of the Roche SARS-CoV-2 Rapid Antigen Test. J Virol Methods 2023; 319:114758. [PMID: 37263352 PMCID: PMC10228153 DOI: 10.1016/j.jviromet.2023.114758] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/12/2023] [Accepted: 05/27/2023] [Indexed: 06/03/2023]
Abstract
We evaluated the new 2.0 version of the Roche Diagnostics SARS-CoV-2 Rapid Antigen Test (RAT 2.0) for the detection of SARS-CoV-2. Our evaluation material comprised of nasopharyngeal samples of 140 persons positive for SARS-CoV-2 nucleic acid amplification test (NAAT) and of 100 persons negative for SARS-CoV-2 NAAT. The sensitivity limit of the RAT 2.0 was further estimated with the additional selected samples of 27 persons with high NAAT cycle threshold (Ct) value representing low viral load. For the detection of possible cross-reactions in the RAT 2.0, routine respiratory samples positive for influenza A (N=5), respiratory syncytial virus (RSV) (N=4), or combined RSV and human coronavirus OC43 (N=1) were included in the study material. The overall sensitivity of the RAT 2.0 was 92.1% and specificity 100%. When evaluating the samples with NAAT Ct value ≤30, the sensitivity was 97.0%. All samples for cross-reactivity testing containing other viruses instead of SARS-CoV-2 remained negative in RAT 2.0. According to our findings, this RAT 2.0 offers a reliable tool for the diagnostics of acute COVID-19 in this pandemic environment.
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Affiliation(s)
- Heini Flinck
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland.
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
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Nevanlinna V, Huttunen R, Aittoniemi J, Luukkaala T, Rantala S. Incidence, seasonal pattern, and clinical manifestations of Streptococcus dysgalactiae subspecies equisimilis bacteremia; a population-based study. Eur J Clin Microbiol Infect Dis 2023:10.1007/s10096-023-04607-8. [PMID: 37119347 DOI: 10.1007/s10096-023-04607-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/19/2023] [Indexed: 05/01/2023]
Abstract
Streptococcus dysgalactiae subspecies equisimilis (SDSE) is a human pathogen causing severe invasive infections. Population-based studies on SDSE bacteremia are limited. The purpose of this study was to investigate the incidence, seasonal pattern, clinical manifestations, and recurrence of SDSE bacteraemia. Records regarding patients aged ≥ 18 years with SDSE bacteremia in the Pirkanmaa health district in August 2015 to July 2018 were retrospectively reviewed. A total of 230 SDSE bacteremia episodes were identified, with 217 episodes (involving 211 patients) available for analysis. The mean annual incidence rate of SDSE bacteremia was 16.9/100 000 inhabitants. Most episodes (33%) were detected in the summer (June to August) (p = 0.058). Episodes with bacteremic cellulitis were statistically significantly more common during the summer compared with other seasons (p = 0.008). Cellulitis was the most common presenting clinical manifestation of SDSE bacteremia (68% of all episodes). Risk factors of recurring bacteremia were chronic eczema and/or skin erosion (OR 3.96 [95% CI 1.11-14.1]), heart disease (OR 3.56 [95% CI 1.22-10.4]), diabetes (OR 3.77 [95% CI 1.35-10.5]) and a history of cellulitis. We found a remarkably high incidence of SDSE bacteraemia in the Pirkanmaa health district. Bacteraemic cellulitis, which was the predominant clinical manifestation is more often occurred in the summer. Risk factors of recurring SDSE bacteremia were a history of cellulitis, chronic eczema or skin erosion, diabetes, and heart disease.
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Affiliation(s)
- Viivi Nevanlinna
- Department of Internal Medicine, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520, Tampere, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Tiina Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sari Rantala
- Department of Internal Medicine, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Nevanlinna V, Huttunen R, Aittoniemi J, Luukkaala T, Rantala S. Major risk factors for Streptococcus dysgalactiae subsp. equisimilis bacteremia: a population-based study. BMC Infect Dis 2023; 23:43. [PMID: 36690934 PMCID: PMC9869575 DOI: 10.1186/s12879-023-07992-9] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/09/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Streptococcus dysgalactiae subspecies equisimilis is a human pathogen causing severe invasive infections. Detailed information on S. dysgalactiae subsp. equisimilis bacteremia and especially of predisposing factors are lacking. The purpose of the study is to investigate the risk factors of S. dysgalactiae subsp. equisimilis bacteremia compared to the general population in Finland. METHODS We retrospectively reviewed all patients older than 18 years with S. dysgalactiae subsp. equisimilis bacteremia in the Pirkanmaa health district from August 2015 to July 2018. The risk factors for S. dysgalactiae subsp. equisimilis bacteremia were investigated with respect to the normal population in Finland using the Finhealth study data provided by the Finnish institute for health and welfare. The study group was matched with the Finhealth study by age and sex. RESULTS Altogether 230 cases of S. dysgalactiae subsp. equisimilis bacteremia were detected. The medical records of 217 episodes of S. dysgalactiae subsp. equisimilis bacteremia (involving 211 patients) were available for analysis. Obesity was a statistically significant risk factor for S. dysgalactiae subsp. equisimilis bacteremia (Odds Ratio 2.96 [95% CI 2.22-3.96]). Diabetes and coronary artery disease were also associated with an increased risk of S. dysgalactiae subsp. equisimilis bacteremia (OR 4.82 [95% CI 3.62-6.42]) and (OR 3.03 [95% CI 2.18-4.19]). CONCLUSIONS We found obesity, diabetes, and coronary artery disease to be associated with an increased risk for S. dysgalactiae subsp. equisimilis bacteremia. These results provide an increased understanding of risk factors for S. dysgalactiae subsp. equisimilis bacteremia.
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Affiliation(s)
- Viivi Nevanlinna
- grid.412330.70000 0004 0628 2985Department of Internal Medicine, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland ,grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Reetta Huttunen
- grid.412330.70000 0004 0628 2985Department of Internal Medicine, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland ,grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Janne Aittoniemi
- grid.511163.10000 0004 0518 4910Fimlab Laboratories, Tampere, Finland
| | - Tiina Luukkaala
- grid.412330.70000 0004 0628 2985Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland ,grid.502801.e0000 0001 2314 6254Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sari Rantala
- grid.412330.70000 0004 0628 2985Department of Internal Medicine, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland ,grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Tamminen P, Kerimov D, Viskari H, Aittoniemi J, Syrjänen J, Lehtimäki L. Nasal nitric oxide is decreased in acute mild COVID-19 and related to viral load. J Breath Res 2022; 16. [PMID: 35772381 DOI: 10.1088/1752-7163/ac7d6a] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/30/2022] [Indexed: 11/12/2022]
Abstract
Gaseous nitric oxide levels from the lungs (FeNO) and from the nose (nNO) have been demonstrated to react to acute infection or influenza vaccination. There are no published data on nNO levels during acute COVID-19, but normal levels of FeNO have been reported in one study. Our aim was to assess if acute mild COVID-19 alters nasal or bronchial NO output at the time of acute infection and at a 2-month follow up, and if this is related to symptoms or viral load. This study included 82 subjects with mild acute airway infection who did not need hospitalisation: 43 cases (RT-PCR-positive for SARS-CoV-2 in routine testing from nasopharynx) and 39 age- (+/- 5 years) and gender-matched controls (RT-PCR-negative for SARS-CoV-2). During acute infection, the cases had lower nNO compared to controls (526 [345-688] vs. 773 [677-929] ppb; p<0.001), but after two months, there was no significant difference between the groups (766 [597-965] vs. 893 [739-1066] ppb; p=0.162). There was no difference in FeNO between the groups at either of the visits. Nasal NO correlated with the cycle threshold (Ct) value of the nasopharyngeal RT-PCR test for SARS-CoV-2 (Spearman's rs=0.550; p<0.001), that is, nNO was lower with a higher viral load. Nasal NO output was decreased in acute COVID-19 in relation to higher viral load, suggesting that the type and intensity of inflammatory response affects the release of NO from airway mucosa. In these subjects without significant lower airway involvement, there were no clinically relevant findings regarding FeNO.
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Affiliation(s)
- Pekka Tamminen
- Tampere University Hospital, Elämänaukio 2, Tampere, 33521, FINLAND
| | - Dominik Kerimov
- Department of Clinical Microbiology, Fimlab Laboratories, Arvo Ylpön Katu 4, Tampere, 33520, FINLAND
| | - Hanna Viskari
- Tampere University Hospital, Elämänaukio 2, Tampere, Pirkanmaa, 33521, FINLAND
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories, Arvo Ylpön Katu 4, Tampere, 33520, FINLAND
| | - Jaana Syrjänen
- Department of Internal Medicine, Tampere University Hospital, Elämänaukio 2, Tampere, Pirkanmaa, 33521, FINLAND
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, Tampere, 33520, FINLAND
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Tamminen P, Kerimov D, Viskari H, Aittoniemi J, Syrjänen J, Lehtimäki L. Lung function during and after acute respiratory infection in COVID-19 positive and negative outpatients. Eur Respir J 2022; 59:13993003.02837-2021. [PMID: 35058250 PMCID: PMC8785400 DOI: 10.1183/13993003.02837-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been associated with prolonged post-acute symptoms in at least 10% of patients [1, 2]. The majority of published data evaluates hospitalised patients with severe SARS-CoV-2 disease (COVID-19) with symptoms and pulmonary function defects several months after discharge [1]. Most of the infected subjects develop mild symptoms and are treated as outpatients. Though they are also reported to suffer from prolonged symptoms, their lung function is studied far less. Furthermore, the prolonged symptoms and objectively measurable findings are usually not compared to a group suffering from airway infection caused by other pathogens [2]. As spirometry and other aerosol-producing procedures are minimised during the pandemic, there are no reports on lung function during acute COVID-19. At acute phase, outpatients with mild COVID-19 had more symptoms, higher small airway resistance and poorer lung elasticity compared to outpatients with other respiratory infections, but there was no difference between the groups after 2 monthshttps://bit.ly/3nalPye
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Flinck H, Kerimov D, Luukinen B, Seiskari T, Aittoniemi J. Evaluation of the Roche-SD Biosensor rapid antigen test: antigen is not reliable in detecting SARS-CoV-2 at the early stage of infection with respiratory symptoms. Diagn Microbiol Infect Dis 2021; 102:115628. [PMID: 35066397 PMCID: PMC8710133 DOI: 10.1016/j.diagmicrobio.2021.115628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
We evaluated a rapid antigen test against SARS-CoV-2 virus (Roche-SD Biosensor; RSDB-RAT) in children and adults with respiratory symptoms compared to those with nonrespiratory symptoms or asymptomatic. Also the performance of RSDB-RAT with respect to the duration of respiratory symptoms was assessed. A viral cross-reactivity panel was included. RSDB-RAT was reliable in detecting SARS-CoV-2 in children and adults if the respiratory symptoms had endured 1 to 7 days. If the respiratory symptoms had lasted less than 1 day, the sensitivity was significantly lower. No cross-reactivity with other respiratory viruses was observed.
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Kerimov D, Tamminen P, Viskari H, Lehtimäki L, Aittoniemi J. Sampling site for SARS-CoV-2 RT-PCR-An intrapatient four-site comparison from Tampere, Finland. PLoS One 2021; 16:e0260184. [PMID: 34784386 PMCID: PMC8594827 DOI: 10.1371/journal.pone.0260184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND SARS-CoV-2 diagnosis relies on the performance of nasopharyngeal swabs. Alternative sample sites have been assessed but the heterogeneity of the studies have made comparing different sites difficult. OBJECTIVES Our aim was to compare the performance of four different sampling sites for SARS-CoV-2 samples with nasopharynx being the benchmark. STUDY DESIGN COVID-19 positive patients were recruited prospectively, and samples were collected and analysed for SARS-CoV-2 with RT-PCR from all four anatomical sites in 43 patients, who provided written informed consent. RESULTS All anterior nasal and saliva samples were positive, while two oropharyngeal samples were negative. There was no significant difference in the cycle threshold values of nasopharyngeal and anterior nasal samples while saliva and oropharynx had higher cycle threshold values. CONCLUSIONS Anterior nasal swab performs as good as nasopharynx swab with saliva also finding all the positives but with higher cycle threshold values. Thus, we can conclude that anterior nasal swabs can be used for SARS-CoV-2 detection instead of nasopharyngeal swabs if the situation would require so.
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Affiliation(s)
- Dominik Kerimov
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Pekka Tamminen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- Department of Otorhinolaryngology–Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
| | - Hanna Viskari
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
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12
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Aronen A, Aittoniemi J, Huttunen R, Nikkola A, Rinta-Kiikka I, Nikkola J, Limnell O, Nordback I, Sand J, Laukkarinen J. Plasma suPAR may help to distinguish between chronic pancreatitis and pancreatic cancer. Scand J Gastroenterol 2021; 56:81-85. [PMID: 33245246 DOI: 10.1080/00365521.2020.1849383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/04/2023]
Abstract
OBJECTIVES SuPAR (soluble urokinase-type plasminogen activator receptor) is a biomarker reflecting the inflammatory state of the human body. Earlier studies suggest that urinary suPAR/creatinine ratio levels are elevated in chronic pancreatitis (CP), and that plasma suPAR (P-suPAR) level is elevated in pancreatic cancer (PC). Our aim was to study the levels of P-suPAR in CP in a long-term prospective follow-up setting to explore the possibility of distinguishing between PC and CP. MATERIALS AND METHODS Two patient groups were compared. The first group included 83 patients who were prospectively followed up after their first acute alcohol-induced pancreatitis (AAP) for median 7.0 (range 0.3-9.8) years. Twelve patients in this group developed CP during follow-up, and two patients were further excluded from the CP cohort. The second group consisted of 25 patients operated on for suspicion of pancreatic malignancy and final pathological diagnosis of PC. P-suPAR levels were measured and compared within and between these groups. RESULTS P-suPAR levels remained low during follow-up despite the development of CP. P-suPAR was significantly higher in PC patients [median 3.7 (IQR 3.1-4.4) ng/mL] than in CP patients [2.6 (1.8-3.6) ng/mL]; p = .014. A cutoff value of 2.8 ng/mL resulted from a ROC curve with area under curve (AUC) of 0.79 (95% CI 0.61-0.97), p = .009 in differentiation between PC and CP with a sensitivity and a specificity of 88% and 70% respectively. CONCLUSION P-suPAR is higher in patients with PC than in patients with CP, and it could thus be used in differentiating between PC and CP.
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Affiliation(s)
- Anu Aronen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | | | - Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Anssi Nikkola
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Irina Rinta-Kiikka
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Nikkola
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Olli Limnell
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Isto Nordback
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Juhani Sand
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Johanna Laukkarinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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13
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Flinck H, Rauhio A, Luukinen B, Lehtimäki T, Haapala AM, Seiskari T, Aittoniemi J. Comparison of 2 fully automated tests detecting antibodies against nucleocapsid N and spike S1/S2 proteins in COVID-19. Diagn Microbiol Infect Dis 2020; 99:115197. [PMID: 32977117 PMCID: PMC7456296 DOI: 10.1016/j.diagmicrobio.2020.115197] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 06/11/2020] [Revised: 07/31/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
Abstract
Automated assays for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in coronavirus disease 2019 (COVID-19) diagnostics have recently come available. We compared the performance of the Elecsys® Anti–SARS-CoV-2 and LIAISON® SARS-CoV-2 S1/S2 IgG tests. The seroconversion panel comprised of 120 samples from 13 hospitalized COVID-19 patients. For the sensitivity and specificity testing, samples from COVID-19 outpatients >15 days after positive nucleic acid amplification test (NAAT) result (n = 35) and serum control samples collected before the COVID-19 era (n = 161) were included in the material. Samples for the detection of possible cross-reactions were also tested. Based on our results, the SARS-CoV-2 antibodies can be quite reliably detected 2 weeks after NAAT positivity and 3 weeks after the symptom onset with both tests. However, since some COVID-19 patients were positive only with Elecsys®, the antibodies should be screened against N-antigen (Elecsys®) and reactive samples confirmed with S antigen (LIAISON®), but both results should be reported. In some COVID-19 patients, the serology can remain negative. Elecsys® and LIAISON® SARS-CoV-2 antibody tests performed reliably. SARS-CoV-2 antibodies should be confirmed with different antigens to increase accuracy. In some patients, the COVID-19 serology may remain completely negative.
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Affiliation(s)
- Heini Flinck
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland.
| | - Anne Rauhio
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Bruno Luukinen
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anna-Maija Haapala
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Tapio Seiskari
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
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14
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Hokkinen L, Kesti A, Lepomäki J, Anttalainen O, Kontunen A, Karjalainen M, Aittoniemi J, Vuento R, Lehtimäki T, Oksala N, Roine A. Differential mobility spectrometry classification of bacteria. Future Microbiol 2020; 15:233-240. [DOI: 10.2217/fmb-2019-0192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: Rapid identification of bacteria would facilitate timely initiation of therapy and improve cost–effectiveness of treatment. Traditional methods (culture, PCR) require reagents, consumables and hours to days to complete the identification. In this study, we examined whether differential mobility spectrometry could classify most common bacterial species, genera and between Gram status within minutes. Materials & methods: Cultured bacterial sample gaseous headspaces were measured with differential mobility spectrometry and data analyzed using k-nearest-neighbor and leave-one-out cross-validation. Results: Differential mobility spectrometry achieved a correct classification rate 70.7% for all bacterial species. For bacterial genera, the rate was 77.6% and between Gram status, 89.1%. Conclusion: Largest difficulties arose in distinguishing bacteria of the same genus. Future improvement of the sensor characteristics may improve the classification accuracy.
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Affiliation(s)
- Lauri Hokkinen
- Faculty of Medicine & Health Technology, Tampere University, Tampere, Finland
| | - Artturi Kesti
- Faculty of Medicine & Health Technology, Tampere University, Tampere, Finland
| | - Jaakko Lepomäki
- Faculty of Medicine & Health Technology, Tampere University, Tampere, Finland
| | - Osmo Anttalainen
- Vascular & interventional Center, Tampere University Hospital, Tampere, Finland
| | - Anton Kontunen
- Faculty of Medicine & Health Technology, Tampere University, Tampere, Finland
| | - Markus Karjalainen
- Faculty of Medicine & Health Technology, Tampere University, Tampere, Finland
| | | | | | - Terho Lehtimäki
- Faculty of Medicine & Health Technology, Tampere University, Tampere, Finland
- Fimlab Laboratories, Tampere, Finland
- Finnish Cardiovascular Research Center – Tampere, Tampere University, Tampere, Finland
| | - Niku Oksala
- Vascular & interventional Center, Tampere University Hospital, Tampere, Finland
- Department of Surgery, Faculty of Medicine & Health Technology, Tampere University, Tampere, Finland
| | - Antti Roine
- Faculty of Medicine & Health Technology, Tampere University, Tampere, Finland
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15
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Rannikko J, Jacome Sanz D, Ortutay Z, Seiskari T, Aittoniemi J, Huttunen R, Syrjänen J, Pesu M. Reduced plasma PCSK9 response in patients with bacteraemia is associated with mortality. J Intern Med 2019; 286:553-561. [PMID: 31166632 DOI: 10.1111/joim.12946] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 12/12/2022]
Abstract
BACKGROUND The proprotein convertase subtilisin/kexin type 9 (PCSK9) enzyme controls blood cholesterol levels by downregulating the expression of the low-density lipoprotein receptor (LDLR). Pathogenic lipids (e.g. lipopolysaccharide) are removed from the circulation by an LDLR/PCSK9-dependent mechanism; thus, it has been suggested that PCSK9 inhibitors may be beneficial in the treatment of infections. We measured plasma PCSK9 levels in patients with culture-positive bacteraemia and explored pathogen-dependent and infection site-dependent effects as well as correlations between patient characteristics and outcome. METHODS Proprotein convertase subtilisin/kexin type 9 in the plasma was measured with an enzyme-linked immunosorbent assay from 481 patients with blood culture-positive infection on days 0 to 4 after admission to the emergency department. Patient outcome and clinical and laboratory data were gathered retrospectively from patient records. RESULTS The plasma PCSK9 level was elevated equally in patients with Gram-positive or Gram-negative bacterial infections; particularly high levels were seen in patients with a lower respiratory tract infection and Streptococcus pneumoniae bacteraemia. PCSK9 levels showed a significant positive correlation with C-reactive protein (CRP) level. Bacteraemia patients with liver disease or a history of alcohol abuse had significantly lower levels of plasma PCSK9. Reduced PCSK9 plasma responses in patients were significantly associated with mortality at days 7, 28 and 90. CONCLUSION Proprotein convertase subtilisin/kexin type 9 is upregulated in blood culture-positive infections. Plasma PCSK9 resembles acute-phase proteins; its expression is induced during an infection, reduced in liver disease and correlates positively with CRP level. We have shown that PCSK9 levels are lower in patients with a fatal prognosis.
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Affiliation(s)
- J Rannikko
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - D Jacome Sanz
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Z Ortutay
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - T Seiskari
- Department of Clinical Microbiology, Fimlab Laboratories Ltd, Tampere, Finland
| | - J Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories Ltd, Tampere, Finland
| | - R Huttunen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - J Syrjänen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - M Pesu
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Dermatology, Tampere University Hospital, Tampere, Finland
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16
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Lindström V, Aittoniemi J, Salmenniemi U, Käyhty H, Huhtala H, Sinisalo M. Antibody response to the 23-valent pneumococcal polysaccharide vaccine after conjugate vaccine in patients with chronic lymphocytic leukemia. Hum Vaccin Immunother 2019; 15:2910-2913. [PMID: 31216225 PMCID: PMC6930110 DOI: 10.1080/21645515.2019.1627160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/05/2019] [Accepted: 05/24/2019] [Indexed: 01/09/2023] Open
Abstract
The 23-valent pneumococcal polysaccharide vaccine (PPV23) given alone is ineffective in patients with chronic lymphocytic leukemia (CLL) and better antibody response is achieved with pneumococcal conjugate vaccines (PCVs). In this study, we determine whether CLL patients would achieve a significant antibody response and broaden their serotype coverage against invasive pneumococcal disease (IPD) with PPV23 given five years after the 7-valent conjugate vaccine (PCV7). A total of 24 patients with CLL and eight controls were vaccinated with PPV23 five years after PCV7. Blood samples for evaluation of antibody response to PCV7 serotypes and PPV23 serotypes 5 and 7 were taken before vaccination and one month after it. Post-vaccination samples were available from 20 patients. IgG antibodies were measured with ELISA. Antibody concentrations after PPV23 were significantly lower in CLL patients for six of the PCV7 serotypes and for both PPV23 serotypes. Only 10% to 15% of CLL patients achieved an antibody response suggested to be protective against IPD. Hence, PCV7 given five years before PPV23 did not improve antibody response in patients with CLL. Based on our results, PPV23 given after a PCV primer is not useful against IPD in CLL patients.
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Affiliation(s)
- Vesa Lindström
- Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Urpu Salmenniemi
- Department of Hematology and Stem Cell Transplantation Unit, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Helena Käyhty
- Research prof emerita, visiting scientist, Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Marjatta Sinisalo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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17
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Aronen A, Aittoniemi J, Huttunen R, Nikkola A, Nikkola J, Limnell O, Nordback I, Sand J, Laukkarinen J. Plasma level of soluble urokinase plasminogen activator receptor (suPAR) predicts long-term mortality after first acute alcohol-induced pancreatitis. Eur J Intern Med 2019; 64:72-75. [PMID: 31060962 DOI: 10.1016/j.ejim.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/03/2019] [Accepted: 04/19/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker associated with inflammatory and certain malignancies. Earlier we have shown that plasma suPAR (P-suPAR) predicts severity of acute alcohol-induced pancreatitis (AAP) on admission. Our aim was to investigate whether P-suPAR levels predict AAP recurrences or mortality during long-term follow-up after first AAP. METHODS Eighty-three patients (median age 47.5, range 25-71 years) suffering their first AAP during 2001-2005 were recruited and followed prospectively for 9 years with a median follow-up time of 7.0 (range 0.3-9.8) years. P-suPAR was measured by enzyme-linked immunosorbent assay (ELISA) from the samples taken at follow-up visits. Survival was registered in November 2014. RESULTS P-suPAR level on admission or after recovery of the first AAP did not predict the recurrence of AAP. However, higher P-suPAR measured after recovery of first AAP (3.6 vs. 2.9 ng/mL) predicted mortality during follow-up period (hazard ratio 1.48, p = .008). Cut-off value for P-suPAR indicating a higher risk for 10-year mortality resulted a value of ≥3.4 ng/mL. When adjusted for other covariates, P-suPAR above cut-off level retained its statistical significance as an independent factor. CONCLUSIONS P-suPAR level on admission or after recovery of the first AAP does not predict the recurrence of AAP during long-term follow-up. However, P-suPAR ≥3.4 mg/mL measured after recovery from first AAP is associated with an increased risk of 10-year mortality as an independent factor. This can be used to detect patients with highest risk after AAP, in order to focus the preventive healthcare actions.
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Affiliation(s)
- Anu Aronen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Teiskontie 35, 33521, Finland
| | | | - Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, Teiskontie 35, 33521 Tampere, Finland
| | - Anssi Nikkola
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Teiskontie 35, 33521, Finland; University of Tampere, Faculty of Medicine and Life Sciences, Arvo Ylpön katu 34, 33520 Tampere, Finland
| | - Jussi Nikkola
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Teiskontie 35, 33521, Finland
| | - Olli Limnell
- University of Tampere, Faculty of Medicine and Life Sciences, Arvo Ylpön katu 34, 33520 Tampere, Finland
| | - Isto Nordback
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Teiskontie 35, 33521, Finland
| | - Juhani Sand
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Teiskontie 35, 33521, Finland
| | - Johanna Laukkarinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Teiskontie 35, 33521, Finland; University of Tampere, Faculty of Medicine and Life Sciences, Arvo Ylpön katu 34, 33520 Tampere, Finland.
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18
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Rantakokko-Jalava K, Hokynar K, Hieta N, Keskitalo A, Jokela P, Muotiala A, Jokiranta TS, Kuusela R, Sarkkinen H, Aittoniemi J, Vuorinen T, Hakanen AJ, Puolakkainen M. Chlamydia trachomatis samples testing falsely negative in the Aptima Combo 2 test in Finland, 2019. Euro Surveill 2019; 24:1900298. [PMID: 31164192 PMCID: PMC6549458 DOI: 10.2807/1560-7917.es.2019.24.22.1900298] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Indexed: 12/29/2022] Open
Abstract
Since February 2019, over 160 Chlamydia trachomatis (CT) cases testing negative or equivocal by Aptima Combo 2 (AC2) but positive by Aptima CT test run with Panther instruments occurred in Finland. The AC2 test targets chlamydial 23S rRNA while the CT test targets 16S rRNA. Sequencing of 10 strains revealed a nucleotide substitution in 23S rRNA. The significance of this for the failure of the AC2 test to detect the variant is not yet known.
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Affiliation(s)
- Kaisu Rantakokko-Jalava
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland,University of Turku, Turku, Turku, Finland
| | - Kati Hokynar
- Department of virology, University of Helsinki, Helsinki, Finland
| | - Niina Hieta
- Venereal Diseases Outpatient Clinic, Turku University Hospital, Turku, Finland,University of Turku, Turku, Turku, Finland
| | - Anniina Keskitalo
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland,University of Turku, Turku, Turku, Finland
| | - Pia Jokela
- Department of Virology and Immunology, University of Helsinki and Helsinki University Hospital, Huslab, Helsinki, Finland
| | | | | | | | | | | | - Tytti Vuorinen
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland,University of Turku, Turku, Turku, Finland
| | - Antti J Hakanen
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland,University of Turku, Turku, Turku, Finland
| | - Mirja Puolakkainen
- Department of Virology and Immunology, University of Helsinki and Helsinki University Hospital, Huslab, Helsinki, Finland
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19
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Rannikko J, Seiskari T, Huttunen R, Tarkiainen I, Jylhävä J, Hurme M, Syrjänen J, Aittoniemi J. Plasma cell-free DNA and qSOFA score predict 7-day mortality in 481 emergency department bacteraemia patients. J Intern Med 2018; 284:418-426. [PMID: 29687943 DOI: 10.1111/joim.12766] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND A few studies have shown that both quick Sequential Organ Failure Assessment (qSOFA) score and cell-free DNA (cfDNA) have potential use as a prognostic marker in patients with infection. We studied these two markers alone and in combination to identify those emergency department (ED) patients with the highest risk of death. METHODS Plasma cfDNA level was studied on days 0 to 4 after admittance to the ED from 481 culture-positive bloodstream infection cases. The qSOFA score was evaluated retrospectively according to Sepsis-3 definitions. The primary outcome was death by day 7. RESULTS CfDNA on day 0 was significantly higher in nonsurvivors than in survivors (2.02 μg mL-1 vs. 1.35 μg mL-1 , P < 0.001). CfDNA level was high (>1.69 μg mL-1 ) in 134 (28%) of 481 cases, and the qSOFA score was ≥2 in 128 (28%) of 458 cases. High cfDNA and qSOFA score ≥2 had 70% and 77% sensitivity and 76% and 76% specificity in predicting death by day 7, respectively. High cfDNA alone had odds ratio (OR) of 7.7 (95% CI 3.9-15.3) and qSOFA score ≥2 OR of 11.6 (5.5-24.3), but their combination had OR of 20.3 (10.0-41.4) in predicting death by day 7 when compared with those with low cfDNA and qSOFA score <2. Amongst the five cases with the highest cfDNA levels, there were three patients with severe disseminated intravascular coagulation. CONCLUSION CfDNA and qSOFA score can be used independently to identify those bacteraemia patients at high risk of death, and combining these two markers gives additional advantage.
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Affiliation(s)
- J Rannikko
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - T Seiskari
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - R Huttunen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - I Tarkiainen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - J Jylhävä
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - M Hurme
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - J Syrjänen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - J Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
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20
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Zacarías MF, Collado MC, Gómez-Gallego C, Flinck H, Aittoniemi J, Isolauri E, Salminen S. Pregestational overweight and obesity are associated with differences in gut microbiota composition and systemic inflammation in the third trimester. PLoS One 2018; 13:e0200305. [PMID: 30005082 PMCID: PMC6044541 DOI: 10.1371/journal.pone.0200305] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/22/2018] [Indexed: 12/13/2022] Open
Abstract
The obesity epidemic is a global challenge, and the velocity of propagation is high in the population at reproductive age. Overweight and obesity during pregnancy have been associated with high birth weight and an increased risk of childhood obesity, reinforcing the risk of other non-communicable diseases. Obesity involves chronic low-grade systemic inflammation. New biomarkers for early detection of obesity risk are urgently required. The aim of this study was to identify the connection between pregestational BMI (pre-BMI) status and inflammatory biomarkers during the third trimester of pregnancy and their association with intestinal microbiota composition. Fifty-four pregnant women were classified according to pre-pregnancy BMI as normoweight, overweight, or obese. Weight gain, inflammatory biomarkers (hs_CRP, haptoglobin, and suPAR), and microbiota composition were assessed during the third trimester. A significant lower weight gain for obese mothers and a positive correlation between pre-BMI and inflammatory biomarkers were detected (Spearman’s correlation). Haptoglobin levels were significantly higher in overweight and obese mothers. Higher Firmicutes levels and a higher ratio Firmicutes/Bacteroidetes were observed in the overweight and obese subjects. High hs_CRP and haptoglobin levels were also correlated with decreased microbiota diversity (Shannon index), whereas haptoglobin and hs_CRP values were correlated with several microbiota components, such as Ruminococcus gnavus and Faecalibacterium, and with specific phyla in the normoweight and overweight mothers; no significant associations with microbiota were found for suPAR. In conclusion, haptoglobin and hs_CRP reflected pregestational BMI status and related microbiota components, but haptoglobin was a better biomarker for microbiota associated with overweight. suPAR was associated with low grade inflammation dependent on pre-pregnancy BMI, but it was not related to deviated microbiota profiles.
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Affiliation(s)
| | - María Carmen Collado
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
- Institute of Agrochemistry and Food Technology, National Research Council (IATA-CSIC), Department of Biotechnology, Valencia, Spain
| | - Carlos Gómez-Gallego
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
| | - Heini Flinck
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Erika Isolauri
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Clinical Sciences, Faculty of Medicine, University of Turku, Turku, Finland
| | - Seppo Salminen
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
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21
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Åttman E, Korhonen P, Tammela O, Vuento R, Aittoniemi J, Syrjänen J, Mattila E, Österblad M, Huttunen R. A Serratia marcescens outbreak in a neonatal intensive care unit was successfully managed by rapid hospital hygiene interventions and screening. Acta Paediatr 2018; 107:425-429. [PMID: 29068091 DOI: 10.1111/apa.14132] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 02/24/2017] [Revised: 08/14/2017] [Accepted: 10/19/2017] [Indexed: 12/17/2022]
Abstract
AIM Serratia marcescens is a rare, but important, pathogen in hospital-acquired infections, especially in neonatal units. Outbreaks may cause significant mortality among neonates. This study describes how an outbreak of S. marcescens was handled in a neonatal intensive care unit in Finland in June 2015. METHODS Tampere University Hospital is the only hospital that offers intensive care for preterm neonates in the Pirkanmaa health district area in Finland. Between June 9, 2015 and June 29, 2015, seven neonates were screened positive for S. marcescens in the hospital. We examined the management and outcomes, including environmental sampling. RESULTS Two of the seven neonates developed a bloodstream infection, and one with S. marcescens sepsis died after six days of antibiotic treatment. The outbreak was rapidly managed with active hospital hygiene interventions, including strict hand hygiene, cleaning, patient screening, contact precautions and education. Environmental sampling was limited to one water tap and a ventilator, and the results were negative. The outbreak was contained within three weeks, and no further cases appeared. The screening of healthcare workers was not necessary. CONCLUSION A S. marcescens outbreak caused significant morbidity in neonates and one death. Rapid hospital hygiene interventions and patient screening effectively contained the outbreak.
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Affiliation(s)
- Emilia Åttman
- Tampere Medical School; University of Tampere; Tampere Finland
| | - Päivi Korhonen
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| | - Outi Tammela
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| | | | | | - Jaana Syrjänen
- Department of Internal Medicine; Tampere University Hospital; Tampere Finland
| | - Erja Mattila
- Department of Internal Medicine; Tampere University Hospital; Tampere Finland
| | - Monica Österblad
- Bacterial Infections Unit; National Institute for Health and Welfare; Turku Finland
| | - Reetta Huttunen
- Department of Internal Medicine; Tampere University Hospital; Tampere Finland
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22
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Lindström V, Aittoniemi J, Salmenniemi U, Käyhty H, Huhtala H, Itälä-Remes M, Sinisalo M. Antibody persistence after pneumococcal conjugate vaccination in patients with chronic lymphocytic leukemia. Hum Vaccin Immunother 2018; 14:1471-1474. [PMID: 29420116 DOI: 10.1080/21645515.2018.1436424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Patients with chronic lymphocytic leukemia (CLL) are at a high risk for infections caused by Streptococcus pneumoniae. A pneumococcal conjugate vaccine (PCV) can induce a significant antibody response for some CLL patients. In this study we investigated antibody persistence after PCV7 in patients with CLL. The study material comprised 24 patients with CLL and 8 immunocompetent controls. The median antibody concentrations five years after PCV7 were lower for six pneumococcal serotypes in patients with CLL compared to controls, but the difference was not statistically significant. Depending on the serotype, the percentage of the CLL patients with antibody levels suggested to provide protection against invasive pneumococcal disease (IPD) varied from 29 to 71% five years after vaccination. This data suggests that PCV could result in antibody persistence at least five years in CLL patients.
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Affiliation(s)
- Vesa Lindström
- a Department of Hematology , Comprehensive Cancer Center, Helsinki University Hospital , Helsinki , Finland
| | - Janne Aittoniemi
- b Department of Clinical Microbiology, Fimlab Laboratories , Tampere , Finland
| | - Urpu Salmenniemi
- c Department of Hematology and Stem Cell Transplantation Unit , Division of Medicine, Turku University Hospital , Turku , Finland
| | - Helena Käyhty
- d Department of Health Security , National Institute for Health and Welfare , Helsinki , Finland
| | - Heini Huhtala
- e Faculty of Social Sciences, University of Tampere , Tampere , Finland
| | - Maija Itälä-Remes
- f Department of Hematology , Comprehensive Cancer Center, Helsinki University Hospital, HUS , Helsinki , Finland
| | - Marjatta Sinisalo
- g Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
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23
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Kolonen A, Sinisalo M, Huttunen R, Syrjänen J, Aittoniemi J, Huhtala H, Sankelo M, Rintala H, Räty R, Jantunen E, Nousiainen T, Säily M, Kauppila M, Itälä-Remes M, Ollikainen H, Rauhala A, Koistinen P, Elonen E. Bloodstream infections in acute myeloid leukemia patients treated according to the Finnish Leukemia Group AML-2003 protocol - a prospective nationwide study. Infect Dis (Lond) 2017; 49:799-808. [PMID: 28683646 DOI: 10.1080/23744235.2017.1347814] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 12/13/2022] Open
Abstract
BACKGROUND Infections greatly influence the outcome of acute myeloid leukemia (AML) patients receiving intensive treatment. The aim of this study was to establish the incidence, microbial etiology, risk factors and prognosis of bloodstream infections (BSIs) in patients with AML and compare the results with the previous treatment protocol (AML-92). METHODS Registery data were gathered prospectively from 357 patients aged 16-65 years recruited on the AML-2003 treatment protocol between November 2003 and November 2011 during different treatment cycles. RESULTS Blood culture data were available on 977 treatment episodes, in which there were 503 BSIs (51%). The overall incidence rate (IR) for BSIs (per 1000 hospital days) was 16.7. Twenty patients (5.6%) died due to an infection and 16 of them (80%) had a BSI. The most commonly detected microbes (polymicrobial episodes included) in blood cultures were coagulase-negative staphylococci (CoNS, 24.7%), viridans group streptococci (VGS, 19.1%), enterococci (13.9%) and Enterobacteriacae group (25.9%). The etiology of BSIs varied greatly from treatment cycle to cycle. CONCLUSIONS Enterococcal BSIs have increased compared to our previous treatment protocol, and they represent significant pathogens in blood cultures. Infection-related mortality has decreased despite the increase in the IR of BSIs. Enterococci seem to be an increasingly prominent pathogen underlying BSIs in the AML patients, especially during induction therapy (20%).
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Affiliation(s)
- Aarne Kolonen
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Marjatta Sinisalo
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Reetta Huttunen
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Jaana Syrjänen
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | | | - Heini Huhtala
- c Faculty of Social Sciences , University of Tampere , Tampere , Finland
| | - Marja Sankelo
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Hannele Rintala
- a Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Riikka Räty
- d Department of Hematology , Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Finland
| | - Esa Jantunen
- e Department of Internal Medicine, Kuopio University Hospital , Kuopio , Finland
| | - Tapio Nousiainen
- e Department of Internal Medicine, Kuopio University Hospital , Kuopio , Finland
| | - Marjaana Säily
- f Department of Internal Medicine, Oulu University Hospital , Oulu , Finland
| | - Marjut Kauppila
- g Division of Medicine, Turku University Hospital , Turku , Finland.,h Department of Hematology and Stem Cell Transplantation, Turku University Hospital , Turku , Finland
| | - Maija Itälä-Remes
- g Division of Medicine, Turku University Hospital , Turku , Finland.,h Department of Hematology and Stem Cell Transplantation, Turku University Hospital , Turku , Finland
| | - Hanna Ollikainen
- i Department of Hematology, Satakunta Central Hospital , Pori , Finland
| | | | - Pirjo Koistinen
- f Department of Internal Medicine, Oulu University Hospital , Oulu , Finland
| | - Erkki Elonen
- d Department of Hematology , Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Finland
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24
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Rannikko J, Syrjänen J, Seiskari T, Aittoniemi J, Huttunen R. Sepsis-related mortality in 497 cases with blood culture-positive sepsis in an emergency department. Int J Infect Dis 2017; 58:52-57. [PMID: 28288925 DOI: 10.1016/j.ijid.2017.03.005] [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] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/15/2017] [Accepted: 03/05/2017] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Few studies have sought to establish how often death after sepsis is related to the sepsis and how often underlying diseases have a major role in case fatality. METHODS In this retrospective cohort study, data were collected on 497 cases with blood culture-positive sepsis in an emergency department (ED). RESULTS Sepsis was categorized as severe in 31% of cases; 7% had septic shock. The quick Sepsis-related Organ Failure Assessment score was positive in 136 out of 473 cases (29%). Ninety-eight patients died by day 90; in 16 of these cases (16%) the death was sepsis-related in a patient without a rapidly fatal underlying disease, in 45 cases (46%) the death was sepsis-related in a patient with a rapidly fatal underlying disease, and in 37 cases (38%) the death was unrelated to sepsis. Sepsis-related death occurred in 58 out of 61 cases (95%) by day 28. CONCLUSIONS Underlying diseases were found to have a considerable role in the death of patients suffering from blood culture-positive sepsis in an ED of a developed country, as only 16% of the deaths by day 90 occurred where death was sepsis-related and the patient had a life-expectancy of more than 6 months. Improving the outcome of sepsis with new treatments is thus challenging. It is possible that day 7+day 28 mortality is a more appropriate endpoint than day 90 mortality when studying the outcome of sepsis, as this time-span includes most of the patients whose death was related to sepsis.
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Affiliation(s)
- Juha Rannikko
- Department of Internal Medicine, Tampere University Hospital, Box 2000, FI-33521 Tampere, Finland.
| | - Jaana Syrjänen
- Department of Internal Medicine, Tampere University Hospital, Box 2000, FI-33521 Tampere, Finland
| | - Tapio Seiskari
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, Box 2000, FI-33521 Tampere, Finland
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25
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Ranta N, Turpeinen H, Oksanen A, Hämäläinen S, Huttunen R, Uusitalo-Seppälä R, Rintala E, Aittoniemi J, Pesu M. The Plasma Level of Proprotein Convertase FURIN in Patients with Suspected Infection in the Emergency Room: A Prospective Cohort Study. Scand J Immunol 2016; 82:539-46. [PMID: 26346780 DOI: 10.1111/sji.12386] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/26/2015] [Indexed: 01/26/2023]
Abstract
There is an increasing need for novel biomarkers that enable better diagnostic and prognostic stratification of patients with suspected infection. A proprotein convertase enzyme FURIN is upregulated upon immune cell activation, and it promotes infectivity by cleaving and activating pathogens. In this study, we determined FURIN levels in plasma using ELISA from 537 patients that were admitted to emergency room with suspected infection. Patients were sorted to high- and low-level FURIN groups with a cut-off level of 370 pg/ml. The study cohort included five diagnostic groups: Group 1, no systemic inflammatory response syndrome (SIRS, n = 59 patients); Group 2, bacterial infection without SIRS (n = 67); Group 3, SIRS, but no bacterial infection (n = 308); Group 4, sepsis without organ failure (n = 308); and Group 5, severe sepsis (n = 49). Statistically significant associations were not found between the plasma level of FURIN and the prevalence of sepsis (P = 0.957), diagnostic group of a patient (P = 0.737) or the bacteria in blood culture (P = 0.499). Additionally, the concentration of FURIN did not predict the severity or case fatality of the infectious disease. However, statistically significant associations were found between high plasma level of FURIN and diagnosed rheumatic disease (P < 0.001) as well as with the prevalence of non-smokers (P = 0.034). Thus, albeit the plasma level of FURIN does not predict the severity of infectious disease, it may be of use in the diagnostics of autoimmune diseases.
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Affiliation(s)
- N Ranta
- Immunoregulation, BioMediTech, University of Tampere, Tampere, Finland.,School of Medicine, University of Tampere, Tampere, Finland
| | - H Turpeinen
- Immunoregulation, BioMediTech, University of Tampere, Tampere, Finland
| | - A Oksanen
- Immunoregulation, BioMediTech, University of Tampere, Tampere, Finland
| | - S Hämäläinen
- Immunoregulation, BioMediTech, University of Tampere, Tampere, Finland
| | - R Huttunen
- Department of Infectious Diseases, Tampere University Hospital, Tampere, Finland
| | - R Uusitalo-Seppälä
- Department of Infectious Diseases, Satakunta Central Hospital, Pori, Finland
| | - E Rintala
- Department of Hospital Hygiene & Infection Control, Turku University Hospital, Turku, Finland
| | | | - M Pesu
- Immunoregulation, BioMediTech, University of Tampere, Tampere, Finland.,Fimlab Laboratories, Tampere, Finland.,Department of Dermatology, Tampere University Hospital, Tampere, Finland
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26
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Tapiainen T, Aittoniemi J, Immonen J, Jylkkä H, Meinander T, Nuolivirta K, Peltola V, Salo E, Seuri R, Walle SM, Korppi M. Finnish guidelines for the treatment of laryngitis, wheezing bronchitis and bronchiolitis in children. Acta Paediatr 2016; 105:44-9. [PMID: 26295564 DOI: 10.1111/apa.13162] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 01/13/2015] [Revised: 06/22/2015] [Accepted: 08/17/2015] [Indexed: 01/04/2023]
Abstract
UNLABELLED Evidence-based guidelines are needed to harmonise and improve the diagnostics and treatment of children's lower respiratory tract infections. Following a professional literature search, an interdisciplinary working group evaluated and graded the available evidence and constructed guidelines for treating laryngitis, bronchitis, wheezing bronchitis and bronchiolitis. CONCLUSION Currently available drugs were not effective in relieving cough symptoms. Salbutamol inhalations could relieve the symptoms of wheezing bronchitis and should be administered via a holding chamber. Nebulised adrenaline or inhaled or oral glucocorticoids did not reduce hospitalisation rates or relieve symptoms in infants with bronchiolitis and should not be routinely used.
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Affiliation(s)
- Terhi Tapiainen
- Department of Pediatrics and Adolescence; Oulu University Hospital; Oulu Finland
- PEDEGO Research Unit - Research Unit for Pediatrics; Dermatology; Clinical Genetics; Obstetrics and Gynecology; and Medical Research Center; University of Oulu; Oulu Finland
| | | | | | - Heli Jylkkä
- Department of Pediatrics; University of Tampere; Tampere Finland
| | - Tuula Meinander
- Department of Internal Medicine; Tampere University Hospital and the Finnish Medical Society Duodecim; Tampere Finland
| | | | - Ville Peltola
- Department of Pediatrics; Turku University Hospital and University of Turku; Turku Finland
| | - Eeva Salo
- Department of Pediatrics; Helsinki University Hospital; Helsinki Finland
| | - Raija Seuri
- HUS Imaging; Children′s Hospital; Helsinki University Hospital; Helsinki Finland
| | | | - Matti Korppi
- Department of Pediatrics; Tampere University Hospital and University of Tampere; Tampere Finland
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27
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Tapiainen T, Aittoniemi J, Immonen J, Jylkkä H, Meinander T, Nuolivirta K, Peltola V, Salo E, Seuri R, Walle SM, Korppi M. Finnish guidelines for the treatment of community-acquired pneumonia and pertussis in children. Acta Paediatr 2016; 105:39-43. [PMID: 26341383 DOI: 10.1111/apa.13177] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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] [Received: 01/13/2015] [Revised: 04/23/2015] [Accepted: 09/01/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED Evidence-based guidelines are needed to harmonise and improve the diagnostics and treatment of children's lower respiratory tract infections. Following a professional literature search, an interdisciplinary working group evaluated and graded the available evidence and constructed guidelines for the treatment of community-acquired pneumonia and pertussis. CONCLUSION The clinical guidelines state that chest radiography is not needed if the child is diagnosed with pneumonia and treated at home. Complications should be considered if there is no improvement after antimicrobial therapy and a paroxysmal cough can indicate pertussis, which is life-threatening in unvaccinated infants and can lead to respiratory failure.
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Affiliation(s)
- Terhi Tapiainen
- Department of Pediatrics and Adolescence; Oulu University Hospital; Oulu Finland
- PEDEGO Research Unit - Research Unit for Pediatrics; Dermatology; Clinical Genetics Obstetrics and Gynecology, and Medical Research Center; University of Oulu; Finland
| | | | | | - Heli Jylkkä
- Department of Pediatrics; University of Tampere; Tampere Finland
| | - Tuula Meinander
- Department of Internal Medicine; Tampere University Hospital and the Finnish Medical Society Duodecim; Tampere Finland
| | | | - Ville Peltola
- Department of Pediatrics; Turku University Hospital and University of Turku; Turku Finland
| | - Eeva Salo
- Department of Pediatrics; Helsinki University Hospital; Helsinki Finland
| | - Raija Seuri
- HUS Imaging; Children′s Hospital; Helsinki University Hospital; Helsinki Finland
| | | | - Matti Korppi
- Department of Pediatrics; Tampere University Hospital and University of Tampere; Tampere Finland
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28
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Lindström V, Aittoniemi J, Lyytikäinen O, Klemets P, Ollgren J, Silvennoinen R, Nuorti JP, Sinisalo M. Invasive pneumococcal disease in patients with haematological malignancies before routine use of conjugate vaccines in Finland. Infect Dis (Lond) 2015; 48:399-402. [PMID: 26635103 DOI: 10.3109/23744235.2015.1115894] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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] Open
Abstract
The baseline national invasive pneumococcal disease (IPD) incidence rate, serotype distribution and serotype coverage of pneumococcal vaccines were evaluated in patients with Hodgkin's and non-Hodgkin's lymphomas, myeloma and leukaemia within 1 year after haematological diagnosis during 1995-2002, before introduction of pneumococcal conjugate vaccines. Pneumococcal serotype distribution among these patients was different from serotypes causing IPD in the general population. The serotype coverages of PCV13 and PPSV23 were 57% and 64%, respectively, lower than in the general population. This reflects a higher predisposition to IPD in vaccinated patients with haematological malignancies and possibly less benefit of herd immunity gained with the wide use of pneumococcal conjugate vaccines in the general population. This data will be useful as a baseline for determining the future role of adult PCV vaccination in these patient groups.
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Affiliation(s)
- Vesa Lindström
- a Cancer Center, Department of Hematology , Helsinki University Hospital , Helsinki , Finland
| | - Janne Aittoniemi
- b Department of Clinical Microbiology , Fimlab Laboratories , Tampere , Finland
| | - Outi Lyytikäinen
- c Epidemiologic Surveillance and Control Unit, Department of Infectious Disease Surveillance and Control , National Institute for Health and Welfare (THL) , Helsinki , Finland
| | | | - Jukka Ollgren
- c Epidemiologic Surveillance and Control Unit, Department of Infectious Disease Surveillance and Control , National Institute for Health and Welfare (THL) , Helsinki , Finland
| | - Raija Silvennoinen
- e Department of Medicine , Kuopio University Hospital , Kuopio , Finland
| | - J Pekka Nuorti
- c Epidemiologic Surveillance and Control Unit, Department of Infectious Disease Surveillance and Control , National Institute for Health and Welfare (THL) , Helsinki , Finland ;,f School of Health Sciences , University of Tampere , Finland
| | - Marjatta Sinisalo
- g Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
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29
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Åttman E, Aittoniemi J, Sinisalo M, Vuento R, Lyytikäinen O, Kärki T, Syrjänen J, Huttunen R. Etiology, clinical course and outcome of healthcare-associated bloodstream infections in patients with hematological malignancies: a retrospective study of 350 patients in a Finnish tertiary care hospital. Leuk Lymphoma 2015; 56:3370-7. [DOI: 10.3109/10428194.2015.1032967] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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30
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Hirvonen JJ, Seiskari T, Harju I, Rantakokko-Jalava K, Vuento R, Aittoniemi J. Use of an automated PCR assay, the GenomEra S. pneumoniae, for rapid detection of Streptococcus pneumoniae in blood cultures. Infect Dis (Lond) 2015; 47:796-800. [PMID: 26162002 DOI: 10.3109/23744235.2015.1063157] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Streptococcus pneumoniae is recognized as a major cause of pneumonia, meningitis, and bacteremia. Since the mortality rate for pneumococcal bacteremia remains high, the reliable detection of the bacterium in blood samples is important. In this study, the performance of a new automated PCR assay, the GenomEra(™) S. pneumoniae, for direct detection of S. pneumoniae in blood cultures was investigated. METHODS In total, 200 samples were analyzed, including 90 previously identified culture collection isolates and 110 blood culture specimens. The species identification was confirmed with routine diagnostic methods including MALDI-TOF or 16S rDNA sequencing. RESULTS From culture collection, the GenomEra S. pneumoniae assay correctly identified all 37 S. pneumoniae isolates consisting of 18 different serotypes, while all 53 non-S. pneumoniae isolates yielded negative test results. Of 110 blood culture specimens, 46 grew S. pneumoniae and all were positive by the GenomEra assay direct from bottle. The detection sensitivity and specificity of the GenomEra assay for direct analysis of S. pneumoniae in signal positive blood culture bottles was 100%, respectively. With a straightforward sample preparation protocol of blood cultures the results were available within 55 min, thus being significantly quicker than by the routinely used identification methods (18-48 h). The two-step, time-resolved fluorometric measurement mode employed by the GenomEra CDX(™) instrument showed no interference from blood or charcoal. CONCLUSION The GenomEra S. pneumoniae assay is a tool that performs well for the rapid and reliable detection of S. pneumoniae in blood cultures.
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31
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Karppelin M, Siljander T, Aittoniemi J, Hurme M, Huttunen R, Huhtala H, Kere J, Vuopio J, Syrjänen J. Predictors of recurrent cellulitis in five years. Clinical risk factors and the role of PTX3 and CRP. J Infect 2015; 70:467-73. [DOI: 10.1016/j.jinf.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 09/22/2014] [Accepted: 11/08/2014] [Indexed: 10/24/2022]
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32
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Roine A, Saviauk T, Kumpulainen P, Karjalainen M, Tuokko A, Aittoniemi J, Vuento R, Lekkala J, Lehtimäki T, Tammela TL, Oksala NKJ. Rapid and accurate detection of urinary pathogens by mobile IMS-based electronic nose: a proof-of-principle study. PLoS One 2014; 9:e114279. [PMID: 25526592 PMCID: PMC4272258 DOI: 10.1371/journal.pone.0114279] [Citation(s) in RCA: 29] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/08/2014] [Indexed: 01/20/2023] Open
Abstract
Urinary tract infection (UTI) is a common disease with significant morbidity and economic burden, accounting for a significant part of the workload in clinical microbiology laboratories. Current clinical chemisty point-of-care diagnostics rely on imperfect dipstick analysis which only provides indirect and insensitive evidence of urinary bacterial pathogens. An electronic nose (eNose) is a handheld device mimicking mammalian olfaction that potentially offers affordable and rapid analysis of samples without preparation at athmospheric pressure. In this study we demonstrate the applicability of ion mobility spectrometry (IMS) –based eNose to discriminate the most common UTI pathogens from gaseous headspace of culture plates rapidly and without sample preparation. We gathered a total of 101 culture samples containing four most common UTI bacteries: E. coli, S. saprophyticus, E. faecalis, Klebsiella spp and sterile culture plates. The samples were analyzed using ChemPro 100i device, consisting of IMS cell and six semiconductor sensors. Data analysis was conducted by linear discriminant analysis (LDA) and logistic regression (LR). The results were validated by leave-one-out and 5-fold cross validation analysis. In discrimination of sterile and bacterial samples sensitivity of 95% and specificity of 97% were achieved. The bacterial species were identified with sensitivity of 95% and specificity of 96% using eNose as compared to urine bacterial cultures. In conclusion: These findings strongly demonstrate the ability of our eNose to discriminate bacterial cultures and provides a proof of principle to use this method in urinanalysis of UTI.
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Affiliation(s)
- Antti Roine
- School of Medicine, University of Tampere, Tampere, Finland
- * E-mail:
| | - Taavi Saviauk
- School of Medicine, University of Tampere, Tampere, Finland
| | - Pekka Kumpulainen
- Department of Automation Science and Engineering, Tampere University of Technology, Tampere, Finland
| | - Markus Karjalainen
- Department of Automation Science and Engineering, Tampere University of Technology, Tampere, Finland
| | - Antti Tuokko
- School of Medicine, University of Tampere, Tampere, Finland
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Risto Vuento
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Jukka Lekkala
- Department of Automation Science and Engineering, Tampere University of Technology, Tampere, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and University of Tampere, School of Medicine, Tampere, Finland
| | - Teuvo L. Tammela
- Department of Surgery, School of Medicine, University of Tampere and Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Niku K. J. Oksala
- Department of Surgery, School of Medicine, University of Tampere and Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland
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33
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Louhelainen AM, Aho J, Tuomisto S, Aittoniemi J, Vuento R, Karhunen PJ, Pessi T. Oral bacterial DNA findings in pericardial fluid. J Oral Microbiol 2014; 6:25835. [PMID: 25412607 PMCID: PMC4239404 DOI: 10.3402/jom.v6.25835] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 11/14/2022] Open
Abstract
Background We recently reported that large amounts of oral bacterial DNA can be found in thrombus aspirates of myocardial infarction patients. Some case reports describe bacterial findings in pericardial fluid, mostly done with conventional culturing and a few with PCR; in purulent pericarditis, nevertheless, bacterial PCR has not been used as a diagnostic method before.
Objective To find out whether bacterial DNA can be measured in the pericardial fluid and if it correlates with pathologic–anatomic findings linked to cardiovascular diseases. Methods Twenty-two pericardial aspirates were collected aseptically prior to forensic autopsy at Tampere University Hospital during 2009–2010. Of the autopsies, 10 (45.5%) were free of coronary artery disease (CAD), 7 (31.8%) had mild and 5 (22.7%) had severe CAD. Bacterial DNA amounts were determined using real-time quantitative PCR with specific primers and probes for all bacterial strains associated with endodontic disease (Streptococcus mitis group, Streptococcus anginosus group, Staphylococcus aureus/Staphylococcus epidermidis, Prevotella intermedia, Parvimonas micra) and periodontal disease (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, Fusobacterium nucleatus, and Dialister pneumosintes).
Results Of 22 cases, 14 (63.6%) were positive for endodontic and 8 (36.4%) for periodontal-disease-associated bacteria. Only one case was positive for bacterial culturing. There was a statistically significant association between the relative amount of bacterial DNA in the pericardial fluid and the severity of CAD (p=0.035). Conclusions Oral bacterial DNA was detectable in pericardial fluid and an association between the severity of CAD and the total amount of bacterial DNA in pericardial fluid was found, suggesting that this kind of measurement might be useful for clinical purposes.
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Affiliation(s)
| | - Joonas Aho
- School of Medicine, University of Tampere, Tampere, Finland
| | - Sari Tuomisto
- School of Medicine, University of Tampere, Tampere, Finland
| | - Janne Aittoniemi
- Fimlab Laboratories Ltd, Pirkanmaa Hospital District, Tampere, Finland
| | - Risto Vuento
- Fimlab Laboratories Ltd, Pirkanmaa Hospital District, Tampere, Finland
| | - Pekka J Karhunen
- School of Medicine, University of Tampere, Tampere, Finland; Department of Clinical Pathology and Forensic Medicine, University of Eastern Finland, Kuopio Campus, Finland
| | - Tanja Pessi
- School of Medicine, University of Tampere, Tampere, Finland; Fimlab Laboratories Ltd, Pirkanmaa Hospital District, Tampere, Finland;
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Karppelin M, Siljander T, Haapala AM, Aittoniemi J, Huttunen R, Kere J, Vuopio J, Syrjänen J. Evidence of streptococcal origin of acute non-necrotising cellulitis: a serological study. Eur J Clin Microbiol Infect Dis 2014; 34:669-72. [PMID: 25403372 DOI: 10.1007/s10096-014-2274-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/31/2014] [Indexed: 11/29/2022]
Abstract
Bacteriological diagnosis is rarely achieved in acute cellulitis. Beta-haemolytic streptococci and Staphylococcus aureus are considered the main pathogens. The role of the latter is, however, unclear in cases of non-suppurative cellulitis. We conducted a serological study to investigate the bacterial aetiology of acute non-necrotising cellulitis. Anti-streptolysin O (ASO), anti-deoxyribonuclease B (ADN) and anti-staphylolysin (ASTA) titres were measured from acute and convalescent phase sera of 77 patients hospitalised because of acute bacterial non-necrotising cellulitis and from the serum samples of 89 control subjects matched for age and sex. Antibiotic treatment decisions were also reviewed. Streptococcal serology was positive in 53 (69%) of the 77 cases. Furthermore, ten cases without serological evidence of streptococcal infection were successfully treated with penicillin. Positive ASO and ADN titres were detected in ten (11%) and three (3%) of the 89 controls, respectively, and ASTA was elevated in three patients and 11 controls. Our findings suggest that acute non-necrotising cellulitis without pus formation is mostly of streptococcal origin and that penicillin can be used as the first-line therapy for most patients.
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Affiliation(s)
- M Karppelin
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland,
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Huttunen R, Åttman E, Aittoniemi J, Outinen T, Syrjänen J, Kärki T, Lyytikäinen O. Nosocomial bloodstream infections in a Finnish tertiary care hospital: a retrospective cohort study of 2175 episodes during the years 1999-2001 and 2005-2010. Infect Dis (Lond) 2014; 47:20-6. [PMID: 25351869 DOI: 10.3109/00365548.2014.956791] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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] Open
Abstract
BACKGROUND Nosocomial infections are major causes of morbidity in hospitalized patients. METHODS Retrospective laboratory-based surveillance during 1999-2001 and 2005-2010 identified 2175 cases of nosocomial bloodstream infections (BSIs) in Tampere University Hospital (TAUH), Finland. RESULTS Analysis revealed that 57% of BSIs were caused by a gram-positive organism, 27% by a gram-negative organism, 5% by a fungal organism, and 11% were polymicrobial. The most common cause of nosocomial BSI was coagulase-negative staphylococci (23%). Candida species caused 5% of the infections. The 7-day and 30-day case fatalities were 8% (161/2158) and 15% (313/2175), respectively, and were highest in BSIs caused by Candida albicans (22% and 44%) and Pseudomonas aeruginosa (17% and 25%). The median age of patients was 54 years in 1999-2001, 57 years in 2005-2007, and 60 years in 2008-2010 (p < 0.001). The median time from hospital admission to the onset of BSI was 11 days (quartiles 5-18 days). This period was shortest for Streptococcus agalactiae BSI and longest for Candida non-albicans fungemia (1 vs 19 days). The case fatality rate in nosocomial BSI decreased during the years studied: 7-day and 30-day case fatalities were 9% and 16% during 1999-2001, 8.5% and 16% during 2005-2007, and 5% and 12% during 2008-2010, respectively (p < 0.003 and p = 0.022, respectively). CONCLUSIONS Gram-positive infections predominate in nosocomial BSIs. The median age of patients with nosocomial BSI has risen during the study years. The case fatality associated with nosocomial BSI has decreased.
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Affiliation(s)
- Reetta Huttunen
- From the Department of Internal Medicine, Tampere University Hospital , Tampere
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Outinen TK, Mäkelä S, Huttunen R, Mäenpää N, Libraty D, Vaheri A, Mustonen J, Aittoniemi J. Urine soluble urokinase-type plasminogen activator receptor levels correlate with proteinuria in Puumala hantavirus infection. J Intern Med 2014; 276:387-95. [PMID: 24717117 PMCID: PMC4172514 DOI: 10.1111/joim.12257] [Citation(s) in RCA: 15] [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] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Urokinase-type plasminogen activator receptor (uPAR) is upregulated during inflammation and known to bind to β3 -integrins, receptors used by pathogenic hantaviruses to enter endothelial cells. It has been proposed that soluble uPAR (suPAR) is a circulating factor that causes focal segmental glomerulosclerosis and proteinuria by activating β3 -integrin in kidney podocytes. Proteinuria is also a characteristic feature of hantavirus infections. The aim of this study was to evaluate the relation between urine suPAR levels and disease severity in acute Puumala hantavirus (PUUV) infection. DESIGN A single-centre, prospective cohort study. SUBJECTS AND METHODS Urinary suPAR levels were measured twice during the acute phase and once during convalescence in 36 patients with serologically confirmed PUUV infection. Fractional excretion of suPAR (FE suPAR) and of albumin (FE alb) was calculated. RESULTS The FE suPAR was significantly elevated during the acute phase of PUUV infection compared to the convalescent phase (median 3.2%, range 0.8-52.0%, vs. median 1.9%, range 1.0-5.8%, P = 0.005). Maximum FE suPAR was correlated markedly with maximum FE alb (r = 0.812, P < 0.001) and with several other variables that reflect disease severity. There was a positive correlation with the length of hospitalization (r = 0.455, P = 0.009) and maximum plasma creatinine level (r = 0.780, P < 0.001) and an inverse correlation with minimum urinary output (r = -0.411, P = 0.030). There was no correlation between FE suPAR and plasma suPAR (r = 0.180, P = 0.324). CONCLUSION Urinary suPAR is markedly increased during acute PUUV infection and is correlated with proteinuria. High urine suPAR level may reflect local production of suPAR in the kidney during the acute infection.
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Affiliation(s)
- T K Outinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Tuomisto S, Pessi T, Collin P, Vuento R, Aittoniemi J, Karhunen PJ. Changes in gut bacterial populations and their translocation into liver and ascites in alcoholic liver cirrhotics. BMC Gastroenterol 2014; 14:40. [PMID: 24564202 PMCID: PMC3996058 DOI: 10.1186/1471-230x-14-40] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/19/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The liver is the first line of defence against continuously occurring influx of microbial-derived products and bacteria from the gut. Intestinal bacteria have been implicated in the pathogenesis of alcoholic liver cirrhosis. Escape of intestinal bacteria into the ascites is involved in the pathogenesis of spontaneous bacterial peritonitis, which is a common complication of liver cirrhosis. The association between faecal bacterial populations and alcoholic liver cirrhosis has not been resolved. METHODS Relative ratios of major commensal bacterial communities (Bacteroides spp., Bifidobacterium spp., Clostridium leptum group, Enterobactericaea and Lactobacillus spp.) were determined in faecal samples from post mortem examinations performed on 42 males, including cirrhotic alcoholics (n = 13), non-cirrhotic alcoholics (n = 15), non-alcoholic controls (n = 14) and in 7 healthy male volunteers using real-time quantitative PCR (RT-qPCR). Translocation of bacteria into liver in the autopsy cases and into the ascites of 12 volunteers with liver cirrhosis was also studied with RT-qPCR. CD14 immunostaining was performed for the autopsy liver samples. RESULTS Relative ratios of faecal bacteria in autopsy controls were comparable to those of healthy volunteers. Cirrhotics had in median 27 times more bacterial DNA of Enterobactericaea in faeces compared to the healthy volunteers (p = 0.011). Enterobactericaea were also the most common bacteria translocated into cirrhotic liver, although there were no statistically significant differences between the study groups. Of the ascites samples from the volunteers with liver cirrhosis, 50% contained bacterial DNA from Enterobactericaea, Clostridium leptum group or Lactobacillus spp.. The total bacterial DNA in autopsy liver was associated with the percentage of CD14 expression (p = 0.045). CD14 expression percentage in cirrhotics was significantly higher than in the autopsy controls (p = 0.004). CONCLUSIONS Our results suggest that translocation of intestinal bacteria into liver may be involved as a one factor in the pathogenesis of alcoholic liver cirrhosis.
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Affiliation(s)
- Sari Tuomisto
- Department of Forensic Medicine, University of Tampere, School of Medicine, Medisiinarinkatu 3, 33014 Tampere, Finland.
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Forsblom E, Aittoniemi J, Ruotsalainen E, Helmijoki V, Huttunen R, Jylhävä J, Hurme M, Järvinen A. High cell-free DNA predicts fatal outcome among Staphylococcus aureus bacteraemia patients with intensive care unit treatment. PLoS One 2014; 9:e87741. [PMID: 24520336 PMCID: PMC3919733 DOI: 10.1371/journal.pone.0087741] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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: 09/21/2013] [Accepted: 12/28/2013] [Indexed: 12/13/2022] Open
Abstract
Introduction Among patients with bacteraemia or sepsis the plasma cell-free DNA (cf-DNA) biomarker has prognostic value and Pitt bacteraemia scores predict outcome. We evaluated the prognostic value of plasma cf-DNA in patients with Staphylococcus aureus bacteraemia (SAB) treated in the ICU or in the general ward. Methods 418 adult patients with positive blood culture for S. aureus were prospectively followed for 90 days. SAB patients were grouped according to ICU treatment: 99 patients were treated in ICU within 7 days of documented SAB whereas 319 patients were managed outside ICU. Pitt bacteraemia scores were assessed at hospital arrival and cf-DNA was measured at days 3 and 5 from positive blood culture. Results SAB patients with high Pitt bacteraemia scores and ICU treatment presented higher cf-DNA values as compared to SAB patients with low Pitt bacteraemia scores and non-ICU treatment at both days 3 and 5. Among ICU patients cf-DNA >1.99 µg/ml at day 3 predicted death with a sensitivity of 67% and a specificity of 77% and had an AUC in receiver operating characteristic analysis of 0.71 (p<0.01). The cut-off cf-DNA >1.99 µg/ml value demonstrated a strong association to high Pitt bacteraemia scores (≥4 points) (p<0.000). After controlling for all prognostic markers, Pitt bacteraemia scores ≥4 points at hospital admission (OR 4.47, p<0.000) and day 3 cf-DNA (OR 3.56, p<0.001) were the strongest factors significantly predicting outcome in ICU patients. cf-DNA at day 5 did not predict fatal outcome. Conclusion High cf-DNA concentrations were observed among patients with high Pitt bacteraemia scores and ICU treatment. Pitt bacteraemia scores (≥4 points) and cf-DNA at day 3 from positive blood culture predicted death among SAB patients in ICU and were found to be independent prognostic markers. cf-DNA had no prognostic value among non-ICU patients.
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Affiliation(s)
- Erik Forsblom
- Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
- * E-mail:
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Eeva Ruotsalainen
- Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Visa Helmijoki
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
- Department of Microbiology and Immunology, School of Medicine, University of Tampere, Tampere, Finland
| | - Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Juulia Jylhävä
- Department of Microbiology and Immunology, School of Medicine, University of Tampere, Tampere, Finland
| | - Mikko Hurme
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
- Department of Microbiology and Immunology, School of Medicine, University of Tampere, Tampere, Finland
| | - Asko Järvinen
- Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
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Outinen TK, Tervo L, Mäkelä S, Huttunen R, Mäenpää N, Huhtala H, Vaheri A, Mustonen J, Aittoniemi J. Plasma levels of soluble urokinase-type plasminogen activator receptor associate with the clinical severity of acute Puumala hantavirus infection. PLoS One 2013; 8:e71335. [PMID: 23990945 PMCID: PMC3749226 DOI: 10.1371/journal.pone.0071335] [Citation(s) in RCA: 32] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 07/02/2013] [Indexed: 11/18/2022] Open
Abstract
Objectives Urokinase-type plasminogen activator receptor is a multifunctional glycoprotein, the expression of which is increased during inflammation. It is known to bind to β3-integrins, which are elementary for the cellular entry of hantaviruses. Plasma soluble form of the receptor (suPAR) levels were evaluated as a predictor of severe Puumala hantavirus (PUUV) infection and as a possible factor involved in the pathogenesis of the disease. Design A single-centre prospective cohort study. Subjects and Methods Plasma suPAR levels were measured twice during the acute phase and once during the convalescence in 97 patients with serologically confirmed acute PUUV infection using a commercial enzyme-linked immunosorbent assay (ELISA). Results The plasma suPAR levels were significantly higher during the acute phase compared to the control values after the hospitalization (median 8.7 ng/ml, range 4.0–18.2 ng/ml vs. median 4.7 ng/ml, range 2.4–12.2 ng/ml, P<0.001). The maximum suPAR levels correlated with several variables reflecting the severity of the disease. There was a positive correlation with maximum leukocyte count (r = 0.475, p<0.001), maximum plasma creatinine concentration (r = 0.378, p<0.001), change in weight during the hospitalization (r = 0.406, p<0.001) and the length of hospitalization (r = 0.325, p = 0.001), and an inverse correlation with minimum platelet count (r = −0.325, p = 0.001) and minimum hematocrit (r = −0.369, p<0.001). Conclusion Plasma suPAR values are markedly increased during acute PUUV infection and associate with the severity of the disease. The overexpression of suPAR possibly activates β3-integrin in PUUV infection, and thus might be involved in the pathogenesis of the disease.
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Affiliation(s)
- Tuula K. Outinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
- * E-mail:
| | - Laura Tervo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Niina Mäenpää
- School of Medicine, University of Tampere, Tampere, Finland
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Heini Huhtala
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Antti Vaheri
- Department of Virology, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
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Huttunen R, Syrjänen J, Vuento R, Aittoniemi J. Current concepts in the diagnosis of blood stream infections. Are novel molecular methods useful in clinical practice? Int J Infect Dis 2013; 17:e934-8. [PMID: 23871281 DOI: 10.1016/j.ijid.2013.04.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 04/02/2013] [Accepted: 04/04/2013] [Indexed: 12/21/2022] Open
Abstract
The decision on the right empirical treatment in bacteremia places particular demands on the clinician. As long as no microbiological diagnosis can be immediately drawn, the clinical diagnosis together with knowledge of local antimicrobial resistance must determine the antimicrobial choice. The use of several amplification, hybridization, and mass spectrometry methods has been studied in patient cohorts in comparison with blood culture-based conventional techniques. However, no clinical outcome trials have been conducted in which the use of these novel methods would guide antimicrobial therapy. Local differences in bacterial antimicrobial resistance cause differences in the regional need for molecular methods for the early detection of resistance mechanisms. The implementation of novel methods in clinical use requires active discussion between laboratory experts and clinicians. Providing rapid susceptibility results using conventional methods can lead to timely changes to appropriate antimicrobial therapy and the costs are lower than with the molecular methods. Gram-stain information in combination with clinical data is an underestimated, underused, rapid, and economical means of assessing the etiology of blood stream infection.
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Affiliation(s)
- Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, Box 2000, FI-33521 Tampere, Finland; University of Tampere Medical School, University of Tampere, Tampere, Finland.
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Tuomisto S, Karhunen PJ, Vuento R, Aittoniemi J, Pessi T. Evaluation of postmortem bacterial migration using culturing and real-time quantitative PCR. J Forensic Sci 2013; 58:910-6. [PMID: 23550887 DOI: 10.1111/1556-4029.12124] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [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: 09/21/2011] [Revised: 04/24/2012] [Accepted: 05/05/2012] [Indexed: 01/12/2023]
Abstract
Postmortem bacteriology can be a valuable tool for evaluating deaths due to bacterial infection or for researching the involvement of bacteria in various diseases. In this study, time-dependent postmortem bacterial migration into liver, mesenteric lymph node, pericardial fluid, portal, and peripheral vein was analyzed in 33 autopsy cases by bacterial culturing and real-time quantitative polymerase chain reaction (RT-qPCR). None suffered or died from bacterial infection. According to culturing, pericardial fluid and liver were the most sterile samples up to 5 days postmortem. In these samples, multigrowth and staphylococci were not or rarely detected. RT-qPCR was more sensitive and showed higher bacterial positivity in all samples. Relative amounts of intestinal bacterial DNA (bifidobacteria, bacteroides, enterobacter, clostridia) increased with time. Sterility of blood samples was low during the studied time periods (1-7 days). The best postmortem microbiological sampling sites were pericardial fluid and liver up to 5 days after death.
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Affiliation(s)
- Sari Tuomisto
- School of Medicine, University of Tampere, Tampere, Finland.
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Uusitalo-Seppälä R, Huttunen R, Aittoniemi J, Koskinen P, Leino A, Vahlberg T, Rintala EM. Pentraxin 3 (PTX3) is associated with severe sepsis and fatal disease in emergency room patients with suspected infection: a prospective cohort study. PLoS One 2013; 8:e53661. [PMID: 23341967 PMCID: PMC3544919 DOI: 10.1371/journal.pone.0053661] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [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: 05/29/2012] [Accepted: 12/03/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Early diagnostic and prognostic stratification of patients with suspected infection is a difficult clinical challenge. We studied plasma pentraxin 3 (PTX3) upon admission to the emergency department in patients with suspected infection. METHODS The study comprised 537 emergency room patients with suspected infection: 59 with no systemic inflammatory response syndrome (SIRS) and without bacterial infection (group 1), 67 with bacterial infection without SIRS (group 2), 54 with SIRS without bacterial infection (group 3), 308 with sepsis (SIRS and bacterial infection) without organ failure (group 4) and 49 with severe sepsis (group 5). Plasma PTX3 was measured on admission using a commercial solid-phase enzyme-linked immunosorbent assay (ELISA). RESULTS The median PTX3 levels in groups 1-5 were 2.6 ng/ml, 4.4 ng/ml, 5.0 ng/ml, 6.1 ng/ml and 16.7 ng/ml, respectively (p<0.001). The median PTX3 concentration was higher in severe sepsis patients compared to others (16.7 vs. 4.9 ng/ml, p<0.001) and in non-survivors (day 28 case fatality) compared to survivors (14.1 vs. 5.1 ng/ml, p<0.001). A high PTX3 level predicted the need for ICU stay (p<0.001) and hypotension (p<0.001). AUC(ROC) in the prediction of severe sepsis was 0.73 (95% CI 0.66-0.81, p<0.001) and 0.69 in case fatality (95% CI 0.58-0.79, p<0.001). PTX3 at a cut-off level for 14.1 ng/ml (optimal cut-off value for severe sepsis) showed 63% sensitivity and 80% specificity. At a cut-off level 7.7 ng/ml (optimal cut-off value for case fatality) showed 70% sensitivity and 63% specificity in predicting case fatality on day 28.In multivariate models, high PTX3 remained an independent predictor of severe sepsis and case fatality after adjusting for potential confounders. CONCLUSIONS A high PTX3 level on hospital admission predicts severe sepsis and case fatality in patients with suspected infection.
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Lindström V, Aittoniemi J, Jylhävä J, Eklund C, Hurme M, Paavonen T, Oja SS, Itälä-Remes M, Sinisalo M. Indoleamine 2,3-Dioxygenase Activity and Expression in Patients With Chronic Lymphocytic Leukemia. Clinical Lymphoma Myeloma and Leukemia 2012; 12:363-5. [DOI: 10.1016/j.clml.2012.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 05/17/2012] [Accepted: 06/15/2012] [Indexed: 12/14/2022]
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Uusitalo-Seppälä R, Huttunen R, Tarkka M, Aittoniemi J, Koskinen P, Leino A, Vahlberg T, Rintala EM. Soluble urokinase-type plasminogen activator receptor in patients with suspected infection in the emergency room: a prospective cohort study. J Intern Med 2012; 272:247-56. [PMID: 22755554 DOI: 10.1111/j.1365-2796.2012.02569.x] [Citation(s) in RCA: 44] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The soluble form of urokinase-type plasminogen activator (suPAR) was evaluated as an early prognostic marker of sepsis in patients with suspected infection. DESIGN A single-centre prospective cohort study. METHODS The cohort comprised 539 patients in the emergency department with suspected infection: 59 without systemic inflammatory response syndrome (SIRS) and without bacterial infection (group 1), 68 with bacterial infection and without SIRS (group 2), 54 with SIRS and without bacterial infection (group 3), 309 with sepsis (SIRS and bacterial infection) and without organ failure (group 4) and 49 with severe sepsis (SIRS, bacterial infection and organ failure) (group 5). suPAR was measured on admission using a commercial solid-phase enzyme-linked immunosorbent assay. RESULTS The median soluble form of the receptor (suPAR) concentrations in groups 1-5 were 4.7, 5.0, 4.4, 4.8 and 7.9 ng mL(-1) , respectively (P < 0.001). The levels were significantly higher in nonsurvivors compared with survivors (8.3 vs. 4.9 ng mL(-1) , P < 0.001) and in patients with severe sepsis (group 5) compared with those in the other groups (7.9 vs. 4.8 ng mL(-1) , P < 0.001). Area under the receiver operating characteristics curve (AUC(ROC) ) for the prediction of case fatality was 0.79 (95% confidence interval [CI]: 0.72-0.86, P < 0.0001) and 0.75 for severe sepsis (95% CI: 0.68-0.81, P < 0.0001). At a cut-off level of 6.4 ng mL(-1) , suPAR had 76% sensitivity and 69% specificity for fatal disease; at a cut-off level of 6.6 ng mL(-1) , the sensitivity and specificity for severe sepsis were 67% and 72%, respectively. In multivariate models, high suPAR remained an independent predictor of case fatality and severe sepsis after adjusting for potential confounders. CONCLUSIONS A high suPAR level predicts case fatality and severe sepsis in patients with suspected infection.
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Affiliation(s)
- R Uusitalo-Seppälä
- Department of Infectious Diseases, Satakunta Central Hospital, Pori, Finland.
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Haarala A, Kähönen M, Lehtimäki T, Aittoniemi J, Jylhävä J, Hutri-Kähönen N, Taittonen L, Laitinen T, Juonala M, Viikari J, Raitakari OT, Hurme M. Relation of high cytomegalovirus antibody titres to blood pressure and brachial artery flow-mediated dilation in young men: the Cardiovascular Risk in Young Finns Study. Clin Exp Immunol 2012; 167:309-16. [PMID: 22236008 DOI: 10.1111/j.1365-2249.2011.04513.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Human cytomegalovirus (CMV) infection is associated with a higher risk of cardiovascular disease in immunocompromised organ transplant patients. It has been linked with the pathogenesis of elevated arterial blood pressure. However, controversy exists as to whether CMV infection is associated with endothelial function, and little is known about its role as a potential risk factor for early atherosclerosis development at a young age. We aimed to discover if CMV antibody titres are associated with early vascular changes (carotid intima-media thickness, carotid artery distensibility and brachial artery flow-mediated dilation), blood pressure elevation or other traditional cardiovascular risk factors. CMV antibody titres were measured in 1074 women and 857 men (aged 24-39 years) taking part in the Cardiovascular Risk in Young Finns study. CMV antibody titres were significantly higher in women compared to men. In men, high CMV antibody titres were associated directly with age (P < 0·001) and systolic (P = 0·053) and diastolic (P = 0·002) blood pressure elevation, and associated inversely with flow-mediated dilation (P = 0·014). In women, CMV antibody titres did not associate with any of the analysed parameters. In a multivariate regression model, which included traditional atherosclerotic risk factors, CMV antibody titres were independent determinants for systolic (P = 0·029) and diastolic (P = 0·004) blood pressure elevation and flow-mediated dilation (P = 0·014) in men. High CMV antibody titres are associated independently with blood pressure and brachial artery flow-mediated dilation in young men. This association supports the hypothesis that common CMV infection and/or an immune response to CMV may lead to impaired vascular function at a young age.
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Affiliation(s)
- A Haarala
- Department of Microbiology and Immunology, University of Tampere, Medical School, Tampere, Finland.
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Huttunen R, Aittoniemi J. Risk Factors for Mortality in Patients With Clostridium difficile Infection. Clin Infect Dis 2012; 54:1214; author reply 1214-5. [DOI: 10.1093/cid/cis019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Huttunen R, Aittoniemi J. New concepts in the pathogenesis, diagnosis and treatment of bacteremia and sepsis. J Infect 2011; 63:407-19. [PMID: 21840338 DOI: 10.1016/j.jinf.2011.08.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 08/01/2011] [Accepted: 08/04/2011] [Indexed: 01/05/2023]
Abstract
Bacteremia and sepsis are major health concerns. Despite intensive research, there are only a limited number of successful treatment options, and it is difficult to see the forest for the trees when considering the pathogenesis of this condition. Studies in the last decade have shown that a major pathophysiologic event in sepsis is the progression from proinflammation to an immunosuppressive state. However, recent genome-based data indicate that sepsis-related inflammatory responses are highly variable, which calls in question the classic two-phase model of sepsis. Adequate and timely antimicrobial treatment is a cornerstone for survival in patients with bacteremia and sepsis. However, microbial resistance has emerged as an increasing challenge for clinicians and with an increasing number of resistant pathogens causing infections, selection of empiric antimicrobial treatment has become difficult. Treatment options currently under way are targeted to enhance immune responses, rebalance the regulation of the dysregulated immune system, remove endotoxin and block/inhibit apoptosis.
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Affiliation(s)
- Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, Box 2000, FI-33521 Tampere, Finland.
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Huttunen R, Syrjänen J, Vuento R, Hurme M, Huhtala H, Laine J, Pessi T, Aittoniemi J. Plasma level of soluble urokinase-type plasminogen activator receptor as a predictor of disease severity and case fatality in patients with bacteraemia: a prospective cohort study. J Intern Med 2011; 270:32-40. [PMID: 21332843 DOI: 10.1111/j.1365-2796.2011.02363.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [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: 12/16/2022]
Abstract
OBJECTIVES Urokinase-type plasminogen activator receptor (uPAR) is expressed on a variety of different immune cells and vascular endothelial cells during inflammation. Previous studies indicate that a high plasma concentration of the soluble form of the receptor (suPAR) predicts poor outcome in infectious diseases. DESIGN A prospective cohort study. SUBJECTS AND METHODS Plasma suPAR levels were measured in 132 patients with bacteraemia caused by Staphylococcus aureus, Streptococcus pneumoniae, ß-haemolytic streptococcae or Escherichia coli using a commercial enzyme-linked immunosorbent assay (ELISA). Values were measured on days 1-4 after a positive blood culture, on days 13-18 and on recovery. RESULTS The maximum suPAR values on days 1-4 were markedly higher in nonsurvivors compared to survivors (15.8 vs. 7.3 ng mL(-1) , P < 0.001) and the area under the receiver operating characteristic curve (AUC(ROC) ) in the prediction of case fatality was 0.84 (95% confidence interval (CI) 0.76-0.93, P < 0.001). At a cut-off level of 11.0 ng mL(-1) , the sensitivity and specificity of suPAR for fatal disease was 83% and 76%, respectively. A high level of suPAR (≥ 11 ng mL(-1) ) was associated with hypotension (mean arterial pressure < 70 mmHg) (odds ratio (OR) 6.5; 95% CI 2.9-14.6) and high sequential organ failure assessment score (≥ 4) (OR 9.3; 95% CI 4.0-21.9). A high suPAR level remained an independent risk factor for case fatality in a logistic regression model adjusted for potential confounders. CONCLUSION Plasma suPAR level is a sensitive and specific independent prognostic biomarker in patients with bacteraemia.
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Affiliation(s)
- R Huttunen
- Department of Internal Medicine, Tampere University Hospital, University of Tampere Medical School, University of Tampere, Tampere, Finland.
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Huttunen R, Kuparinen T, Jylhävä J, Aittoniemi J, Vuento R, Huhtala H, Laine J, Syrjänen J, Hurme M. Fatal outcome in bacteremia is characterized by high plasma cell free DNA concentration and apoptotic DNA fragmentation: a prospective cohort study. PLoS One 2011; 6:e21700. [PMID: 21747948 PMCID: PMC3128600 DOI: 10.1371/journal.pone.0021700] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [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: 03/09/2011] [Accepted: 06/05/2011] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Recent studies have shown that apoptosis plays a critical role in the pathogenesis of sepsis. High plasma cell free DNA (cf-DNA) concentrations have been shown to be associated with sepsis outcome. The origin of cf-DNA is unclear. METHODS Total plasma cf-DNA was quantified directly in plasma and the amplifiable cf-DNA assessed using quantitative PCR in 132 patients with bacteremia caused by Staphylococcus aureus, Streptococcus pneumoniae, ß-hemolytic streptococcae or Escherichia coli. The quality of cf-DNA was analyzed with a DNA Chip assay performed on 8 survivors and 8 nonsurvivors. Values were measured on days 1-4 after positive blood culture, on day 5-17 and on recovery. RESULTS The maximum cf-DNA values on days 1-4 (n = 132) were markedly higher in nonsurvivors compared to survivors (2.03 vs 1.26 ug/ml, p<0.001) and the AUCROC in the prediction of case fatality was 0.81 (95% CI 0.69-0.94). cf-DNA at a cut-off level of 1.52 ug/ml showed 83% sensitivity and 79% specificity for fatal disease. High cf-DNA (>1.52 ug/ml) remained an independent risk factor for case fatality in a logistic regression model. Qualitative analysis of cf-DNA showed that cf-DNA displayed a predominating low-molecular-weight cf-DNA band (150-200 bp) in nonsurvivors, corresponding to the size of the apoptotic nucleosomal DNA. cf-DNA concentration showed a significant positive correlation with visually graded apoptotic band intensity (R = 0.822, p<0.001). CONCLUSIONS Plasma cf-DNA concentration proved to be a specific independent prognostic biomarker in bacteremia. cf-DNA displayed a predominating low-molecular-weight cf-DNA band in nonsurvivors corresponding to the size of apoptotic nucleosomal DNA.
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Affiliation(s)
- Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
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Seiskari T, Horsti J, Aittoniemi J. The value of HCV antigen test with reference to PCR in confirming infection in cases with indefinite antibody test result. J Clin Virol 2011; 51:90-1. [DOI: 10.1016/j.jcv.2011.02.003] [Citation(s) in RCA: 3] [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] [Received: 09/21/2010] [Revised: 01/24/2011] [Accepted: 02/07/2011] [Indexed: 11/27/2022]
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