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van der Maas NAT, Sanders EAM, Versteegh FGA, Baauw A, Westerhof A, de Melker HE. Pertussis hospitalizations among term and preterm infants: clinical course and vaccine effectiveness. BMC Infect Dis 2019; 19:919. [PMID: 31664950 PMCID: PMC6820906 DOI: 10.1186/s12879-019-4563-5] [Citation(s) in RCA: 10] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pertussis causes severe disease in young unvaccinated infants, with preterms potentially at highest risk. We studied pertussis in hospitalized infants as related to gestational age (GA) and vaccination history. METHODS Medical record data of 0-2y old patients hospitalized for pertussis during 2005-2014 were linked to vaccination data. Multivariable logistic regression was used to study the association between GA and vaccination history on the clinical disease course. We compared vaccine effectiveness (VE) against hospitalization for pertussis between term and preterm infants (i.e., <37w GA) using the screening method as developed by Farrington. RESULTS Of 1187 records, medical data from 676 were retrieved. Of these, 12% concerned preterms, whereas they are 8% of Dutch birth cohorts. Median age at admission was 3 m for preterms and 2 m for terms (p < 0.001). Preterms more often had received pertussis vaccination (62% vs 44%; p = 0.01) and more often had coinfections (37% vs 21%; p = 0.01). Preterms tended more often to have complications, to require artificial respiration or to need admittance to the intensive care unit (ICU). Preterms had longer ICU stays (15d vs 9d; p = 0.004). Vaccinated preterms and terms had a lower median length of hospital stay and lower crude risks of apneas and the need for artificial respiration, additional oxygen, and ICU admittance than those not vaccinated. After adjustment for presence of coinfections and age at admittance, these differences were not significant, except the lower need of oxygen treatment in vaccinated terms. Effectiveness of the first vaccination against pertussis hospitalizations was 95% (95% CI 93-96%) and 73% (95% CI 20-91%) in terms and preterms, respectively. Effectiveness of the second dose of the primary vaccination series was comparable in both groups (86 and 99%, respectively). CONCLUSIONS Infants hospitalized for pertussis suffer from severe disease. Preterms were overrepresented, with higher need for intensive treatment and less VE of first vaccination. These findings stress the need for alternative prevention, in particular prenatal vaccination of mothers, to reduce pertussis in both groups.
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Affiliation(s)
- Nicoline A T van der Maas
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PObox 1, 3720BA, Bilthoven, The Netherlands.
| | - Elisabeth A M Sanders
- Department of Paediatric Immunology and Infectious Diseases, University Medical Hospital Utrecht, Utrecht, the Netherlands
| | - Florens G A Versteegh
- University of Groningen, University Medical Centre Groningen/Beatrix Children's Hospital, Groningen, the Netherlands
| | - Albertine Baauw
- Department of Paediatrics, Rijnstate Hospital, Arnhem, the Netherlands
| | - Anneke Westerhof
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PObox 1, 3720BA, Bilthoven, The Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PObox 1, 3720BA, Bilthoven, The Netherlands
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Wishaupt JO, Ploeg TVD, Smeets LC, Groot RD, Versteegh FGA, Hartwig NG. Pitfalls in interpretation of CT-values of RT-PCR in children with acute respiratory tract infections. J Clin Virol 2017; 90:1-6. [PMID: 28259567 PMCID: PMC7185604 DOI: 10.1016/j.jcv.2017.02.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/26/2016] [Accepted: 02/19/2017] [Indexed: 11/12/2022]
Abstract
Background The relation between viral load and disease severity in childhood acute respiratory tract infections (ARI) is not fully understood. Objectives To assess the clinical relevance of the relation between viral load, determined by cycle threshold (CT) value of real-time reverse transcription-polymerase chain reaction assays and disease severity in children with single- and multiple viral ARI. Study design 582 children with ARI were prospectively followed and tested for 15 viruses. Correlations were calculated between CT values and clinical parameters. Results In single viral ARI, statistically significant correlations were found between viral loads of Respiratory Syncytial Virus (RSV) and hospitalization and between viral loads of Human Coronavirus (HCoV) and a disease severity score. In multiple-viral ARI, statistically significant correlations between viral load and clinical parameters were found. In RSV-Rhinovirus (RV) multiple infections, a low viral load of RV was correlated with a high length of hospital stay and a high duration of extra oxygen use. The mean CT value for RV, HCoV and Parainfluenza virus was significantly lower in single- versus multiple infections. Conclusion Although correlations between CT values and clinical parameters in patients with single and multiple viral infection were found, the clinical importance of these findings is limited because individual differences in host-, viral and laboratory factors complicate the interpretation of statistically significant findings. In multiple infections, viral load cannot be used to differentiate between disease causing virus and innocent bystanders.
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Affiliation(s)
- Jérôme O Wishaupt
- Reinier de Graaf Hospital, Department of Pediatrics, PO Box 5011, 2600GA Delft, The Netherlands.
| | - Tjeerd van der Ploeg
- Pieter van Foreest Institute for Education and Research, Medical Center Alkmaar, PO Box 501, 1800AM Alkmaar, The Netherlands
| | - Leo C Smeets
- Reinier Haga Medisch Diagnostisch Centrum, PO Box 5011, 2600GA Delft, The Netherlands
| | - Ronald de Groot
- Radboud University Medical Center, Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, PO Box 9101, 6500HB Nijmegen, The Netherlands
| | - Florens G A Versteegh
- Groene Hart Ziekenhuis, Department of Pediatrics, PO Box 1098, 2800BB Gouda, The Netherlands; Ghent University Hospital, Department of Pediatrics, De Pintelaan 185, 9000 Gent, Belgium
| | - Nico G Hartwig
- Franciscus Gasthuis en Vlietland, Department of Pediatrics, Postbus 10900, 3004BA Rotterdam, The Netherlands; Erasmus MC, University Medical Center Rotterdam, Department of Pediatric Infectious Diseases and Immunology, PO Box 2040, 3000CA Rotterdam, The Netherlands
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Wishaupt JO, van der Ploeg T, de Groot R, Versteegh FGA, Hartwig NG. Single- and multiple viral respiratory infections in children: disease and management cannot be related to a specific pathogen. BMC Infect Dis 2017; 17:62. [PMID: 28077074 PMCID: PMC5225597 DOI: 10.1186/s12879-016-2118-6] [Citation(s) in RCA: 39] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/14/2016] [Indexed: 11/16/2022] Open
Abstract
Background The number of viral pathogens associated with pediatric acute respiratory tract infection (ARI) has grown since the introduction of reverse transcription real-time polymerase chain reaction (RT-PCR) assays. Multiple viruses are detected during a single ARI episode in approximately a quarter of all cases. The clinical relevance of these multiple detections is unclear, as is the role of the individual virus. We therefore investigated the correlation between clinical data and RT-PCR results in children with single- and multiple viral ARI. Methods Data from children with ARI were prospectively collected during two winter seasons. RT-PCR testing for 15 viruses was performed in 560 ARI episodes. In the patients with a single-viral etiology, clinical data, laboratory findings, patient management- and outcome data were compared between the different viruses. With this information, we compared data from children of whom RT-PCR data were negative, with children with single- and multiple viral positive results. Results The viral detection rate was 457/560 (81.6%) of which 331/560 (59.1%) were single infections and 126/560 (22.5%) were multiple infections. In single viral infections, some statistically significant differences in demographics, clinical findings, disease severity and outcome were found between children with different viral etiologies. However, no clinically recognizable pattern was established to be virus-specific. In a multivariate analysis, the only variables that were correlated with longer hospital stay were the use of oxygen and nebulizer therapy, irrespective of the viral pathogen. Children with RT-PCR positive test results had a significant higher disease severity, fever, length of hospital stay, days of extra oxygen supply, and days of antibiotic treatment than children with a negative RT-PCR test result. For children with single- versus children with multiple positive RT-PCR test results, these differences were not significant. Conclusions Disease (severity), management and outcome in pediatric ARI are not associated with a specific virus. Single- and multiple viral ARI do not significantly differ with regard to clinical outcome and patient management. For general pediatrics, RT-PCR assays should be restricted to pathogens for which therapy is available or otherwise may have clinical consequences. Further research with an extended panel of RT-PCR assays and a larger number of inclusions is necessary to further validate our findings. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2118-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jérôme O Wishaupt
- Department of Pediatrics, Reinier de Graaf Hospital, P.O. Box 5011, 2600, GA, Delft, The Netherlands.
| | - Tjeerd van der Ploeg
- Pieter van Foreest Institute for Education and Research, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - Ronald de Groot
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Florens G A Versteegh
- Department of Pediatrics, Groene Hart Ziekenhuis, Gouda, The Netherlands.,Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Nico G Hartwig
- Department of Pediatrics, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands.,Department of Pediatric Infectious Diseases and Immunology, ErasmusMC-Sophia, Rotterdam, The Netherlands
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Harteveld CL, Pissard S, Korver AMH, Riou J, Legac E, Lansbergen G, Pardijs IL, Giordano PC, Versteegh FGA. Hb Olivet (HBA1: C.40G > A; p.Ala14Thr), a Novel Silent Hemoglobin Variant in Two Families of Distinct Origin. Hemoglobin 2016; 40:349-352. [PMID: 27624280 DOI: 10.1080/03630269.2016.1210160] [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] [Indexed: 10/21/2022]
Abstract
We report two families, members of which are carriers of a novel hemoglobin (Hb) variant that was named Hb Olivet [α13(A11)Ala→Thr (α1) (GCC > ACC); HBA1: c.40G > A; p.Ala14Thr]. The analysis of these cases allowed a clear description of this anomaly that behaves as a silent Hb. In the first family, of Portuguese ethnicity living in France, the proband, a 24-year-old male and his 57-year-old mother, both appeared to be carriers. The son presented with borderline mean corpuscular volume (MCV), while the mother was normocytic and normochromic. Hemoglobin separation on capillary electrophoresis (CE) was normal, while a slightly asymmetric peak was observed on high performance liquid chromatography (HPLC). In a second family, originally from Surinam but living in The Netherlands, the proband, a 6-year-old girl, showed a mild microcytosis at low ferritin levels. The abnormal Hb was inherited from the mother who was clearly iron depleted, was not present in the sister and brother of the proband. The microcytic hypochromic anemia was only shown in two out of a total of four carriers. It therefore seems likely that iron depletion is causative as two carriers are completely normal. Characterization and genotype/phenotype correlation are briefly described.
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Affiliation(s)
- Cornelis L Harteveld
- a Hemoglobinopathies Laboratory, Department of Human and Clinical Genetics , Leiden University Medical Center (LUMC) , Leiden , the Netherlands
| | - Serge Pissard
- b Laboratory of Genetics , Assistance Publique-Hôitaux De Paris (APHP), Groupe Hospitalier Universitaire (GHU) Henri Mondor, Universite Paris Est Créteil (UPEC) and Inserm Institut Mondor De Recherche Biologique (IMRB) U955eq2 , Créteil , France
| | - Anna M H Korver
- c Department of Pediatrics , Groene Hart Hospital , Gouda , the Netherlands
| | - Jean Riou
- d Laboratory of Genetics , Assistance Publique-Hôitaux De Paris (APHP), Groupe Hospitalier Universitaire (GHU) Henri Mondor , Créteil , France
| | - Eric Legac
- e Laboratory of Biology , Centre Hospitalier Régioonale (CHR) Orleans , Orleans , France
| | - Gideon Lansbergen
- f Clinical Chemistry, Groene Hart Hospital , Gouda , the Netherlands
| | - Inge L Pardijs
- c Department of Pediatrics , Groene Hart Hospital , Gouda , the Netherlands.,g General Practitioner , Gouda , the Netherlands
| | - Piero C Giordano
- a Hemoglobinopathies Laboratory, Department of Human and Clinical Genetics , Leiden University Medical Center (LUMC) , Leiden , the Netherlands
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Vasbinder EC, Goossens LMA, Rutten-van Mölken MPMH, de Winter BCM, van Dijk L, Vulto AG, Blankman EIM, Dahhan N, Veenstra-van Schie MTM, Versteegh FGA, Wolf BHM, Janssens HM, van den Bemt PMLA. e-Monitoring of Asthma Therapy to Improve Compliance in children (e-MATIC): a randomised controlled trial. Eur Respir J 2016; 48:758-67. [PMID: 27230437 DOI: 10.1183/13993003.01698-2015] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 04/17/2016] [Indexed: 01/28/2023]
Abstract
Real-time medication monitoring (RTMM) is a promising tool for improving adherence to inhaled corticosteroids (ICS), but has not been sufficiently tested in children with asthma. We aimed to study the effects of RTMM with short message service (SMS) reminders on adherence to ICS, asthma control, asthma-specific quality of life and asthma exacerbation rate; and to study the associated cost-effectiveness.In a multicentre, randomised controlled trial, children (aged 4-11 years) using ICS were recruited from five outpatient clinics and were given an RTMM device for 12 months. The intervention group also received tailored SMS reminders, sent only when a dose was at risk of omission. Outcome measures were adherence to ICS (RTMM data), asthma control (childhood asthma control test questionnaire), quality of life (paediatric asthma quality of life questionnaire) and asthma exacerbations. Costs were calculated from a healthcare and societal perspective.We included 209 children. Mean adherence was higher in the intervention group: 69.3% versus 57.3% (difference 12.0%, 95% CI 6.7%-17.7%). No differences were found for asthma control, quality of life or asthma exacerbations. Costs were higher in the intervention group, but this difference was not statistically significant.RTMM with tailored SMS reminders improved adherence to ICS, but not asthma control, quality of life or exacerbations in children using ICS for asthma.
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Affiliation(s)
- Erwin C Vasbinder
- Dept of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands Dept of Hospital Pharmacy, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - Lucas M A Goossens
- Erasmus University Institute for Medical Technology Assessment, Rotterdam, The Netherlands
| | | | - Brenda C M de Winter
- Dept of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Arnold G Vulto
- Dept of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Nordin Dahhan
- Division of Paediatric Respiratory Medicine, Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands
| | | | | | - Bart H M Wolf
- Dept of Paediatrics, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands
| | - Hettie M Janssens
- Division of Paediatric Respiratory Medicine, Erasmus University Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
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Wishaupt JO, van den Berg EAN, van Wijk T, van der Ploeg T, Versteegh FGA, Hartwig NG. Paediatric apnoeas are not related to a specific respiratory virus, and parental reports predict hospitalisation. Acta Paediatr 2016; 105:542-8. [PMID: 26910649 PMCID: PMC7159689 DOI: 10.1111/apa.13375] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 12/05/2015] [Accepted: 02/17/2016] [Indexed: 12/27/2022]
Abstract
Aim The aim of this study was to determine the frequency of apnoeas in previously healthy young infants with acute respiratory tract infection (ARI) and correlate their occurrence with isolated micro‐organisms, clinical findings, disease severity and outcome. Methods We performed reverse transcriptase real‐time polymerase chain reaction (RT‐PCR) on the nasal wash specimens of a prospective cohort study of 582 children with ARI. Clinical data on a subgroup of 241 infants under three months of age, with and without apnoeas, were compared. Results Our study found that 19 (7.9%) of the 241 infants under three months old had a history of apnoeas: eight had a respiratory syncytial virus (RSV), five had a different virus than RSV and seven RT‐PCR results were negative. Infants with apnoeas were more likely to have cyanosis, had longer hospital stays and required extra oxygen for a longer period. Most patients with parental reported apnoeas also experienced apnoeas during hospitalisation. Conclusion This study observed apnoeas irrespective of the isolated micro‐organism, and we hypothesise that they were related to the pathophysiology of the respiratory infection and not to the micro‐organism itself. Parental reported apnoeas were a major warning sign and predicted that apnoeas would occur in hospital.
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Affiliation(s)
- JO Wishaupt
- Department of Paediatrics; Reinier de Graaf Hospital; Delft The Netherlands
| | - EAN van den Berg
- Department of Paediatrics; Reinier de Graaf Hospital; Delft The Netherlands
| | - T van Wijk
- Department of Paediatrics; Reinier de Graaf Hospital; Delft The Netherlands
| | - T van der Ploeg
- Pieter van Foreest Institute for Education and Research; Medical Centre Alkmaar; Alkmaar The Netherlands
| | - FGA Versteegh
- Department of Paediatrics; Groene Hart Ziekenhuis; Gouda The Netherlands
- Department of Paediatrics; Ghent University Hospital; Ghent Belgium
| | - NG Hartwig
- Department of Paediatrics; Franciscus Gasthuis & Vlietland; Rotterdam The Netherlands
- Department of Infectious Diseases and Immunology; ErasmusMC-Sophia; Rotterdam The Netherlands
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van Twillert I, Bonačić Marinović AA, van Gaans-van den Brink JAM, Kuipers B, Berbers GAM, van der Maas NAT, Verheij TJM, Versteegh FGA, Teunis PFM, van Els CACM. The Use of Innovative Two-Component Cluster Analysis and Serodiagnostic Cut-Off Methods to Estimate Prevalence of Pertussis Reinfections. PLoS One 2016; 11:e0148507. [PMID: 26848833 PMCID: PMC4743910 DOI: 10.1371/journal.pone.0148507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/19/2016] [Indexed: 01/13/2023] Open
Abstract
Bordetella pertussis circulates even in highly vaccinated countries affecting all age groups. Insight into the scale of concealed reinfections is important as they may contribute to transmission. We therefore investigated whether current single-point serodiagnostic methods are suitable to estimate the prevalence of pertussis reinfection. Two methods based on IgG-Ptx plasma levels alone were used to evaluate the proportion of renewed seroconversions in the past year in a cohort of retrospective pertussis cases ≥ 24 months after a proven earlier symptomatic infection. A Dutch population database was used as a baseline. Applying a classical 62.5 IU/ml IgG-Ptx cut-off, we calculated a seroprevalence of 15% in retrospective cases, higher than the 10% observed in the population baseline. However, this method could not discriminate between renewed seroconversion and waning of previously infection-enhanced IgG-Ptx levels. Two-component cluster analysis of the IgG-Ptx datasets of both pertussis cases and the general population revealed a continuum of intermediate IgG-Ptx levels, preventing the establishment of a positive population and the comparison of prevalence by this alternative method. Next, we investigated the complementary serodiagnostic value of IgA-Ptx levels. When modelling datasets including both convalescent and retrospective cases we obtained new cut-offs for both IgG-Ptx and IgA-Ptx that were optimized to evaluate renewed seroconversions in the ex-cases target population. Combining these cut-offs two-dimensionally, we calculated 8.0% reinfections in retrospective cases, being below the baseline seroprevalence. Our study for the first time revealed the shortcomings of using only IgG-Ptx data in conventional serodiagnostic methods to determine pertussis reinfections. Improved results can be obtained with two-dimensional serodiagnostic profiling. The proportion of reinfections thus established suggests a relatively increased period of protection to renewed infection after clinical pertussis.
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Affiliation(s)
- Inonge van Twillert
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Axel A. Bonačić Marinović
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Betsy Kuipers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Guy A. M. Berbers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Nicoline A. T. van der Maas
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Theo J. M. Verheij
- Julius Center Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Florens G. A. Versteegh
- Department of Pediatrics, Groene Hart Ziekenhuis, Gouda, the Netherlands
- Ghent University Hospital, department of pediatrics, Ghent, Belgium
| | - Peter F. M. Teunis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- RSPH, Emory University, Atlanta, United States of America
| | - Cécile A. C. M. van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- * E-mail:
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van den Brink G, Wishaupt JO, Douma JC, Hartwig NG, Versteegh FGA. Bordetella pertussis: an underreported pathogen in pediatric respiratory infections, a prospective cohort study. BMC Infect Dis 2014; 14:526. [PMID: 25267437 PMCID: PMC4261543 DOI: 10.1186/1471-2334-14-526] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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: 02/11/2014] [Accepted: 09/24/2014] [Indexed: 01/11/2023] Open
Abstract
Background The incidence of pertussis has been increasing worldwide. In the Netherlands, the seroprevalence has risen higher than the reported cases, suggesting that laboratory tests for pertussis are considered infrequently and that even more pertussis cases are missed. The objective of our study was to determine the frequency of pertussis in clinically unsuspect cases compared to suspect cases with the intention of finding clinical predictors. Methods The present prospective cohort study was part of a controlled clinical trial evaluating the impact of molecular diagnostics on clinical decision making in pediatric respiratory infections, performed during 2 winter seasons. For this study, in the first season pertussis was only tested in case of clinical suspicion, in the second season, pertussis was also tested without clinical suspicion. Multivariate and univariate analysis were performed using SPSS 18 and Statistical software ‘R’. Results In the two seasons respectively 22/209 (10,5%) and 49/373 (13,1%) cases were clinically suspected of pertussis. Bordetella pertussis was detected by real time RT-PCR in respectively 2/22 (9,1%) and 7/49 (14,3%) cases. In the second season an additional 7 cases of pertussis were found in clinically unsuspected cases (7/257 = 2,7%). These additional cases didn’t differ in clinical presentation from children without a positive test for pertussis with respect to respiratory symptoms. Conclusions Pertussis in children sometimes mimics viral respiratory tract infections. If pertussis diagnostics are based on clinical suspicion alone, about 1 in 5 cases (19%) is missed. Despite widely accepted clinical criteria, paroxysmal cough is not a good predictor of pertussis. To prevent spreading, physicians should include B. pertussis in routine diagnostics in respiratory tract infections. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-526) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gertrude van den Brink
- Department of Pediatrics, ErasmusMC-Sophia, Wytemaweg 80 3015 CN, Rotterdam, The Netherlands.
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Smallenburg LCS, van Welie NA, Elvers LH, van Huisseling JCM, Teunis PFM, Versteegh FGA. Decline of IgG pertussis toxin measured in umbilical cord blood, and neonatal and early infant serum. Eur J Clin Microbiol Infect Dis 2014; 33:1541-5. [PMID: 24756212 DOI: 10.1007/s10096-014-2110-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 04/02/2014] [Indexed: 11/30/2022]
Abstract
Maternal pertussis-specific antibodies are passively acquired by infants during pregnancy. An IgG pertussis toxin (IgG-PT) concentration of >20 U/ml is considered to protect neonates against pertussis. To evaluate the IgG concentration at birth and during the first two months of life, we examined the IgG-PT concentration in the umbilical cord blood and three times during the neonatal and early infant period. IgG-PT was measured by validated IgG-specific enzyme-linked immunosorbent assays (ELISA) in umbilical cord blood and in Guthrie card blood samples of umbilical cord blood in 2,790 children, born between 1 August 2006 and 1 December 2008. These measurements were comparable. All children with concentrations of IgG-PT >30 U/ml were included. IgG-PT was also measured in Guthrie card blood samples, when the neonates or early infants were 5 days, 1 month and 2 months old. The mean concentrations of IgG-PT were calculated. The mean concentration of IgG-PT in umbilical cord blood was 60.1 U/ml (LN 4.1; 0.6 SD; n = 103). At the age of 5 days, 1 month and 2 months, the mean concentration of IgG-PT was 40.6 U/ml (LN 3.7; 0.5 SD; n = 103), 20.7 U/ml (LN 3.0; 0.7 SD; n = 62) and 16.7 U/ml (LN 2.8; 0.9 SD; n = 61), respectively. Four percent of the neonates had a concentration of IgG-PT >30 U/ml in umbilical cord blood, which declined to levels around the concentration needed for protection against pertussis (>20 U/ml) in the first two months of life. Hence, it is of great importance to further investigate the safety of maternal immunisation during pregnancy to prevent life-threatening pertussis in newborns.
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Affiliation(s)
- L C S Smallenburg
- Department of Pediatrics, Groene Hart Ziekenhuis, 2803 HH, Gouda, The Netherlands,
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10
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van Twillert I, van Gaans-van den Brink JAM, Poelen MCM, Helm K, Kuipers B, Schipper M, Boog CJP, Verheij TJM, Versteegh FGA, van Els CACM. Age related differences in dynamics of specific memory B cell populations after clinical pertussis infection. PLoS One 2014; 9:e85227. [PMID: 24454823 PMCID: PMC3890308 DOI: 10.1371/journal.pone.0085227] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 10/07/2013] [Accepted: 11/26/2013] [Indexed: 01/10/2023] Open
Abstract
For a better understanding of the maintenance of immune mechanisms to Bordetella pertussis (Bp) in relation to age, we investigated the dynamic range of specific B cell responses in various age-groups at different time points after a laboratory confirmed pertussis infection. Blood samples were obtained in a Dutch cross sectional observational study from symptomatic pertussis cases. Lymphocyte subpopulations were phenotyped by flowcytometry before and after culture. Memory B (Bmem) cells were differentiated into IgG antibody secreting cells (ASC) by polyclonal stimulation and detected by an ELISPOT assay specific for pertussis antigens pertussis toxin (Ptx), filamentous haemagglutinin (FHA) and pertactin (Prn). Bp antigen specific IgG concentrations in plasma were determined using multiplex technology. The majority of subjects having experienced a clinical pertussis episode demonstrated high levels of both Bp specific IgG and Bmem cell levels within the first 6 weeks after diagnosis. Significantly lower levels were observed thereafter. Waning of cellular and humoral immunity to maintenance levels occurred within 9 months after antigen encounter. Age was found to determine the maximum but not base-line frequencies of Bmem cell populations; higher levels of Bmem cells specific for Ptx and FHA were reached in adults and (pre-) elderly compared to under-fours and schoolchildren in the first 6 weeks after Bp exposure, whereas not in later phases. This age effect was less obvious for specific IgG levels. Nonetheless, subjects' levels of specific Bmem cells and specific IgG were weakly correlated. This is the first study to show that both age and closeness to last Bp encounter impacts the size of Bp specific Bmem cell and plasma IgG levels.
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Affiliation(s)
- Inonge van Twillert
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | - Martien C. M. Poelen
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Kina Helm
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Betsy Kuipers
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Maarten Schipper
- Department of Statistics, Mathematical Modelling and Data Logistics, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | - Theo J. M. Verheij
- Julius Center Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Cécile A. C. M. van Els
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- * E-mail:
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11
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Han WGH, van Twillert I, Poelen MCM, Helm K, van de Kassteele J, Verheij TJM, Versteegh FGA, Boog CJP, van Els CACM. Loss of multi-epitope specificity in memory CD4(+) T cell responses to B. pertussis with age. PLoS One 2013; 8:e83583. [PMID: 24391789 PMCID: PMC3877060 DOI: 10.1371/journal.pone.0083583] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 11/06/2013] [Indexed: 02/05/2023] Open
Abstract
Pertussis is still occurring in highly vaccinated populations, affecting individuals of all ages. Long-lived Th1 CD4(+) T cells are essential for protective immunity against pertussis. For better understanding of the limited immunological memory to Bordetella pertussis, we used a panel of Pertactin and Pertussis toxin specific peptides to interrogate CD4(+) T cell responses at the epitope level in a unique cohort of symptomatic pertussis patients of different ages, at various time intervals after infection. Our study showed that pertussis epitope-specific T cell responses contained Th1 and Th2 components irrespective of the epitope studied, time after infection, or age. In contrast, the breadth of the pertussis-directed CD4(+) T cell response seemed dependent on age and closeness to infection. Multi-epitope specificity long-term after infection was lost in older age groups. Detailed knowledge on pertussis specific immune mechanisms and their insufficiencies is important for understanding resurgence of pertussis in highly vaccinated populations.
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Affiliation(s)
- Wanda G. H. Han
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Inonge van Twillert
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Martien C. M. Poelen
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kina Helm
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Jan van de Kassteele
- Department of Statistics, Mathematical Modelling and Data Logistics, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Theo J. M. Verheij
- Julius Center Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Cécile A. C. M. van Els
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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12
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Berbers GAM, van de Wetering MSE, van Gageldonk PGM, Schellekens JFP, Versteegh FGA, Teunis PFM. A novel method for evaluating natural and vaccine induced serological responses to Bordetella pertussis antigens. Vaccine 2013; 31:3732-8. [PMID: 23742995 DOI: 10.1016/j.vaccine.2013.05.073] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/26/2013] [Accepted: 05/17/2013] [Indexed: 11/17/2022]
Abstract
We studied the time course of serum IgG antibodies against 3 different pertussis vaccine antigens: PT (pertussis toxin), FHA (filamentous hemagglutinin), Prn (pertactin) in sera from individuals vaccinated with four different pertussis vaccines at 4 years of age: (N=44, 44, 23 and 23, respectively,) and compared the responses to/after natural infection with Bordetella pertussis (N=44, age 1-8 years). These longitudinal data were analyzed with a novel method, using a mathematical model to describe the observed responses, and their variation among subjects. This allowed us to estimate biologically meaningful characteristics of the serum antibody response, like peak level and decay rate, and to compare these among natural infections and vaccine responses. Compared to natural infection, responses to PT after vaccination with the tested vaccines are smaller in magnitude and tend to decay slightly faster. When present in vaccines, FHA and Prn tend to produce high peak levels, higher than those in naturally infected patients, but these decay faster. As expected, the Dutch whole cell vaccine produced lower antibody responses than the acellular vaccines. This model allows a better comparison of the kinetics of vaccine induced antibody responses and after natural infection over a long follow up period.
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Affiliation(s)
- G A M Berbers
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
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13
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Abstract
The authors report a case of acute onset of comitant esotropia with diplopia in a 5-year-old boy with a diffuse pontine glioma. On first presentation, the angle of esodeviation was 30 prism diopters at distance fixation and 25 prism diopters at near fixation. Neurological symptoms appeared 10 weeks after the first visit.
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15
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Wishaupt JO, Russcher A, Smeets LC, Versteegh FGA, Hartwig NG. Clinical impact of RT-PCR for pediatric acute respiratory infections: a controlled clinical trial. Pediatrics 2011; 128:e1113-20. [PMID: 21987698 DOI: 10.1542/peds.2010-2779] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [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: 01/11/2023] Open
Abstract
OBJECTIVE Real-time polymerase chain reaction (RT-PCR) testing is a quick sensitive method for detecting respiratory pathogens. We evaluated the diagnostic yield of RT-PCR assays and measured the effect of rapid reporting on patient care. METHODS In a controlled clinical trial, nasal wash specimens were obtained from patients <12 years of age with suspected acute respiratory infections. In addition to the standard hospital protocol, RT-PCR assays for 17 pathogens were performed. The RT-PCR results were communicated to the clinicians within 12 to 36 hours in the intervention group and after 4 weeks in the control group. RESULTS A total of 583 patients were included (mean age: 8.1 months [range: 0-107.5 months]): 298 in the intervention group and 285 in the control group. Eighty-two percent of nasal wash specimens tested positive for ≥1 pathogen. Respiratory syncytial virus was the most frequently encountered (55%) pathogen. There were no significant differences between the groups with respect to hospital admissions (intervention group: 223 admissions; control group: 211 admissions; P = .825), length of hospital stay (mean ± SD: 3.68 ± 2.68 days [intervention group] and 3.96 ± 2.67 days [control group]; P = .178), or duration of antibiotic use (mean ± SD: 6.52 ± 2.15 days [intervention group] and 6.97 ± 2.86 days [control group]; P = .490), when antibiotic treatment had been initiated. CONCLUSIONS RT-PCR testing has a high yield of viral diagnoses, but rapid communication does not lead to decreases in hospital admissions, shorter hospital stays, or less antibiotic use for children with acute respiratory infections.
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Affiliation(s)
- Jérôme O Wishaupt
- Department of Pediatrics, Reinier de Graaf Hospital, Delft, Netherlands.
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16
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Versteegh FGA, Arkesteijn SGJ, Bakker-Verweij M, Haanappel K, van Delft P, Phylipsen M, Kaufmann JO, Kok PJMJ, Lansbergen GWA, Giordano PC, Harteveld CL. Hb Boskoop [HBA2c.112C>T p.Pro38Ser]: a new α2 chain variant observed in a Morrocan family. Hemoglobin 2011; 35:97-102. [PMID: 21417565 DOI: 10.3109/03630269.2011.557459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We describe a new nondeletional α-thalassemia (α-thal) determinant found in a Moroccan infant and in two members of his family. The new mutation generates an abnormal hemoglobin (Hb) as a consequence of a Pro→Ser amino acid substitution at codon 37 (old nomenclature) of the α2 gene. The new Hb variant is barely separable on high performance liquid chromatography (HPLC) but the expression of the α chain mutant measured on reversed phase chromatography is one-third of that expected from a stable α2 variant, which explains the mild α-thal phenotype observed in the carriers. As shown for other mutations described in our laboratory (i.e., Hb Gouda), this variant could also be common in the North African population, overlooked because of the mild phenotype and silent behavior on HPLC. Nevertheless, these silent variants could generate intermediate Hb H diseases in association with Mediterranean α(0)-thal deletion defect.
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de Vries R, Kretzschmar M, Schellekens JFP, Versteegh FGA, Westra TA, Roord JJ, Postma MJ. Cost-effectiveness of adolescent pertussis vaccination for the Netherlands: using an individual-based dynamic model. PLoS One 2010; 5:e13392. [PMID: 20976213 PMCID: PMC2955521 DOI: 10.1371/journal.pone.0013392] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [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: 03/25/2010] [Accepted: 07/19/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite widespread immunization programs, a clear increase in pertussis incidence is apparent in many developed countries during the last decades. Consequently, additional immunization strategies are considered to reduce the burden of disease. The aim of this study is to design an individual-based stochastic dynamic framework to model pertussis transmission in the population in order to predict the epidemiologic and economic consequences of the implementation of universal booster vaccination programs. Using this framework, we estimate the cost-effectiveness of universal adolescent pertussis booster vaccination at the age of 12 years in the Netherlands. METHODS/PRINCIPAL FINDINGS We designed a discrete event simulation (DES) model to predict the epidemiological and economic consequences of implementing universal adolescent booster vaccination. We used national age-specific notification data over the period 1996-2000--corrected for underreporting--to calibrate the model assuming a steady state situation. Subsequently, booster vaccination was introduced. Input parameters of the model were derived from literature, national data sources (e.g. costing data, incidence and hospitalization data) and expert opinions. As there is no consensus on the duration of immunity acquired by natural infection, we considered two scenarios for this duration of protection (i.e. 8 and 15 years). In both scenarios, total pertussis incidence decreased as a result of adolescent vaccination. From a societal perspective, the cost-effectiveness was estimated at €4418/QALY (range: 3205-6364 € per QALY) and €6371/QALY (range: 4139-9549 € per QALY) for the 8- and 15-year protection scenarios, respectively. Sensitivity analyses revealed that the outcomes are most sensitive to the quality of life weights used for pertussis disease. CONCLUSIONS/SIGNIFICANCE To our knowledge we designed the first individual-based dynamic framework to model pertussis transmission in the population. This study indicates that adolescent pertussis vaccination is likely to be a cost-effective intervention for The Netherlands. The model is suited to investigate further pertussis booster vaccination strategies.
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Affiliation(s)
- Robin de Vries
- Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
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Harteveld CL, Van Delft P, Akkermans N, Arkesteijn S, Van Rooijen-Nijdam IH, Kok PJMJ, Versteegh FGA, Giordano PC. Hb Buffalo [α89(FG1)His→Gln (α1)], Observed Solely and in the Presence of an Hb S [β6(A3)Glu→Val] Heterozygosity. Hemoglobin 2009; 28:223-7. [PMID: 15481890 DOI: 10.1081/hem-200029150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The hemoglobin (Hb) pattern of a 32-year-old Somali male living in The Netherlands, during routine diabetes mellitus monitoring, showed two more peaks in addition to the characteristic heterozygous Hb A/S pattern. A major peak of 15% faster than Hb A, and a minor one of 10.8%, overlapping Hb A2 and the glycated Hb S1c fraction were present. The patient was not anemic or microcytic but had a low haptoglobin level, possibly indicating a slightly elevated red blood cell (RBC) turnover. Hb S was confirmed by a sickle test and at the DNA level. The DNA sequence of the alpha1 gene revealed a C-->G transversion at position 89, changing the local positively charged histidine to a neutral glutamine. This mutant has been previously described in a Yemenite woman and two apparently unrelated Somali males. Our case is the first showing Hb Buffalo in combination with Hb S and a G6PD deficiency, and is again observed in a Somali. No functional abnormalities associated with mutations at this amino acid residue are reported in the literature. Also, in this case no sign of any hematological abnormalities that could not be explained by the Hb S heterozygosity G6PD deficiency was found. The abnormal alpha chain is expressed at the expected rate and without thalassemic effect or instability. The mutated alpha chain seems to associate with a slight preference to the beta(A) (15%) rather than with the beta(S) counterpart. The sum of both Hb A(Buffalo) and Hb S(Buffalo) results in about 19-20% of total Hb. This figure is in agreement with a stable mutant of the alpha1 gene.
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Affiliation(s)
- Cornelis L Harteveld
- The Hemoglobinopathies and Red Cell Diagnostics, Department of Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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Harteveld CL, Versteegh FGA, van Leer EHG, Starreveld JS, Kok PJMJ, van Rooijen-Nijdam I, van Delft P, Zanella-Cleon I, Becchi M, Wajcman H, Giordano PC. Hb St. Jozef, A Val→Leu N-Terminal Mutation Leading to Retention of the Methionine, and Partial Acetylation Found in the Globin Genein Ciswith a −α3.7Thalassemia Deletion. Hemoglobin 2009; 31:313-23. [PMID: 17654068 DOI: 10.1080/03630260701459473] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report a new hemoglobin (Hb) variant found in a 6-year-old girl of Moroccan origin, living in the Dutch city of Gouda. The child was referred because of microcytic and hypochromic parameters. A normal zinc protoporphyirin (ZPP) value excluded iron deficiency and gap-polymerase chain reaction (gap-PCR) revealed a heterozygosity for the common -alpha(3.7) thalassemia deletion, partially justifying the hematological picture. The Hb pattern on alkaline electrophoresis and capillary electrophoresis was normal, while a fraction of 9% preceding the Hb A peak, remained visible on different high performance liquid chromatography (HPLC) devices. This fraction, located in front of the Hb A peak, is usually considered as a Hb A derivate that becomes more expressed in older samples. However, the sample was freshly collected and the peak unusually evident. Therefore, direct sequencing of the alpha-globin genes was performed revealing a GTG-->CTG transversion at codon 1 of the alpha1-globin gene or of the hybrid gene. This point mutation induces a single amino acid substitution from valine to leucine. Electrospray-mass spectrometry (ES-MS) analysis revealed, in addition to this substitution, that the N-terminal methionine was retained and that about 20% of the variant was acetylated. As expected for an association with a -alpha(3.7)-thalassemia (thal) deletion, the non acetylated and acetylated abnormal alpha chain amounted to 32% of the total alpha chains. Family studies revealed that the mutated codon was located in cis of the deletion.
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Affiliation(s)
- Cornelis L Harteveld
- The Hemoglobinopathies Laboratory, Department of Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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Harteveld CL, Versteegh FGA, Kok PJMJ, van Rooijen-Nijdam IH, van Delft P, Giordano PC. Hb Bleuland [α108(G15)Thr→Asn, ACC→AAC (α2)]: A New Abnormal Hemoglobin Associated with a Mild α-Thalassemia Phenotype. Hemoglobin 2009; 30:349-54. [PMID: 16840225 DOI: 10.1080/03630260600755351] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report a new structural defect of the alpha2-globin chain, not detectable on high performance liquid chromatography (HPLC) or electrophoresis, characterized in a 12-year-old boy of Surinamese-Hindustani origin. The child was suspected to be a carrier of alpha-thalassemia (thal) because of microcytic hypochromic parameters in the absence of iron depletion. Gap-polymerase chain reaction (gap-PCR) revealed only normal fragments in the proband, and the pattern of a -alpha4.2 (leftward) deletion in his father and sister. Direct sequencing of the alpha-globin genes revealed an ACC-->AAC transversion at codon 108 of the alpha2-globin gene in the proband, in his mother and in a younger sister. The new mutation predicts a Thr -->Asn amino acid substitution at the corresponding residue. Threonine, a covalent binder with an R-active OH group, situated in the G helix of the alpha-globin chain, is involved in alpha1beta1 contacts. Asparagine, being an equally covalent binder but with a different R-active H2N-C=O group, could make the mutated chain less suitable for tetramer cooperation. Alternatively, an absent or reduced interaction with the alpha hemoglobin (Hb) stabilizing protein (AHSP) could lead to loss of alpha chains. Hb Bleuland is the first mutation described at codon 108 and is therefore interesting in regard to the possible effects and genetic risk. The nearest variant, Hb Suan-Dok [alpha109(G16)Leu -->Arg, CTG-->CGG (alpha2)] was originally observed in a Thai patient affected with Hb H, in combination with an alpha0-thal allele. The same Hb Suan-Dok mutation, recently described in our laboratory in a carrier of African ancestry, was also not detectable as a protein and presented with an alpha-thal phenotype similar to Hb Bleuland.
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Affiliation(s)
- Cornelis L Harteveld
- The Hemoglobinopathies Laboratory, Department of Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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Trip HF, Schonenberg D, Starreveld JS, Versteegh FGA. An enterovirus epidemic in infants in the summer and fall of 2006. Eur J Clin Microbiol Infect Dis 2008; 28:469-72. [PMID: 18987901 DOI: 10.1007/s10096-008-0652-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 10/10/2008] [Indexed: 10/21/2022]
Abstract
The aim of this study was to evaluate the diagnostic procedures in infants presenting with febrile illness in the summer and fall of 2006. Infants younger than 90 days presenting with febrile illness were included. A sepsis evaluation was performed. Stool and/or cerebrospinal fluid were tested for enterovirus (polymerase chain reaction [PCR]). Twenty-four infants were included, with a median age of 36 days (range 5-87). Nineteen infants (79%) were diagnosed with enterovirus infection. In nine infants, both stool and cerebrospinal fluid were tested for enterovirus; both specimens were positive in three infants. In seven infants, only the stool and in three infants, only the cerebrospinal fluid was tested. The five infants without enterovirus infection were only partly tested; in four infants, only the stool and in one infant, only the cerebrospinal fluid was tested. Three infants (13%) were diagnosed with a urinary tract infection, one of which tested positive for enterovirus as well. Twenty-three infants received antibiotic treatment. The median duration of antibiotic treatment of infants without bacterial infection was 3.2 days. Thorough diagnostic evaluation for enterovirus in different specimens is important, as, often, only one specimen is positive for enterovirus. When enterovirus is diagnosed, patient management may be influenced.
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Affiliation(s)
- H F Trip
- Department of Pediatrics, Groene Hart Ziekenhuis, Gouda, The Netherlands
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Abstract
Little is known on growth, growth hormone (GH) levels and GH treatment in patients with Ellis-van Creveld syndrome (EvC). The aim of the present study was to assess growth, growth hormone status and the possible effectiveness of GH treatment in literature and in a small series of EvC patients. A review of literature indicated retarded growth for most EvC patients (-2 to -4.5 SDS) and minimal data on GH levels or treatment which did not allow any conclusion. We studied eight EvC patients, seven of whom were treated with GH. Four were GH deficient (GHD) and four were GH sufficient. In all patients treated with GH, first year growth velocity increased. In three of the four GHD and in one GH-sufficient patient a gain in height SDS was noted. In the present small EvC series GHD occurred more often than expected. Patient acquisition through the Growth Hormone Database will have caused a significant bias, but the present results indicate that GH treatment may improve growth in at least some patients with EvC. Therefore we conclude that EvC patients may benefit from being tested for GHD and, if indicated, treated. In addition a prospective study to evaluate GH status and linear growth in patients with EvC as well as the potential effectiveness of GH treatment is warranted.
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Giordano PC, Zweegman S, Akkermans N, Arkesteijn SGJ, van Delft P, Versteegh FGA, Wajcman H, Harteveld CL. The first case of Hb Groene Hart [alpha119(H2)Pro-->Ser, CCT-->TCT (alpha1)] homozygosity confirms that a thalassemia phenotype is associated with this abnormal hemoglobin variant. Hemoglobin 2007; 31:179-82. [PMID: 17486500 DOI: 10.1080/03630260701289490] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Hb Groene Hart [alpha119(H2)Pro-->Ser, CCT-->TCT (alpha1)] has been reported in heterozygotes of Moroccan origin and also in association with the common -alpha(3.7) deletion. In all cases, the mutated protein was not detectable but was apparently associated with a mild alpha-thalassemia (thal) phenotype, presumably due to a modification of the alpha-globin chain domain that is recognized by the a hemoglobin stabilizing protein (AHSP). The present case of Hb Groene Hart homozygosity, confirms that the alpha-thal phenotype is associated with this alpha-globin chain. Hb Groene Hart must be quite frequent not only in Morocco but probably also among the northern African coastal population.
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Affiliation(s)
- Piero C Giordano
- The Hemoglobinopathies Laboratory, Department of Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
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Benninga MA, Lilien M, de Koning TJ, Duran M, Versteegh FGA, Goldschmeding R, Poll-The BT. Renal Fanconi syndrome with ultrastructural defects in lysinuric protein intolerance. J Inherit Metab Dis 2007; 30:402-3. [PMID: 17530437 DOI: 10.1007/s10545-007-0446-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Revised: 03/06/2007] [Accepted: 03/07/2007] [Indexed: 10/23/2022]
Abstract
Renal Fanconi syndrome developed rapidly in a 3-year-old Moroccan girl with established lysinuric protein intolerance. She was hospitalized because of lowered consciousness, uncoordinated movements and hepatosplenomegaly after a febrile period. Laboratory investigations revealed plasma ammonia 270 micromol/L (normal <70 micromol/L), ferritin 159 micromol/L (normal 2-59 micromol/L), LDH 1180 U/L (normal 26-534 U/L). LPI was diagnosed based on the findings of reduced plasma ornithine, arginine and lysine, and an increased level of glutamine. Urinary orotic acid (645 micromol/mmol creatinine; normal <3.6) was strongly increased. A defect in the SLC7A7 amino acid transporter was established (homozygous c.726G > A mutation). Detailed renal function tests including an acid challenge test, bicarbonate loading, and tubular maximal reabsorption of glucose showed complex tubular dysfunction. No evidence of respiratory chain defects was found in muscle or kidney tissue. No morphological abnormalities were demonstrated in the mitochondria. Ultrastructural analysis of proximal tubular cells showed vacuolization and sloughing of the apical brush border (Fig. 1). Renal involvement in LPI has only been described in a few reports; however, no detailed studies of the renal acidification mechanism were performed. Our patient had evidence of a full-blown Fanconi syndrome. Surprisingly, a metabolic acidosis was found with a moderately increased serum anion gap combined with repeatedly normal plasma organic acid values. This finding is in contrast with the diagnosis of renal tubular acidosis. Patients with hyperlysinaemia have a similar heavy load on the renal tubules; they never develop a renal Fanconi syndrome. Therefore, we consider the intratubular accumulation of lysine an unlikely candidate for the development of the renal Fanconi syndrome.
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Affiliation(s)
- M A Benninga
- Academic Medical Center, Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam, The Netherlands
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Dierselhuis MP, Boelens JJ, Versteegh FGA, Weemaes C, Wulffraat NM. Recurrent and opportunistic infections in children with primary intestinal lymphangiectasia. J Pediatr Gastroenterol Nutr 2007; 44:382-5. [PMID: 17325562 DOI: 10.1097/01.mpg.0000233192.77521.2f] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Miranda P Dierselhuis
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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26
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Abstract
AIM To describe the prevalence of somatic and psychiatric co-morbidity in children diagnosed with ADHD and other behavioural problems compared to this prevalence in children seen at the outpatient department without either of these conditions. METHODS A retrospective controlled case study was conducted in 369 children. All children with ADHD were diagnosed by a clinical psychologist in a hospital setting according to the DSM IV classification. Co-morbidity was determined by pediatricians. RESULTS Somatic co-morbidity was seen in 94 % of the children. However, there was no significant difference in the prevalence of somatic co-morbidity in patients with ADHD nor in patients with behavioural problems other than ADHD when compared with the control group. Only two differences slight were observed. In the ADHD group and the group with behavioural problems motor impairment was seen more often and in the control group constipation was diagnosed more frequently. CONCLUSION Except for motor impairment, somatic co-morbidity of any kind does not seem to occur more frequently in children with ADHD.
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Affiliation(s)
- E van den Heuvel
- Department of Pediatrics, Groene Hart Hospital, Gouda, The Netherlands
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27
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Nooitgedagt JE, Harteveld CL, Starreveld JS, Versteegh FGA, Giordano PC. A new deletion defect leading to ?-thalassaemia in a large Dutch Caucasian family. Br J Haematol 2007; 136:662-5. [PMID: 17367415 DOI: 10.1111/j.1365-2141.2006.06475.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
alpha-thalassaemia is a common inherited haemoglobin disorder that can cause only mild symptoms in carriers and is often either not diagnosed or mistaken for iron deficiency anaemia in the Netherlands. Although considered rare in North-Europeans, we also regularly observe common and rare defects in this population. It is important to be alert for the mild symptoms of these carriers because compound heterozygous and homozygous combinations can result in intermediate, severe or fatal disease in the progeny of healthy carriers. Using a new technical application, a novel alpha degrees -thalassaemia deletion was recently detected in our laboratories in a propositus of a large Dutch Caucasian family. We report the phenotypic and molecular study of this new form of alpha(o)-thalassaemia (called--(OH)alpha-thalassaemia deletion), which was observed in 10 of the 19 individuals studied in the index family. Our results indicate that the frequency of these unsuspected alpha(o)-thalassaemia defects is probably underestimated in the Netherlands.
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Affiliation(s)
- J E Nooitgedagt
- Department of Paediatrics, Groene Hart Hospital, Gouda, The Netherlands
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28
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Muller B, Kemper J, Hartwig NG, Mooi-Kokenberg EANM, van Altena R, Versteegh FGA. Mycobacterium avium intracellulare otomastoiditis: case report and literature review. Eur J Clin Microbiol Infect Dis 2006; 25:723-7. [PMID: 17061096 DOI: 10.1007/s10096-006-0218-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Otomastoiditis caused by Mycobacterium avium intracellulare (MAI) is rare. Sub-optimal management of this condition can lead to significant morbidity and serious damage to the middle ear. Diagnosis is difficult, especially since most physicians are not familiar with the mode of presentation and symptoms. Presented here is a new case, followed by a review of the literature on MAI mastoiditis.
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Affiliation(s)
- B Muller
- Department of Pediatrics, Groene Hart Hospital, P.O. Box 1098, 2800 BB, Gouda, The Netherlands
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29
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de Melker HE, Versteegh FGA, Schellekens JFP, Teunis PFM, Kretzschmar M. The incidence of Bordetella pertussis infections estimated in the population from a combination of serological surveys. J Infect 2006; 53:106-13. [PMID: 16352342 DOI: 10.1016/j.jinf.2005.10.020] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Revised: 08/15/2005] [Accepted: 10/22/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Bordetella pertussis circulates even in highly vaccinated populations. There is a considerable amount of infection in adults. For designing more effective vaccination schedules it is important to quantify the age-dependent relation between the number of notified cases and the number of infections. METHODS We used a statistical relationship between the time since infection and the IgG antibody titers against pertussis toxin, derived from a longitudinal data set, to estimate time since infection for all individuals in a cross-sectional population-based study (1995-1996) based on their titers. Age-specific incidence of infection with B. pertussis was calculated and compared with the age-distribution of notified cases of pertussis in 1994-1996. RESULTS Estimated incidence of infection was 6.6% per year for 3-79-year olds, annual incidence of notified cases 0.01%. Estimated age-specific incidence of infection was lowest for 3-4-year olds (3.3%) and increased gradually up to the age of 20-24 years (10.8%). The number of notified cases was highest for 3-9-year olds. CONCLUSIONS In the Dutch population B. pertussis infections occur more frequently and in elder age-categories then suggested by notifications. Mathematical modeling could explore what booster vaccination strategies are most effective in reducing severe disease among not (completely) vaccinated infants.
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Affiliation(s)
- Hester E de Melker
- Department of Infectious Diseases Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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30
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Versteegh FGA, Mooi-Kokenberg EANM, Schellekens JFP, Roord JJ. Bordetella pertussis and mixed infections. Minerva Pediatr 2006; 58:131-7. [PMID: 16835573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
AIM In pertussis-like respiratory infections, once pertussis has been laboratory confirmed, other potential causative pathogens will seldom be looked for. Probably most mixed infections are found accidentally and since these mixed infections might cause a more severe disease we performed a retrospective study of their incidence. METHODS We selected from 2 groups of patients with serologically confirmed Bordetella (B.) pertussis infection those in whom serology for other respiratory pathogens had also been performed. Group 1 consisted of 50 pertussis patients with 51 episodes of B. pertussis infection selected from 100 patients with serologically confirmed pertussis. They participated in a long-term follow-up after a B. pertussis infection. In group 2, 31 pertussis patients were selected from 98 consecutive patients with positive pertussis serology from one routine practice. RESULTS In 23 of 82 pertussis infections (28%) serological evidence of 1 (n = 21) or 2 (n = 2) additional infections were demonstrated. These involved para-influenza virus (n = 6), respiratory syncytial virus (RSV) (n = 6), Mycoplasma pneumoniae (n = 5), adenovirus (n = 4), influenza A virus (n = 3) and influenza B virus (n = 1). CONCLUSIONS We conclude that in patients with B. pertussis infection, coinfection with another respiratory pathogen is often present.
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Affiliation(s)
- F G A Versteegh
- Department of Pediatrics, Groene Hart Ziekenhuis, Gouda, The Netherlands.
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31
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Giordano PC, Plancke A, Van Meir CA, Janssen CAH, Kok PJMJ, Van Rooijen-Nijdam IH, Tanis BC, van Huisseling JCM, Versteegh FGA. Carrier diagnostics and prevention of hemoglobinopathies in early pregnancy in The Netherlands: a pilot study. Prenat Diagn 2006; 26:719-24. [PMID: 16752436 DOI: 10.1002/pd.1490] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We have offered, for the first time in The Netherlands, carrier diagnostics for hemoglobinopathies (HbP) to early pregnant women. The aim of this study was to establish whether carrier analysis would be welcome by the public and feasible at the outpatient level. METHOD One hundred and thirty-nine randomly selected women were informed and offered basic carrier diagnostics at the first pregnancy control. RESULTS Carrier diagnostics was accepted by 136 women (97.8%). The population consisted of 31% of recent immigrants and 69% of native Dutch. One carrier of HbS and one of beta-thalassemia were found, both among the group of the recent immigrants. In both cases, partners were tested excluding a couple at risk. In addition, five carriers of alpha(+)-thalassemia were diagnosed at the molecular level, one of them in the native Dutch population. Basic carrier analysis was done both at the Hospital Laboratory and at the Reference Laboratory. No discrepancies were found. CONCLUSIONS This pilot study shows that (1) as predicted the prevalence of risk-related HbP and of alpha(+)-thalassemia is high in the immigrant population. (2) The compliance with carrier analysis in both native Dutch and immigrants is virtually total and (3) carrier diagnosis in early pregnancy and partner analysis in Hospital Laboratories is possible and is an effective tool for primary prevention of HbP in The Netherlands.
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Affiliation(s)
- P C Giordano
- Hemoglobinopathies Laboratory, Department of Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
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32
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Versteegh FGA, Weverling GJ, Peeters MF, Wilbrink B, Veenstra-van Schie MTM, van Leeuwen-Gerritsen JM, Mooi-Kokenberg EANM, Schellekens JFP, Roord JJ. Community-acquired pathogens associated with prolonged coughing in children: a prospective cohort study. Clin Microbiol Infect 2005; 11:801-7. [PMID: 16153253 PMCID: PMC7128758 DOI: 10.1111/j.1469-0691.2005.01234.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A 2-year prospective study was performed of children with prolonged coughing to investigate the frequency of different respiratory pathogens, the rate of mixed infections, and possible differences in severity of disease between single and mixed infections. Sera from 135 children (136 episodes of prolonged coughing lasting 1-6 weeks) were tested for antibodies to different viruses and bacteria. Swabs were taken for culture and PCR to detect different viral and bacterial pathogens. One or more pathogens were found in 91 (67%) patients. One infectious agent was found in 49 (36%) patients, two agents in 35 (26%) patients, and more than two agents in seven (5%) patients. The most frequent pathogens encountered were rhinovirus (n = 43; 32%), Bordetella pertussis (n = 23; 17%) and respiratory syncytial virus (n = 15; 11%). The most frequent mixed infection was B. pertussis and rhinovirus (n = 14; 10%). No significant differences in clinical symptoms were observed between patients with or without pathogens; however, patients with mixed infections were significantly older. There was a strong seasonal influence on the number of infections, but not on the number of mixed infections. In children with prolonged coughing, there was a high frequency of mixed infections regardless of the season. However, mixed infection was not associated with increased disease severity. No clinical symptoms were found that allowed discrimination between specific pathogens.
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Affiliation(s)
- F G A Versteegh
- Groene Hart Ziekenhuis, Department of Pediatrics, Gouda, the Netherlands.
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33
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Versteegh FGA, Mertens PLJM, de Melker HE, Roord JJ, Schellekens JFP, Teunis PFM. Age-specific long-term course of IgG antibodies to pertussis toxin after symptomatic infection with Bordetella pertussis. Epidemiol Infect 2005; 133:737-48. [PMID: 16050521 PMCID: PMC2870303 DOI: 10.1017/s0950268805003833] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
To investigate the possible dependence on age of the rate of decline of IgG antibodies to pertussis toxin (IgG-PT) after natural infection with Bordetella pertussis we measured IgG-PT in follow-up sera of 121 patients (age 0-94 years) obtained after 123 episodes of B. pertussis infection. For analysis we applied a dynamic model for the inactivation of B. pertussis by the immune system. There were no significant differences in rise, peak and decline of IgG-PT between different age groups, although there was a tendency for a more rapid increase, a higher peak and a faster decline with increasing age. The IgG-PT cut-off of 100 U/ml for serodiagnosis of pertussis appeared valid in all age groups. A decline of IgG-PT to < 10 U/ml was associated with increased risk of re-infection with B. pertussis.
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Affiliation(s)
- F G A Versteegh
- Department of Pediatrics, Groene Hart Hospital, Gouda, The Netherlands.
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34
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Hofhuis W, van der Wiel EC, Nieuwhof EM, Hop WCJ, Affourtit MJ, Smit FJ, Vaessen-Verberne AAPH, Versteegh FGA, de Jongste JC, Merkus PJFM. Efficacy of fluticasone propionate on lung function and symptoms in wheezy infants. Am J Respir Crit Care Med 2004; 171:328-33. [PMID: 15531753 DOI: 10.1164/rccm.200402-227oc] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The role of inhaled corticosteroids in the treatment of recurrent or persistent wheeze in infancy remains unclear. We evaluated the effect of 3 months of treatment with inhaled fluticasone propionate, 200 microg daily (FP200), on lung function and symptom scores in wheezy infants. Moreover, we evaluated whether infants with atopy and/or eczema respond better to FP200 as compared with non-atopic infants. Forced expiratory flow (Vmax(FRC)) was measured at baseline and after treatment. Sixty-five infants were randomized to receive FP200 or placebo, and 62 infants (mean age, 11.3 months) completed the study. Mean Vmax(FRC), expressed as a Z score, was significantly below normal at baseline and after treatment in both groups. The change from baseline of Vmax(FRC) was not different between the two treatment arms. After 6 weeks of treatment, and not after 13 weeks, the FP200 group had a significantly higher percentage of symptom-free days and a significant reduction in mean daily cough score compared with placebo. Separate analysis of treatment effect in infants with atopy or eczema showed no effect modification. We conclude that in wheezy infants, after 3 months of treatment with fluticasone, there was no improvement in lung function and no reduction in respiratory symptoms compared with placebo.
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Affiliation(s)
- Ward Hofhuis
- Division of Respiratory Medicine, Department of Pediatrics, Erasmus University MC/Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
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35
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Harteveld CL, Wijermans PW, de Ree JELM, Ter Hal P, Van Delft P, Van Rooijen-Nijdam IH, Rasp E, Kok PJMJ, Souverijn JHM, Versteegh FGA, Giordano PC. A new Hb evanston allele [alpha14(A12)Trp --> Arg] found solely, and in the presence of common alpha-thalassemia deletions, in three independent Asian cases. Hemoglobin 2004; 28:1-5. [PMID: 15008259 DOI: 10.1081/hem-120028881] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Hb Evanston [alpha14(A12)Trp --> Arg] is considered to be a rare alpha chain mutant, and was originally observed in two Black families in 1982, inducing a mild Hb H disease phenotype in a homozygous state for the -alpha3.7 deletion ( -alpha(Evanston)/ -alpha). The mutant, evidently linked with one of the two -alpha3.7 thalassemia (thal) alleles, was considered to be unstable and rapidly proteolyzed. We describe Hb Evanston in three new independent Asian cases, all induced by a TGG --> CGG transition. In all cases the mutation is linked to the alpha1-globin gene, either on a wild type allele or in linkage with the common -alpha3.7 and -alpha4.2 deletion alleles. The beta/alpha ratio was balanced in the presence of the mutation only, and accordingly unbalanced in co-inheritance with the deletion defects. Although a second independent mutation event on a -alpha3.7 or a -alpha4.2 deletion allele could not be excluded, we conclude that at least one independent Hb Evanston mutation has occurred on a wild type allele in the Asian populations. Unstable Hb tetramers tend to degrade and disappear during purification. Both Hb Evanston tetramers, formed in combination with normal beta and delta chains, remain perfectly stable after extensive purification and concentration steps, suggesting an early posttranslational thalassemic effect, probably at the dimer/tetramer affinity level.
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Affiliation(s)
- Cornelis L Harteveld
- Department of Human and Clinical Genetics and The Hemoglobinopathies Laboratory, Leiden University Medical Center, Leiden, The Netherlands
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36
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Troe JWM, Versteegh FGA, Mooi-Kokenberg EANM, Van den Broeck J. No effect of cromoglycate treatment in hospitalized infants with respiratory syncytial virus bronchiolitis. Pediatr Pulmonol 2003; 36:455. [PMID: 14520733 DOI: 10.1002/ppul.10354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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37
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Troe JWM, Versteegh FGA, Mooi-Kokenberg EANM, Van den Broeck J. No effect of cromoglycate treatment in hospitalized infants with respiratory syncytial virus bronchiolitis. Pediatr Pulmonol 2003; 36:170. [PMID: 12833498 DOI: 10.1002/ppul.10334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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38
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Tjon Pian Gi CV, Broeren JPA, Starreveld JS, A Versteegh FG. Melatonin for treatment of sleeping disorders in children with attention deficit/hyperactivity disorder: a preliminary open label study. Eur J Pediatr 2003; 162:554-555. [PMID: 12783318 DOI: 10.1007/s00431-003-1207-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2002] [Accepted: 02/25/2003] [Indexed: 11/24/2022]
Affiliation(s)
- Cecil V Tjon Pian Gi
- Department of Paediatrics, Groene Hart Ziekenhuis, 1098, 2800, Gouda, The Netherlands.
| | - Joris P A Broeren
- Department of Paediatrics, Groene Hart Ziekenhuis, 1098, 2800, Gouda, The Netherlands
| | - J Sander Starreveld
- Department of Paediatrics, Groene Hart Ziekenhuis, 1098, 2800, Gouda, The Netherlands
| | - Florens G A Versteegh
- Department of Paediatrics, Groene Hart Ziekenhuis, 1098, 2800, Gouda, The Netherlands
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39
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Abstract
UNLABELLED Foetal and neonatal ovarian cysts have previously been considered uncommon. With the development of sonography, however, the detection of cysts has increased. As ovarian cyst formation in the perinatal period is a self-limiting process, treatment options depend on the risk of complications and on the ability to differentiate these benign cysts from other pathology. The history of two neonates with an ovarian cyst detected antenatally with ultrasound techniques is described. CONCLUSION It is important that paediatricians have knowledge about the incidence, treatment and prognosis of foetal neonatal ovarian cysts.
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Affiliation(s)
- M F Vogtländer
- Department of Paediatrics, Groene Hart Hospital, Gouda, The Netherlands
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40
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Teunis PFM, van der Heijden OG, de Melker HE, Schellekens JFP, Versteegh FGA, Kretzschmar MEE. Kinetics of the IgG antibody response to pertussis toxin after infection with B. pertussis. Epidemiol Infect 2002; 129:479-89. [PMID: 12558330 PMCID: PMC2869909 DOI: 10.1017/s0950268802007896] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We aimed to provide a quantitative description of decay in pertussis antibody levels to aid in finding a serological estimate of the incidence of pertussis. The serum IgG response against pertussis toxin was studied in a group of clinically diagnosed patients. Individual records consisted of repeated serum IgG measurements at irregular intervals for up to 10 years post diagnosis. These data were analysed with a nonlinear regression model taking into account censoring at upper and lower threshold levels, measurement errors, and individual variation in the shape and magnitude of the immune response. There was considerable variation between individual responses, both in strength (amplitude) and duration (shape). The inverse model relating IgG levels to time from infection (diagnosis) can be applied to cross-sectional IgG data to generate distributions of times from infection, which may be used to calculate infection rates and their variation, in populations sampled for cross-sectional IgG data.
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Affiliation(s)
- P F M Teunis
- Computerization and Methodological Consultancy Unit, National Institute for Public Health and the Environment, PO Box 1. 3720 BA Bilthoven, The Netherlands
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41
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Abstract
UNLABELLED Susceptibility to infection with Bordetella pertussis re-emerges several years after pertussis vaccination. However, the duration of immunity after natural infection with B. pertussis, postulated to be lifelong, is not known. In an ongoing study, the longitudinal course of pertussis antibodies in patients who have had laboratory-confirmed pertussis is being followed using sera obtained at irregular intervals. In 4 patients a reinfection with Bordetella pertussis is described respectively 7 (patient A), 12 (patients B and C) and 3.5 (patient D) y after the first infection. It seems that the longer the interval between the infections the more severe the complaints. CONCLUSION To the authors' knowledge. these are the first patients in whom symptomatic reinfection with B. pertussis has definitely been proven by laboratory confirmation of both episodes. Bordetella pertussis infection should be considered in patients with symptoms of typical or atypical whooping cough, irrespective of their vaccination status or previous whooping cough.
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Affiliation(s)
- F G A Versteegh
- Department of Paediatrics, Groene Hart Hospital, Gouda, The Netherlands.
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42
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Harteveld CL, van Delft P, Plug R, Versteegh FGA, Hagen B, van Rooijen I, Kok PJMJ, Wajcman H, Kister J, Giordano PC. Hb Groene Hart: a new Pro-->Ser amino acid substitution at position 119 of the alpha1-globin chain is associated with a mild alpha-thalassemia phenotype. Hemoglobin 2002; 26:255-60. [PMID: 12403490 DOI: 10.1081/hem-120015029] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Alpha-Thalassemia (thal) is generally considered to be an expression defect caused mostly by deletions silencing one or more alpha-globin genes. Although nondeletional alpha-thalassemia is considered rare, in our laboratory we frequently observe alpha-thal phenotypes induced by point mutations. We report a new point mutation generating an abnormal hemoglobin (Hb) associated with a mild alpha-thal phenotype in two members of a Moroccan family, who presented with mild but persistent microcytic hypochromic parameters and a balanced beta/alpha synthetic ratio. All attempts to separate an abnormal native or denatured fraction were unsuccessful using electrophoresis, isoelectrofocusing (IEE), ion exchange and reversed phase high performance liquid chromatography (HPLC), denaturing polyacrylamide gel electrophoresis (PAGE), and electrospray mass spectrometry (ES/MS). The anomalous protein was only predictable by DNA analysis. The mutated gene product, not separable with any of the techniques used, could be a monomer unsuitable for tetramer formation, which is proteolyzed at an early stage. Alternatively, this mutation could perhaps lead to an abnormal splicing. The CCTCT sequence generated by the mutant, not found in the translated region of the gene, but normally present at the end of the IVS-II, could induce a possible exon skipping. This mutant could generate a mild or a critical Hb H disease in combination with one of the common alpha0-thal deletion defects.
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Affiliation(s)
- Cornelis L Harteveld
- Department of Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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43
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Versteegh FGA, Schellekens JFP, Roord JJ. [Perinatal pertussis: from mother to child]. Ned Tijdschr Geneeskd 2002; 146:387-8. [PMID: 11887627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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