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Helanne H, Forsblom E, Kainulainen K, Järvinen A, Kortela E. Incidence and outcome of hospital-acquired COVID-19 infections in secondary and tertiary care hospitals in the era of COVID-19 vaccinations. Antimicrob Steward Healthc Epidemiol 2023; 3:e216. [PMID: 38156200 PMCID: PMC10753469 DOI: 10.1017/ash.2023.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 12/30/2023]
Abstract
Objective Hospital-acquired (HA) COVID-19 infections are known to increase morbidity and mortality. The aim of this study was to investigate the incidence and outcome of HA COVID-19 in different specialties across the wards in 18 hospitals belonging to the Helsinki University Hospital (HUH) responsible for secondary and tertiary care of a population of 1.8 million. Design Retrospective population-based cohort study. Setting Secondary and tertiary care hospitals. Patients Inpatients with HA COVID-19 infection. Methods The HA COVID-19 infections with patient characteristics were retrospectively searched from HUH patient database from 1st October 2021 to 31st March 2022. All positive SARS-CoV-2 nucleic acid amplification tests (NAATs) from any ward were reviewed. The COVID-19 infection was classified as HA if a notification of HA infection was done or SARS-CoV-2 NAAT was positive ≥6 days after hospital admission or medical records revealed a known exposure for COVID-19 during hospital stay. Results 177 HA COVID-19 infections were retrieved with an incidence of 0.55 per 1000 patient days. Of these patients, 71 (40%) were treated in medicine, 52 (29%) in operative, and 54 (31%) in psychiatric wards, leading to incidences of 0.51, 0.39, and 1.10 per 1,000 patient days, respectively. In association with COVID-19, 16 (23%) in medicine, 3 (6%) in operative, and 1 (2%) patient in psychiatric wards deceased. Of the deceased patients, 16 (80%) had received at least one COVID-19 vaccine. Conclusions Hospital-acquired COVID-19 infections in omicron era were related to high mortality, especially among patients in medicine wards who also had good vaccination coverage.
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Affiliation(s)
- Hanna Helanne
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Erik Forsblom
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Katariina Kainulainen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Asko Järvinen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Elisa Kortela
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
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Lindahl AL, Ahava MJ, Haukipää M, Kreivi HR, Lipponen A, Kortela E. Successful treatment of persisting SARS-CoV-2 infection in an immunocompromised patient with repeated nirmatrelvir/ritonavir courses: a case report. Infect Dis (Lond) 2023; 55:585-589. [PMID: 37334428 DOI: 10.1080/23744235.2023.2223274] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/21/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND In immunocompromised patients, persistent SARS-CoV-2 viral shedding and relapsing COVID-19 pneumonia have been described. Currently, little is known about the management of persisting COVID-19, and immunocompromised patients are recommended to be treated using antivirals and immunomodulatory therapies at similar doses and durations as the general population. Previous case reports have described treatment with repeated and prolonged courses of remdesivir and some evidence is emerging in the use of nirmatrelvir/ritonavir combination (NMV/r). METHODS We describe a patient with recent chemotherapy including rituximab for follicular lymphoma with persisting SARS-CoV-2 infection. Polymerase chain reaction tests (PCR), cycle threshold values and blood SARS-CoV-2 antigen levels were evaluated. RESULTS The patient presented with persisting SARS-CoV-2 with relapsing COVID-19 pneumonia. The patient was treated successfully with repeated courses of NMV/r without any observed adverse effects. After the third, prolonged course, the patient remained afebrile and PCR negative, and no relapses have been observed four months after the third NMV/r course. CONCLUSIONS Nirmatrelvir-ritonavir could offer a more accessible alternative to remdesivir. Further research and guidelines for persisting SARS-CoV-2 infection in immunocompromised patients are urgently needed.
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Affiliation(s)
- Anna L Lindahl
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Maarit J Ahava
- Diagnostic Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Mia Haukipää
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Hanna-Riikka Kreivi
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Anne Lipponen
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Elisa Kortela
- Inflammation Center, Helsinki University Hospital and University of Helsinki, Finland
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Ahava MJ, Kortela E, Forsblom E, Pätäri-Sampo A, Friberg N, Meretoja A, Kivivuori SM, Lappalainen M, Kurkela S, Järvinen A, Jarva H. Low incidence of severe bacterial infections in hospitalised patients with COVID-19: A population-based registry study. Infect Dis (Lond) 2023; 55:132-141. [PMID: 36305894 DOI: 10.1080/23744235.2022.2138963] [Citation(s) in RCA: 2] [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] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Bacterial infections complicating COVID-19 are rare but present a challenging clinical entity. The aim of this study was to evaluate the incidence, aetiology and outcome of severe laboratory-verified bacterial infections in hospitalised patients with COVID-19. METHODS All laboratory-confirmed patients with COVID-19 admitted to specialised healthcare hospitals in the Capital Province of Finland during the first wave of COVID-19 between 27 February and 21 June 2020 were retrospectively studied. We gathered the blood and respiratory tract culture reports of these patients and analysed their association with 90-day case-fatality using multivariable regression analysis. RESULTS A severe bacterial infection was diagnosed in 40/585 (6.8%) patients with COVID-19. The range of bacteria was diverse, and the most common bacterial findings in respiratory samples were gram-negative, and in blood cultures gram-positive bacteria. Patients with severe bacterial infection had longer hospital stay (mean 31; SD 20 days) compared to patients without (mean 9; SD 9 days; p < 0.001). Case-fatality was higher with bacterial infection (15% vs 11%), but the difference was not statistically significant (OR 1.38 CI95% 0.56-3.41). CONCLUSIONS Severe bacterial infection complicating COVID-19 was a rare occurrence in our cohort. Our results are in line with the current understanding that antibiotic treatment for hospitalised COVID-19 patients should only be reserved for situations where a bacterial infection is strongly suspected. The ever-evolving landscape of the pandemic and recent advances in immunomodulatory treatment of COVID-19 patients underline the need for continuous vigilance concerning the possibility and frequency of nosocomial bacterial infections.
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Affiliation(s)
- M J Ahava
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - E Kortela
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - E Forsblom
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - A Pätäri-Sampo
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - N Friberg
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - A Meretoja
- General Administration, Helsinki University Hospital, Helsinki, Finland
| | - S-M Kivivuori
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - M Lappalainen
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - S Kurkela
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - A Järvinen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - H Jarva
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Translational Immunology Research Program, Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
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Pietikäinen A, Glader O, Kortela E, Kanerva M, Oksi J, Hytönen J. Borrelia burgdorferi specific serum and cerebrospinal fluid antibodies in Lyme neuroborreliosis. Diagn Microbiol Infect Dis 2022; 104:115782. [DOI: 10.1016/j.diagmicrobio.2022.115782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/06/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
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Truong Nguyen P, Kant R, Van den Broeck F, Suvanto MT, Alburkat H, Virtanen J, Ahvenainen E, Castren R, Hong SL, Baele G, Ahava MJ, Jarva H, Jokiranta ST, Kallio-Kokko H, Kekäläinen E, Kirjavainen V, Kortela E, Kurkela S, Lappalainen M, Liimatainen H, Suchard MA, Hannula S, Ellonen P, Sironen T, Lemey P, Vapalahti O, Smura T. The phylodynamics of SARS-CoV-2 during 2020 in Finland. Commun Med (Lond) 2022; 2:65. [PMID: 35698660 PMCID: PMC9187640 DOI: 10.1038/s43856-022-00130-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 05/23/2022] [Indexed: 02/01/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused millions of infections and fatalities globally since its emergence in late 2019. The virus was first detected in Finland in January 2020, after which it rapidly spread among the populace in spring. However, compared to other European nations, Finland has had a low incidence of SARS-CoV-2. To gain insight into the origins and turnover of SARS-CoV-2 lineages circulating in Finland in 2020, we investigated the phylogeographic and -dynamic history of the virus. Methods The origins of SARS-CoV-2 introductions were inferred via Travel-aware Bayesian time-measured phylogeographic analyses. Sequences for the analyses included virus genomes belonging to the B.1 lineage and with the D614G mutation from countries of likely origin, which were determined utilizing Google mobility data. We collected all available sequences from spring and fall peaks to study lineage dynamics. Results We observed rapid turnover among Finnish lineages during this period. Clade 20C became the most prevalent among sequenced cases and was replaced by other strains in fall 2020. Bayesian phylogeographic reconstructions suggested 42 independent introductions into Finland during spring 2020, mainly from Italy, Austria, and Spain. Conclusions A single introduction from Spain might have seeded one-third of cases in Finland during spring in 2020. The investigations of the original introductions of SARS-CoV-2 to Finland during the early stages of the pandemic and of the subsequent lineage dynamics could be utilized to assess the role of transboundary movements and the effects of early intervention and public health measures.
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Affiliation(s)
- Phuoc Truong Nguyen
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ravi Kant
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Frederik Van den Broeck
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Maija T. Suvanto
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Hussein Alburkat
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jenni Virtanen
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Ella Ahvenainen
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Robert Castren
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Samuel L. Hong
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
| | - Guy Baele
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
| | - Maarit J. Ahava
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Jarva
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
| | - Suvi Tuulia Jokiranta
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
| | - Hannimari Kallio-Kokko
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eliisa Kekäläinen
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Vesa Kirjavainen
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Elisa Kortela
- Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Satu Kurkela
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maija Lappalainen
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Liimatainen
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marc A. Suchard
- Departments of Biomathematics, Biostatistics and Human Genetics, University of California, Los Angeles (UCLA), Los Angeles, CA USA
| | - Sari Hannula
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
| | - Pekka Ellonen
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
| | - Tarja Sironen
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Philippe Lemey
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
| | - Olli Vapalahti
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teemu Smura
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Forsblom E, Helanne H, Kortela E, Silén S, Meretoja A, Järvinen A. Inflammation parameters predict fatal outcome in male COVID-19 patients in a low case-fatality area - a population-based registry study. Infect Dis (Lond) 2022; 54:558-571. [PMID: 35353030 DOI: 10.1080/23744235.2022.2055786] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Male sex predicts case-fatality in SARS-CoV-2 (COVID-19) - a phenomenon linked to systemic inflammation. We compared sex-related associations of inflammation parameters and outcome in a population-based setting with low case-fatality prior to wide use of immunosuppressives. METHODS A population-based quality registry with laboratory-confirmed COVID-19 cases of specialized hospitals of the Capital Province of Finland were analysed to compare inflammatory parameters by sex during the first COVID-19 wave February-June 2020. RESULTS Altogether, 585 hospitalized patients (54% males) were included. Males required more often intensive care unit (ICU) treatment (26.9 vs. 17.5%) and had higher 90-d case-fatality (14.9 vs. 7.8%) compared with females. Highest association with case-fatality in males was seen for high neutrophil counts (median; interquartile range) (8.70; 7.10-9.10 vs. 5.60; 3.90-7.80) (E9/l), low monocyte (0.50; 0.20-1.50 vs. 0.70; 0.50-0.90) (E9/l) and lymphocyte (0.90; 0.70-1.40 vs. 1.50; 1.10-2.00) (E9/l) counts, and high levels of d-dimer (3.80; 1.80-5.30 vs. 1.10; 0.60-2.75) (mg/l) and C-reactive protein (CRP) (190; 85.5-290 vs. 77.0; 49.0-94.0) (mg/l). In females, low lymphocyte (0.95; interquartile range 0.60-1.28 vs. 1.50; 1.10-2.00) (E9/l) and thrombocyte counts (196; 132-285 vs. 325; 244-464) (E9/l) and high CRP values (95.0; 62.0-256 vs. 66.0; 42.5-89.0) (mg/l) were associated with case-fatality. In multivariable analysis for males, lymphocyte cut-off 0.85 (E9/l) (OR 0.02; 95% CI 0.002-0.260), d-dimer cut-off 1.15 (mg/l) (OR 7.29; 1.01-52.6) and CRP cut-off 110 (mg/l) (OR 15.4; 1.87-127) were independently associated with case-fatality. In female multivariable analysis, CRP cut-off 81 (mg/l) (OR 7.32; 1.44-37.2) was the only inflammatory parameter associated with case-fatality. CONCLUSIONS COVID-19 results in higher inflammation parameter levels in male vs. female patients irrespective of outcome. This study suggests that low lymphocyte, high d-dimer and high CRP cut-off values may serve as potential markers for risk stratification in male patients.
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Affiliation(s)
- Erik Forsblom
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Hanna Helanne
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Elisa Kortela
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Suvi Silén
- Department of Otorhinolaryngology-Head and Neck Center, Helsinki University Hospital, Helsinki, Finland
| | - Atte Meretoja
- General Administration, Helsinki University Hospital, Helsinki, Finland
| | - Asko Järvinen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
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Kortela E, Kanerva MJ, Kurkela S, Oksi J, Koivisto M, Järvinen A. Consumption of healthcare services and antibiotics in patients with presumed disseminated Lyme borreliosis before and after evaluation of an infectious disease specialist. Ticks Tick Borne Dis 2021; 13:101854. [PMID: 34695770 DOI: 10.1016/j.ttbdis.2021.101854] [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: 11/04/2020] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
Our objective was to study the consumption of healthcare services and antibiotics in patients with suspicion of disseminated Lyme borreliosis (LB) before and after consultation of an infectious disease specialist. We evaluated retrospectively all presumed disseminated LB patients (n = 256) with a referral to the Department of Infectious Diseases (DID) in Helsinki University Hospital in 2013. Medical records from all healthcare providers in the area were reviewed and the number of physician contacts because of symptoms leading to LB suspicion and antimicrobial purchases were calculated 1 year before and after consultation or treatment at the DID. Patients were divided into three groups according to certainty of LB: unlikely, possible or probable/definite LB. The number of healthcare contacts 1 year before referral was higher among 121 patients with unlikely LB (6; interquartile range [IQR] 3-10), than 65 possible (4; IQR 2.5-7; p = 0.018) or 66 probable/definite LB patients (4; IQR 2.8-7; p = 0.010). The median number of contacts to healthcare during one year after consultation or treatment was 3 (IQR 0.5-7), 1 (IQR 0-3) and 0.5 (IQR 0-2.3), respectively, with a statistically significant difference between the groups (p<0.001). Antibiotics were purchased by 151 (60%) patients one year before referral and by 127 (50%) patients year after consultation or treatment at DID without statistically significant difference between groups with different LB certainty. These antibiotic purchases do not include the treatments prescribed by infectious disease specialists. In the case of 27 patients, an antimicrobial treatment was recommended in the consultation reply. In conclusion, patients with unlikely LB used more healthcare services than patients with possible or probable/definite LB. Antimicrobial consumption was similar between groups of different LB certainty.
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Affiliation(s)
- Elisa Kortela
- Division of infectious diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland.
| | - Mari J Kanerva
- Division of infectious diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Satu Kurkela
- Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Asko Järvinen
- Division of infectious diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Forsblom E, Silén S, Kortela E, Ahava M, Kreivi HR, Holmberg V, Järvinen A, Hästbacka J, Kivivuori SM, Meretoja A. Male predominance in disease severity and mortality in a low Covid-19 epidemic and low case-fatality area - a population-based registry study. Infect Dis (Lond) 2021; 53:789-799. [PMID: 34100692 DOI: 10.1080/23744235.2021.1936157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Men reportedly suffer from a more severe disease and higher mortality during the global SARS-CoV-2 (Covid-19) pandemic. We analysed sex differences in a low epidemic area with low overall mortality in Covid-19 in a population based setting with patients treated in specialized healthcare. METHODS We entered all hospitalized laboratory-confirmed Covid-19 cases of all specialized healthcare hospitals of the Capital Province of Finland, into a population-based quality registry and described demographics, severity and case-fatality by sex of the first Covid-19 wave February-June 2020. RESULTS Altogether 5471 patients (49% male) were identified. Patients hospitalized in the specialist healthcare (N = 585, 54% male, OR 1.25; 95% CI 1.05-1.48) were of the same age. Men had less asthma and thyroid insufficiency and more coronary artery disease compared to women. Mean time from symptom onset to diagnosis was at least one day longer for men (p=.005). Men required intensive care unit (ICU) more often (27% vs. 17%) with longer lengths-of-stays at ICU. Male sex associated with significantly higher case-fatality at 90-days (15% vs. 8%) and all excess male deaths occurring after three weeks from onset. Men with fatal outcomes had delays in both Covid-19 testing and hospital admission after a positive test. The delays in patients with the most severe and fatal outcomes differed markedly by sex. In multivariable analysis, male sex associated independently with case-fatality (OR 2.37; 95% CI 1.22-4.59). CONCLUSIONS Male sex associated with higher disease severity and case-fatality. Late presentation of male fatal cases could represent different treatment-seeking behaviour or disease progression by sex.
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Affiliation(s)
- Erik Forsblom
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Suvi Silén
- Department of Otorhinolaryngology-Head and Neck Center, Helsinki University Hospital, Helsinki, Finland
| | - Elisa Kortela
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Maarit Ahava
- Diagnostic Center, Clinical Microbiology, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna-Riikka Kreivi
- Division of Respiratory Diseases, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Ville Holmberg
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland.,Department of Medicine, Clinicum, University of Helsinki, Helsinki, Finland
| | - Asko Järvinen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Johanna Hästbacka
- Department of Anesthesiology, Intensive Care and Pain Medicine, Division of Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland
| | | | - Atte Meretoja
- General Administration, Helsinki University Hospital, Helsinki, Finland
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Kortela E, Kirjavainen V, Ahava MJ, Jokiranta ST, But A, Lindahl A, Jääskeläinen AE, Jääskeläinen AJ, Järvinen A, Jokela P, Kallio-Kokko H, Loginov R, Mannonen L, Ruotsalainen E, Sironen T, Vapalahti O, Lappalainen M, Kreivi HR, Jarva H, Kurkela S, Kekäläinen E. Real-life clinical sensitivity of SARS-CoV-2 RT-PCR test in symptomatic patients. PLoS One 2021; 16:e0251661. [PMID: 34019562 PMCID: PMC8139477 DOI: 10.1371/journal.pone.0251661] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [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: 11/26/2020] [Accepted: 04/29/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Understanding the false negative rates of SARS-CoV-2 RT-PCR testing is pivotal for the management of the COVID-19 pandemic and it has implications for patient management. Our aim was to determine the real-life clinical sensitivity of SARS-CoV-2 RT-PCR. METHODS This population-based retrospective study was conducted in March-April 2020 in the Helsinki Capital Region, Finland. Adults who were clinically suspected of SARS-CoV-2 infection and underwent SARS-CoV-2 RT-PCR testing, with sufficient data in their medical records for grading of clinical suspicion were eligible. In addition to examining the first RT-PCR test of repeat-tested individuals, we also used high clinical suspicion for COVID-19 as the reference standard for calculating the sensitivity of SARS-CoV-2 RT-PCR. RESULTS All 1,194 inpatients (mean [SD] age, 63.2 [18.3] years; 45.2% women) admitted to COVID-19 cohort wards during the study period were included. The outpatient cohort of 1,814 individuals (mean [SD] age, 45.4 [17.2] years; 69.1% women) was sampled from epidemiological line lists by systematic quasi-random sampling. The sensitivity (95% CI) for laboratory confirmed cases (repeat-tested patients) was 85.7% (81.5-89.1%) inpatients; 95.5% (92.2-97.5%) outpatients, 89.9% (88.2-92.1%) all. When also patients that were graded as high suspicion but never tested positive were included in the denominator, the sensitivity (95% CI) was: 67.5% (62.9-71.9%) inpatients; 34.9% (31.4-38.5%) outpatients; 47.3% (44.4-50.3%) all. CONCLUSIONS The clinical sensitivity of SARS-CoV-2 RT-PCR testing was only moderate at best. The relatively high false negative rates of SARS-CoV-2 RT-PCR testing need to be accounted for in clinical decision making, epidemiological interpretations, and when using RT-PCR as a reference for other tests.
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Affiliation(s)
- Elisa Kortela
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Vesa Kirjavainen
- HUSLAB Clinical Microbiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit J. Ahava
- HUSLAB Clinical Microbiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Suvi T. Jokiranta
- Translational Immunology Research Program and Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
| | - Anna But
- Biostatistics Consulting, Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna Lindahl
- Department of Respiratory Medicine, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Anu E. Jääskeläinen
- HUSLAB Clinical Microbiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Annemarjut J. Jääskeläinen
- HUSLAB Clinical Microbiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Asko Järvinen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Pia Jokela
- HUSLAB Clinical Microbiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannimari Kallio-Kokko
- HUSLAB Clinical Microbiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Raisa Loginov
- HUSLAB Clinical Microbiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura Mannonen
- HUSLAB Clinical Microbiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eeva Ruotsalainen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tarja Sironen
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Olli Vapalahti
- HUSLAB Clinical Microbiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Maija Lappalainen
- HUSLAB Clinical Microbiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna-Riikka Kreivi
- Department of Respiratory Medicine, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Hanna Jarva
- HUSLAB Clinical Microbiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Translational Immunology Research Program and Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
| | - Satu Kurkela
- HUSLAB Clinical Microbiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eliisa Kekäläinen
- HUSLAB Clinical Microbiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Translational Immunology Research Program and Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
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10
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Kortela E, Kanerva MJ, Puustinen J, Hurme S, Airas L, Lauhio A, Hohenthal U, Jalava-Karvinen P, Nieminen T, Finnilä T, Häggblom T, Pietikäinen A, Koivisto M, Vilhonen J, Marttila-Vaara M, Hytönen J, Oksi J. Oral Doxycycline Compared to Intravenous Ceftriaxone in the Treatment of Lyme Neuroborreliosis: A Multicenter, Equivalence, Randomized, Open-label Trial. Clin Infect Dis 2021; 72:1323-1331. [PMID: 32133487 DOI: 10.1093/cid/ciaa217] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/07/2020] [Accepted: 03/01/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Lyme neuroborreliosis (LNB) is often treated with intravenous ceftriaxone even if doxycycline is suggested to be noninferior to ceftriaxone. We evaluated the efficacy of oral doxycycline in comparison to ceftriaxone in the treatment of LNB. METHODS Patients with neurological symptoms suggestive of LNB without other obvious reasons were recruited. The inclusion criteria were (1) production of Borrelia burgdorferi-specific antibodies in cerebrospinal fluid (CSF) or serum; (2) B. burgdorferi DNA in the CSF; or (3) an erythema migrans during the past 3 months. Participants were randomized in a 1:1 ratio to receive either oral doxycycline 100 mg twice daily for 4 weeks, or intravenous ceftriaxone 2 g daily for 3 weeks. The participants described their subjective condition with a visual analogue scale (VAS) from 0 to 10 (0 = normal; 10 = worst) before the treatment, and 4 and 12 months after the treatment. The primary outcome was the change in the VAS score at 12 months. RESULTS Between 14 September 2012 and 28 December 2017, 210 adults with suspected LNB were assigned to receive doxycycline (n = 104) or ceftriaxone (n = 106). The per-protocol analysis comprised 82 patients with doxycycline and 84 patients with ceftriaxone. The mean change in the VAS score was -3.9 in the doxycycline group and -3.8 in the ceftriaxone group (mean difference, 0.17 [95% confidence interval, -.59 to .92], which is within the prespecified equivalence margins of -1 to 1 units). Participants in both groups improved equally. CONCLUSIONS Oral doxycycline is equally effective as intravenous ceftriaxone in the treatment of LNB. CLINICAL TRIALS REGISTRATION NCT01635530 and EudraCT 2012-000313-37.
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Affiliation(s)
- Elisa Kortela
- Department of Clinical Medicine, University of Turku, Turku, Finland.,Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mari J Kanerva
- Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Puustinen
- Unit of Neurology, Satakunta Central Hospital, Pori, Finland.,Department of Neurology, University of Turku, Turku, Finland.,Division of Pharmacology and Pharmacotherapy, University of Helsinki, Helsinki, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Laura Airas
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | | | - Ulla Hohenthal
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Jalava-Karvinen
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas Nieminen
- Infectious Diseases Unit, Satakunta Central Hospital, Pori, Finland
| | - Taru Finnilä
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Tony Häggblom
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Johanna Vilhonen
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Minna Marttila-Vaara
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Jukka Hytönen
- Institute of Biomedicine, University of Turku, Turku, Finland.,Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
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11
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Rouhiainen M, Pietikäinen A, Kortela E, Kanerva MJ, Oksi J, Hytönen J. C6 peptide enzyme immunoassay in Lyme borreliosis serology. J Microbiol Methods 2020; 180:106122. [PMID: 33326821 DOI: 10.1016/j.mimet.2020.106122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 12/22/2022]
Abstract
The cut-off values used in C6 peptide-based enzyme immunoassay (EIA), a widely used test in Lyme borreliosis (LB) serology, have not been thoroughly analysed. The objective of the study was to examine the performance of the C6 EIA, and to determine optimal cut-off values for the test. The analysed data contained results of 1368 serum samples. C6 EIA index values were compared statistically with the immunoblot (IB) test results. The identified cut-off values were further tested in a well-defined LB patient cohort. Cut-off value 1.6 appeared to be optimal when C6 EIA was used as a stand-alone test. When using C6 EIA as the first-tier test, the optimal cut-off values were 0.9 and 2.4 for negative and positive results. When C6 EIA was used as a second-tier test, samples yielding C6 index values ≥3.0 could be considered positive. The identified cut-off values had also a high sensitivity to identify seropositivity among definite LB patients. The identified cut-off values refine the role of C6 EIA in LB serology. Importantly, the use of C6 EIA leads to a reduction in the number of samples that need to be analysed using an IB, thus also reducing the costs. Two alternative workflows for LB serology including the C6 EIA are suggested.
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Affiliation(s)
- Meri Rouhiainen
- Institute of Biomedicine, University of Turku, Turku, Finland; Doctoral Programme in Clinical Research, Turku, Finland.
| | - Annukka Pietikäinen
- Institute of Biomedicine, University of Turku, Turku, Finland; Laboratory Division, Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Elisa Kortela
- Department of Clinical Medicine, University of Turku, Turku, Finland; Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mari J Kanerva
- Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Jukka Hytönen
- Institute of Biomedicine, University of Turku, Turku, Finland; Laboratory Division, Clinical Microbiology, Turku University Hospital, Turku, Finland
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12
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Kortela E, Kanerva M, Kurkela S, Oksi J, Järvinen A. Suspicion of Lyme borreliosis in patients referred to an infectious diseases clinic: what did the patients really have? Clin Microbiol Infect 2020; 27:1022-1028. [PMID: 32979573 DOI: 10.1016/j.cmi.2020.09.022] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/31/2020] [Accepted: 09/12/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the conditions behind the symptoms in patients with suspected Lyme borreliosis (LB) who were referred to an infectious diseases clinic. METHODS In this retrospective, population-based study, we collected data from the medical records of all patients referred for infectious disease consultations in 2013 due to presumed LB from a population of 1.58 million. The patients were classified according to the certainty of LB on the basis of their symptoms, signs and laboratory results. Data on the outcomes and subsequent alternative diagnoses during the 4-year follow-up period were reviewed from all of the available patient records from public, private and occupational healthcare providers. RESULTS A total of 256 patients (16/100 000) were referred as a result of suspicion of LB; 30 (12%) of 256 were classified with definite, 36 (14%) with probable and 65 (25%) with possible LB. LB was unlikely in 121 (47%) patients. A novel diagnosis was discovered in the background symptoms in 73 (29%) of patients. Previously diagnosed comorbidities caused at least some of the symptoms in 48 (19%) patients. Other explanations for symptoms were found in 81 (67%) of 121 of unlikely and 22 (34%) of 65 of possible LB patients. The spectrum of conditions behind the symptoms was quite broad and most often were musculoskeletal, neurological, psychological or functional disorders. CONCLUSIONS LB was unlikely in half of the patients with presumed LB. In most cases the patients had other conditions that explained their symptoms.
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Affiliation(s)
- Elisa Kortela
- Division of Infectious Diseases, Inflammation Centre, Helsinki University Hospital and University of Helsinki, Finland; Department of Clinical Medicine, University of Turku, Finland.
| | - Mari Kanerva
- Division of Infectious Diseases, Inflammation Centre, Helsinki University Hospital and University of Helsinki, Finland
| | - Satu Kurkela
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Asko Järvinen
- Division of Infectious Diseases, Inflammation Centre, Helsinki University Hospital and University of Helsinki, Finland
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13
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Jääskeläinen AJ, Kekäläinen E, Kallio-Kokko H, Mannonen L, Kortela E, Vapalahti O, Kurkela S, Lappalainen M. Evaluation of commercial and automated SARS-CoV-2 IgG and IgA ELISAs using coronavirus disease (COVID-19) patient samples. Euro Surveill 2020; 25:2000603. [PMID: 32400364 PMCID: PMC7219034 DOI: 10.2807/1560-7917.es.2020.25.18.2000603] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/07/2020] [Indexed: 11/30/2022] Open
Abstract
Antibody-screening methods to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) need to be validated. We evaluated SARS-CoV-2 IgG and IgA ELISAs in conjunction with the EUROLabworkstation (Euroimmun, Lübeck, Germany). Overall specificities were 91.9% and 73.0% for IgG and IgA ELISAs, respectively. Of 39 coronavirus disease patients, 13 were IgG and IgA positive and 11 IgA alone at sampling. IgGs and IgAs were respectively detected at a median of 12 and 11 days after symptom onset.
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Affiliation(s)
- Anne J Jääskeläinen
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eliisa Kekäläinen
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannimari Kallio-Kokko
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura Mannonen
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Elisa Kortela
- Infectious diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Olli Vapalahti
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Satu Kurkela
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- These authors contributed equally to the work
| | - Maija Lappalainen
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- These authors contributed equally to the work
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14
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Kortela E, Hytönen J, Numminen J, Overmyer M, Saxen H, Oksi J. Cerebral vasculitis and intracranial multiple aneurysms in a child with Lyme neuroborreliosis. JMM Case Rep 2017; 4:e005090. [PMID: 29026617 PMCID: PMC5630958 DOI: 10.1099/jmmcr.0.005090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/20/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction. Lyme borreliosis is a multisystem tick-borne disease caused by Borrelia burgdorferi. Neurological manifestations are reported in up to 15 % of adult patients with Lyme disease, while the frequency among children is higher. The most common manifestations are painful radiculopathy, facial nerve paresis and lymphocytic meningitis. Epileptic seizures and cerebral vasculitis with stroke or aneurysms are very rare complications. Case presentation. We describe a paediatric patient with sensorineural auditory dysfunction, headache, fatigue and epileptic seizures as sequelae of meningoencephalitis/Lyme neuroborreliosis (LNB) caused by B. burgdorferi. Brain magnetic resonance imaging revealed widespread enhancement of the leptomeninges, cranial nerves and artery walls compatible with vasculitis and disturbances in cerebrospinal fluid (CSF) circulation. The patient was treated with ceftriaxone for 2 weeks. Two years later, the patient had an ischemic stroke. Brain magnetic resonance angiography revealed multiple aneurysms, which were not present previously. The largest aneurysm was operated rapidly. The patient was treated with another course of intravenous ceftriaxone for 4 weeks and pulse therapy with corticosteroids. He recovered well.
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Affiliation(s)
- Elisa Kortela
- Division of Infectious Diseases, Faculty of Medicine, University of Turku, University of Helsinki, Helsinki University Hospital, P.O. Box 348, 00029 HUS, Finland
| | - Jukka Hytönen
- Department of Medical Microbiology and Immunology and Microbiology and Genetics Department, University of Turku, Turku University Hospital, Turku, Finland
| | - Jussi Numminen
- Helsinki Medical Imaging Centre, University of Helsinki, Helsinki, Finland
| | - Margit Overmyer
- Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Harri Saxen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Division of Medicine, Faculty of Medicine, University of Turku, Turku University Hospital, P.O. Box 52, 20521 Turku, Finland
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15
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Hytönen J, Kortela E, Waris M, Puustinen J, Salo J, Oksi J. CXCL13 and neopterin concentrations in cerebrospinal fluid of patients with Lyme neuroborreliosis and other diseases that cause neuroinflammation. J Neuroinflammation 2014; 11:103. [PMID: 24920219 PMCID: PMC4070086 DOI: 10.1186/1742-2094-11-103] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Laboratory diagnosis of Lyme neuroborreliosis (LNB) is partly based on the detection of intrathecal Borrelia burgdorferi-specific antibody production (increased antibody index (AI)). However, AI can be negative in patients with early LNB and, conversely, can remain elevated for months after antibiotic treatment. Recent studies suggested that the chemokine CXCL13 in the cerebrospinal fluid (CSF) is a biomarker for active LNB. Also, CSF neopterin-level determination has been used to assess the degree of neuroinflammation in a wide variety of diseases. METHODS CXCL13 concentrations were analyzed in CSF samples of 366 retrospectively identified individuals. The samples represented pretreatment LNB (38 patients), non-LNB comparison patients, tick-borne encephalitis, central nervous system (CNS) varicella zoster virus infection, CNS herpes simplex virus infection, CNS HHV6 infection, CNS enterovirus infection, and untreated neurosyphilis. The panel included also samples from patients with multiple sclerosis and other neuroinflammatory conditions. Of the LNB patients, 24 posttreatment CSF samples were available for CXCL13 analysis. Neopterin concentrations were determined in a subset of these samples. RESULTS The CXCL13 concentrations in CSF samples of untreated LNB patients were significantly higher (median, 6,480 pg/ml) than the concentrations in the non-LNB group (median, <7.8 pg/ml), viral CNS infection samples (median, <7.8 pg/ml), or samples from patients with noninfectious neuroinflammatory conditions (median, <7.8 pg/ml). The use of cut-off 415 pg/ml led to a sensitivity of 100% and specificity of 99.7% for the diagnosis of LNB in these samples. CSF CXCL13 median concentrations declined significantly from 16,770 pg/ml before to 109 pg/ml after the treatment.CSF neopterin concentration was significantly higher among the untreated LNB patients than in the non-LNB group. The use of neopterin concentration 10.6 nM as the cut-off led to a sensitivity of 88.6% and a specificity of 65.0% for the diagnosis of LNB. The CSF neopterin concentrations decreased statistically significantly with the treatment. CONCLUSIONS These results clearly indicate that highly elevated CSF CXCL13 levels are strongly associated with untreated LNB. CXCL13 outperformed neopterin and appears to be an excellent biomarker in differentiating LNB from viral CNS infections and from other neuroinflammatory conditions.
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Affiliation(s)
- Jukka Hytönen
- Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland.
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