1
|
Aleksyniene R, Iyer V, Bertelsen HC, Nilsson MF, Khalid V, Schønheyder HC, Larsen LH, Nielsen PT, Kappel A, Thomsen TR, Lorenzen J, Ørsted I, Simonsen O, Jordal PL, Rasmussen S. The Role of Nuclear Medicine Imaging with 18F-FDG PET/CT, Combined 111In-WBC/99mTc-Nanocoll, and 99mTc-HDP SPECT/CT in the Evaluation of Patients with Chronic Problems after TKA or THA in a Prospective Study. Diagnostics (Basel) 2022; 12:diagnostics12030681. [PMID: 35328234 PMCID: PMC8947521 DOI: 10.3390/diagnostics12030681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/27/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 02/07/2023] Open
Abstract
Background: The aim of this prospective study was to assess the diagnostic value of nuclear imaging with 18F-FDG PET/CT (FDG PET/CT), combined 111In-WBC/99mTc-Nanocoll, and 99mTc-HDP SPECT/CT (dual-isotope WBC/bone marrow scan) for patients with chronic problems related to knee or hip prostheses (TKA or THA) scheduled by a structured multidisciplinary algorithm. Materials and Methods: Fifty-five patients underwent imaging with 99mTc–HDP SPECT/CT (bone scan), dual-isotope WBC/bone marrow scan, and FDG PET/CT. The final diagnosis of prosthetic joint infection (PJI) and/or loosening was based on the intraoperative findings and microbiological culture results and the clinical follow-up. Results: The diagnostic performance of dual-isotope WBC/bone marrow SPECT/CT for PJI showed a sensitivity of 100% (CI 0.74–1.00), a specificity of 97% (CI 0.82–1.00), and an accuracy of 98% (CI 0.88–1.00); for PET/CT, the sensitivity, specificity, and accuracy were 100% (CI 0.74–1.00), 71% (CI 0.56–0.90), and 79% (CI 0.68–0.93), respectively. Conclusions: In a standardized prospectively scheduled patient group, the results showed highly specific performance of combined dual-isotope WBC/bone marrow SPECT/CT in confirming chronic PJI. FDG PET/CT has an appropriate accuracy, but the utility of its use in the clinical diagnostic algorithm of suspected PJI needs further evidence.
Collapse
Affiliation(s)
- Ramune Aleksyniene
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (V.I.); (H.C.B.); (M.F.N.)
- Correspondence: ; Tel.: +45-41416038
| | - Victor Iyer
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (V.I.); (H.C.B.); (M.F.N.)
- Department of Radiology and Molecular Medicine, University Hospital Uppsala, 75237 Uppsala, Sweden
| | - Henrik Christian Bertelsen
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (V.I.); (H.C.B.); (M.F.N.)
| | - Majbritt Frost Nilsson
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (V.I.); (H.C.B.); (M.F.N.)
| | - Vesal Khalid
- Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark; (V.K.); (S.R.)
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, 9000 Aalborg, Denmark; (H.C.S.); (L.H.L.)
| | - Lone Heimann Larsen
- Department of Clinical Microbiology, Aalborg University Hospital, 9000 Aalborg, Denmark; (H.C.S.); (L.H.L.)
| | - Poul Torben Nielsen
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark; (P.T.N.); (A.K.); (O.S.)
| | - Andreas Kappel
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark; (P.T.N.); (A.K.); (O.S.)
| | - Trine Rolighed Thomsen
- Center for Microbial Communities, Aalborg University, 9220 Aalborg, Denmark;
- Danish Technology Institute, Medical Biotechnology, 8000 Aarhus, Denmark; (J.L.); (P.L.J.)
| | - Jan Lorenzen
- Danish Technology Institute, Medical Biotechnology, 8000 Aarhus, Denmark; (J.L.); (P.L.J.)
| | - Iben Ørsted
- Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Ole Simonsen
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark; (P.T.N.); (A.K.); (O.S.)
| | - Peter Lüttge Jordal
- Danish Technology Institute, Medical Biotechnology, 8000 Aarhus, Denmark; (J.L.); (P.L.J.)
| | - Sten Rasmussen
- Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark; (V.K.); (S.R.)
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark
| |
Collapse
|
2
|
Martin-Iguacel R, Llibre JM, Pedersen C, Obel N, Stærke NB, Åhsberg J, Ørsted I, Holden I, Kronborg G, Mohey R, Rasmussen LD, Johansen IS. Tuberculosis incidence and mortality in people living with human immunodeficiency virus: a Danish nationwide cohort study. Clin Microbiol Infect 2021; 28:570-579. [PMID: 34438070 DOI: 10.1016/j.cmi.2021.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To explore changes over time in the epidemiology of tuberculosis (TB) in Denmark in people living with human immunodeficiency virus (HIV) (PLWH). METHODS In this nationwide, population-based cohort study we included all adult PLWH from the Danish HIV Cohort Study (1995-2017) without previous TB. We estimated TB incidence rate (IR), all-cause mortality rate (MR), associated risk and prognostic factors using Poisson regression. RESULTS Among 6982 PLWH (73 596 person-years (PY)), we observed 217 TB events (IR 2.9/1000 PY, 95% CI 2.6-3.4: IR 6.7, 95% CI 5.7-7.9 among migrants and IR 1.4, 95% CI 1.1-1.7 among Danish-born individuals; p < 0.001). The IR of concomitant HIV/TB remained high and unchanged over time. The IR of TB diagnosed >3 months after HIV diagnosis declined with calendar time, longer time from HIV diagnosis, and CD4 cell recovery. Independent TB risk factors were African/Asian/Greenland origin (adjusted incidence rate ratio (aIRR) 5.2, 95% CI 3.5-7.6, aIRR 6.5, 95% CI 4.2-10.0, aIRR 7.0, 95% CI 3.4-14.6, respectively), illicit drug use (aIRR 6.9, 95% CI 4.2-11.2), CD4 <200 cells/μL (aIRR 2.7, 95% CI 2.0-3.6) and not receiving antiretroviral therapy (aIRR 3.7, 95% CI 2.5-5.3). Fifty-five patients died (MR 27.9/1000 PY, 95% CI 21.4-36.3), with no improvement in mortality over time. Mortality prognostic factors were Danish-origin (adjusted mortality rate ratio (aMRR) 2.3, 95% CI 1.3-4.3), social burden (aMRR 3.9, 95% CI 2.2-7.0), CD4 <100 cells/μL at TB diagnosis (aMRR 2.6, 95% CI 1.3-4.9), TB diagnosed >3 months after HIV versus concomitant diagnosis (aMRR 4.3, 95% CI 2.2-8.7) and disseminated TB (aMRR 3.3, 95% CI 1.1-9.9). CONCLUSION Late HIV presentation with concomitant TB remains a challenge. Declining TB rates in PLWH were observed over time and with CD4 recovery, highlighting the importance of early and successful antiretroviral therapy. However, MR remained high. Our findings highlight the importance of HIV and TB screening strategies and treatment of latent TB in high-risk groups.
Collapse
Affiliation(s)
- Raquel Martin-Iguacel
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; Research Unit for Infectious Diseases, University of Southern Denmark, Denmark.
| | - Josep M Llibre
- Infectious Diseases Department and Fight AIDS and Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; Research Unit for Infectious Diseases, University of Southern Denmark, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Johanna Åhsberg
- Research Unit for Infectious Diseases, University of Southern Denmark, Denmark; Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Mycobacterial Centre for Research Southern Denmark, MyCRESD, Odense, Denmark
| | - Iben Ørsted
- Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark
| | - Inge Holden
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; Research Unit for Infectious Diseases, University of Southern Denmark, Denmark; Mycobacterial Centre for Research Southern Denmark, MyCRESD, Odense, Denmark
| | - Gitte Kronborg
- Department of Infectious Diseases, Herning Hospital, Herning, Denmark
| | - Rajesh Mohey
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Line Dahlerup Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; Research Unit for Infectious Diseases, University of Southern Denmark, Denmark
| | - Isik Somuncu Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; Research Unit for Infectious Diseases, University of Southern Denmark, Denmark; Mycobacterial Centre for Research Southern Denmark, MyCRESD, Odense, Denmark.
| |
Collapse
|
3
|
Rasmussen SL, Ørsted I, Tarpgaard IH, Nielsen HL. Helicobacter cinaedi bacteraemia secondary to enterocolitis in an immunocompetent patient. Gut Pathog 2021; 13:26. [PMID: 33888153 PMCID: PMC8063464 DOI: 10.1186/s13099-021-00422-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/12/2021] [Indexed: 01/13/2023] Open
Abstract
Background Helicobacter cinaedi are motile, gram-negative spiral rods with a natural reservoir in the intestinal tract of hamsters and rhesus monkeys. In humans, H. cinaedi has been reported in different human infections like fever, abdominal pain, gastroenteritis, proctitis, diarrhoea, erysipelas, cellulitis, arthritis, and neonatal meningitis typically diagnosed by positive blood cultures. Even though H. cinaedi has been detected from human blood and stool the entry of H. cinaedi into the blood stream was undocumented until quite recently. The use of pulse-field gel electrophoresis (PFGE) demonstrated that stool- and blood-derived H. cinaedi strains were consistent. Case presentation Here, we describe a rare Danish case of H. cinaedi bacteraemia in an immunocompetent 44-year-old male with diarrhoea. We isolated H. cinaedi from a blood culture taken at admission, and from a FecalSwab taken at day six despite ongoing antibiotic therapy. Next, we made a genetic comparison of both isolates by use of Multi-locus sequence typing (MLST)- and Single nucleotide polymorphism (SNP)-analysis. The two isolates were identical with zero SNPs and by use of MLST the isolate was identified as a novel ST20, confirming previous data of the intestinal tract as a route of H. cinaedi bacteraemia. The results of our AST showed a resistance pattern with higher MICs for ciprofloxacin and clarithromycin than for ampicillin, amoxicillin, gentamicin, and imipenem. The patient was cured with targeted therapy with pivampicillin; however, the primary source of transmission was unknown. Conclusions In conclusion, this case of H. cinaedi bacteraemia secondary to enterocolitis in an immunocompetent patient provide clear evidence that one route of infection occurs through translocation from the intestinal tract to the bloodstream. Helicobacter cinaedi from blood and faeces were identical with a novel ST20, resistant to ciprofloxacin and clarithromycin however, the patient was cured with oral pivampicillin.
Collapse
Affiliation(s)
- Sofie Larsen Rasmussen
- Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark
| | - Iben Ørsted
- Department of Infectious Diseases, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark
| | - Irene Harder Tarpgaard
- Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark
| | - Hans Linde Nielsen
- Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| |
Collapse
|
4
|
Khalid V, Schønheyder HC, Larsen LH, Nielsen PT, Kappel A, Thomsen TR, Aleksyniene R, Lorenzen J, Ørsted I, Simonsen O, Jordal PL, Rasmussen S. Multidisciplinary Diagnostic Algorithm for Evaluation of Patients Presenting with a Prosthetic Problem in the Hip or Knee: A Prospective Study. Diagnostics (Basel) 2020; 10:diagnostics10020098. [PMID: 32053936 PMCID: PMC7168188 DOI: 10.3390/diagnostics10020098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/28/2020] [Accepted: 02/04/2020] [Indexed: 12/17/2022] Open
Abstract
The predominant indications for revision surgery after total hip (THA) or knee arthroplasty (TKA) are an aseptic failure (AF) and prosthetic joint infection (PJI). Accurate diagnosis is crucial. Therefore, we evaluated prospectively a multidisciplinary diagnostic algorithm including multi-modal radionucleid imaging (RNI) and extended microbiological diagnostics. If the surgeon suspected PJI or AF, revision surgery was performed with multiple samples obtained in parallel for special culture procedures and later molecular analyses. Alternatively, if the underlying cause was not evident, RNI was scheduled comprising 99Tc—HDP SPECT/CT, 111In-labeled white blood cells combined with 99Tc-nanocoll bone marrow SPECT/CT, and 18F-FDG PET/CT. A multidisciplinary clinical team made a recommendation on the indication for a diagnostic procedure guided by RNI images or revision surgery. A total of 156 patients with 163 arthroplasties were included. Fifty-five patients underwent RNI. In all, 118 revision surgeries were performed in 112 patients: 71 on the indication of AF and 41 revision of PJI. Thirty-four patients were concluded with chronic pain, and revision surgery refrained. The effective median follow-up period was 13 months. A structured approach offered by the algorithm was useful for the clinician in the evaluation of patients with a failing TKA or THA. Surgical revision was possibly obviated in approximately 20% of patients where an explanation or cause of failure was not found. The algorithm served as an effective tool.
Collapse
Affiliation(s)
- Vesal Khalid
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark (A.K.); (O.S.); (S.R.)
- Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
- Correspondence: ; Tel.: +45-31336988
| | - Henrik Carl Schønheyder
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
- Department of Clinical Microbiology, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Lone Heimann Larsen
- Department of Clinical Microbiology, Aalborg University Hospital, 9000 Aalborg, Denmark;
- Center for Microbial Communities, Department of Biotechnology, Chemistry and Environmental Engineering, Aalborg University, 9000 Aalborg, Denmark;
| | - Poul Torben Nielsen
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark (A.K.); (O.S.); (S.R.)
- Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
| | - Andreas Kappel
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark (A.K.); (O.S.); (S.R.)
- Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
| | - Trine Rolighed Thomsen
- Center for Microbial Communities, Department of Biotechnology, Chemistry and Environmental Engineering, Aalborg University, 9000 Aalborg, Denmark;
- Danish Technological Institute, Medical Biotechnology, 8000 Aarhus C, Denmark; (J.L.); (P.L.J.)
| | - Ramune Aleksyniene
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Jan Lorenzen
- Danish Technological Institute, Medical Biotechnology, 8000 Aarhus C, Denmark; (J.L.); (P.L.J.)
| | - Iben Ørsted
- Department of Infectious Disease, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Ole Simonsen
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark (A.K.); (O.S.); (S.R.)
- Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
| | - Peter Lüttge Jordal
- Danish Technological Institute, Medical Biotechnology, 8000 Aarhus C, Denmark; (J.L.); (P.L.J.)
| | - Sten Rasmussen
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark (A.K.); (O.S.); (S.R.)
- Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
| |
Collapse
|
5
|
Ørsted I, Mølvadgaard M, Nielsen HL, Nielsen H. The first, second and third wave of pandemic influenza A (H1N1)pdm09 in North Denmark Region 2009-2011: a population-based study of hospitalizations. Influenza Other Respir Viruses 2013; 7:776-82. [PMID: 23398935 PMCID: PMC5781212 DOI: 10.1111/irv.12093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2012] [Indexed: 01/09/2023] Open
Abstract
Background and objectives Denmark experienced three waves of the new pandemic influenza A (H1N1)pdm09 from July 2009 to February 2011. The aim of the study was to describe the epidemiology and clinical characteristics of hospitalized patients in a defined population of North Denmark Region with a mixed urban and rural community of 579 000 inhabitants. Methods Review of medical records of all hospitalized patients with confirmed influenza A from July 2009 to February 2011. Results Two hundred and seventy‐three patients were admitted to hospital. The age‐related population incidences of hospitalization were as follows: 0–14 years: 111/100 000, 15–64 years: 39/100 000, and ≥65 years: 17/100 000. During the first wave (July 2009–August 2009), three patients were admitted – none received treatment in intensive care units (ICUs), during the second wave (October 2009–January 2010), 158 patients were admitted – nine received treatment in ICUs, and during the third wave (December 2010–February 2011), 112 patients were admitted – 25 received treatment in ICUs. Fourteen patients (5%) died within 30 days of diagnosis (median 55 years; range 14–76 years) and additional seven patients (2·6%) died within 365 days (median 25 years; range 1–86 years). Conclusions Patients hospitalized with pandemic influenza A (H1N1)pdm09 were predominantly children and younger adults, and only a few patients were >65 years. The third wave was the most severe taking the number and percentage of patients admitted to ICUs and 30‐day mortality into consideration. We observed that the incidence of hospitalizations as well as clinical severity among younger adults did not decline from the second to the third wave.
Collapse
Affiliation(s)
- Iben Ørsted
- Department of Infectious Diseases, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
| | | | | | | |
Collapse
|
6
|
Abstract
We report two cases of cerebral abscesses with polymicrobial aetiology including Mycoplasma salivarium. In both cases, Mycoplasma was found incidentally, suggesting that a broader aetiological spectrum could be found in brain abscesses by use of molecular techniques targeting fastidious pathogens.
Collapse
Affiliation(s)
- I Ørsted
- Department of Infectious Diseases, Aalborg Hospital, Aarhus University Hospital, Copenhagen, Denmark.
| | | | | | | | | |
Collapse
|