Persistent vs non-persistent candidaemia in adult patients in 2007-2016 : A retrospective cohort study

Abstract Objectives Persistent candidaemia (PC) is a recognized complication of candidaemia. Our objective was to evaluate risk factors and clinical significance of PC in adult patients. Methods This is a retrospective, cohort study. We compared PC with non-PC. All patients with blood cultures positive for Candida species were identified from a microbiological database in the hospital district of Helsinki and Uusimaa from 2007 to 2016. PC was defined as an isolation of the same Candida species from positive blood culture for ≥ 5 days. Results PC criteria were fulfilled by 75/350 patients (21.4%). No significant difference emerged between persistent and non-persistent cases caused by non-albicans Candida species (37.3% vs. 35.1%, P = 0.742). The length of hospital stay before onset of candidaemia was longer before PC (hospital stay > 7 days; 73.3% vs. 59.6%, P = 0.043). No significant impact on 30-day mortality was observed (20.0% vs. 15.5%, P = 0.422). Using multivariable regression analysis, we found the presence of central venous catheter (CVC) (OR = 2.71, 95% CI 1.31-5.59), metastatic infection foci (OR 3.60, 95% CI 1.66-7.79) and ineffective empirical treatment (OR = 3.31, 95% CI 1.43-7.65) to be independent risk factors for PC. In subgroup analysis, early source control was identified as a protective factor against PC (30.5% vs. 57.7%, P = 0.002). Conclusion Presence of CVC, metastatic infection foci and ineffective empirical treatment were independently associated with PC in adult patients. Active search for and treatment of metastatic infection foci and removal of CVC are key elements for preventing PC.Peer reviewe

Systeemiset sieni-infektiot immuunipuutteisten huolena

Vertaisarvioitu.• Systeemisiä sieni-infektioita esiintyy erityisesti vaikeasti sairailla ja syvästi immuunipuutteisilla potilailla. • Tavallisimmat infektioita aiheuttavat sienet jaetaan hiiva- ja rihmasieniin. Lisäksi on joukko dimorfisia sieniä, jotka voivat kasvaa sekä hiiva- että rihmamaisena ympäristön kasvuolosuhteiden mukaan. • Candida-, Aspergillus-, Pneumocystis- ja Cryptococcus-lajit ovat yleisiä syvien sieni-infektioiden aiheuttajia maailmassa. • Suomessa Candida-lajit ovat merkittävimpiä systeemisten sieni-infektioiden aiheuttajia.Peer reviewe

Clinical use of fungal PCR from deep tissue samples in the diagnosis of invasive fungal diseases : a retrospective observational study

Objectives: To assess the clinical use of panfungal PCR for diagnosis of invasive fungal diseases (IFDs). We focused on the deep tissue samples. Methods: We first described the design of panfungal PCR, which is in clinical use at Helsinki University Hospital. Next we retrospectively evaluated the results of 307 fungal PCR tests performed from 2013 to 2015. Samples were taken from normally sterile tissues and fluids. The patient population was nonselected. We classified the likelihood of IFD according to the criteria of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG), comparing the fungal PCR results to the likelihood of IFD along with culture and microscopy results. Results: There were 48 positive (16%) and 259 negative (84%) PCR results. The sensitivity and specificity of PCR for diagnosing IFDs were 60.5% and 91.7%, respectively, while the negative predictive value and positive predictive value were 93.4% and 54.2%, respectively. The concordance between the PCR and the culture results was 86% and 87% between PCR and microscopy, respectively. Of the 48 patients with positive PCR results, 23 had a proven or probable IFD. Conclusions: Fungal PCR can be useful for diagnosing IFDs in deep tissue samples. It is beneficial to combine fungal PCR with culture and microscopy. M. Ala-Houhala, Clin Microbiol Infect 2018;24:301 (C) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Narrowband Ultraviolet B Exposures Maintain Vitamin D Levels During Winter : A Randomized Controlled Trial

Exposure to solar ultraviolet B radiation during the summer months is the main source of vitamin D (VD) for people living in northern latitudes. The aim of this study was to determine whether artificial narrowband ultraviolet B (NB-UVB) whole-body exposures could maintain VD levels in winter. The intervention group received 2 standard erythema doses (SEDs) of NB-UVB exposures every second week from October 2013 to April 2014. In October 2013 serum 25-hydroxyvitamin D concentrations were 78.3 nmol/l in the intervention group (n=16) and 76.8 nmol/l in the control group (n=18). By April 2014 the concentrations had increased by 11.7 nmol/l (p=0.029) in the intervention group and decreased by 11.1 nmol/l (p=0.022) in the control group. The baseline VD concentration showed a negative correlation (p=0.012) with body mass index (BMI). In conclusion, a suberythemal NB-UVB dose of 2 SED every second week maintains and even increases serum VD concentrations during the winter. A high BMI seems to predispose subjects to low levels of VD.Peer reviewe

The effect of vernal solar UV radiation on serum 25-hydroxyvitamin D concentration depends on the baseline level : observations from a high latitude in Finland

Humans obtain vitamin D from conversion of 7-dehydrocholesterol in the skin by ultraviolet B (UVB) radiation or from dietary sources. As the radiation level is insufficient in winter, vitamin D deficiency is common at higher latitudes. We assessed whether vernal solar UVB radiation at latitudes 61 degrees N and 67 degrees N in Finland has an impact on serum 25-hydroxyvitamin D [S-25(OH) D] concentrations. Twenty-seven healthy volunteers participated in outdoor activities in snow-covered terrain for 4-10 days in March or April, with their face and hands sun-exposed. The personal UVB doses and S-25(OH) D levels were monitored. A mean UVB dose of 11.8 standard erythema doses (SED) was received during an average of 12.3 outdoor hours. The mean S-25(OH) D concentration in subjects with a baseline concentration below 90.0 nmol/L (n=13) increased significantly, by 6.0 nmol/L from an initial mean of 62.4 nmol/L (pPeer reviewe

Narrow-band Ultraviolet B Treatment Boosts Serum 25-hydroxyvitamin D in Patients with Psoriasis on Oral Vitamin D Supplementation

Peer reviewe

Thrombocytopenia and Acute Renal Failure in Puumala Hantavirus Infections

Low platelet counts are a novel predictive marker suitable for risk-adapted patient management

Prevention of Vitamin D deficiency in infancy: daily 400 IU vitamin D is sufficient

<p>Summary</p> <p>Aim-objective</p> <p>Vitamin D deficiency and rickets in developing countries continues to be a major health problem. Additionally, the increase of cases of rickets in children of some ethnic groups in the United States and European countries has provided this issue to be updated. Obviously, powerful strategies are necessary to prevent vitamin D deficiency nation-wide. In 2005, a nationwide prevention program for vitamin D deficiency was initiated, recommending 400 IU vitamin D per a day.</p> <p>This study was designed to evaluate the efficacy of the prevention program.</p> <p>Methods</p> <p>Eighty-five infants who were recalled as part of the national screening program for congenital hypothyroidism between February 2010 and August 2010 at Kocaeli University Children's Hospital were evaluated in terms of their vitamin D status as well. All babies had been provided with free vitamin D (Cholecalciferol) solution and recommended to receive 400 IU (3 drops) daily. Information regarding the age at start of supplementation, the dosage and compliance were obtained from the mothers with face-to-face interview. Serum 25-hydroxy vitamin D (25-OH-D), alkaline phosphatase (AP), parathormone (PTH) levels were measured.</p> <p>Results</p> <p>The mean age at which Vitamin D3 supplementation began was 16.5 ± 20.7 (3-120) days. Ninety percent of cases (n:76) were receiving 3 drops (400 IU) vitamin D3 per day as recommended; 70% of cases (n:59) were given vitamin D3 regularly, the remainder had imperfect compliance. Among those children who are older than 12 months, only 20% continued vitamin D supplementation. No subject had clinical signs of rickets. The mean 25-OH-D level was 42,5 ± 25,8 (median: 38.3) ng/ml. Ten subjects (12%) had their serum 25-OH-D levels lower than 20 ng/ml (6 between 15-20 ng/ml, 3 between 5-15 ng/ml and only one < 5 ng/ml).</p> <p>Conclusions</p> <p>400 U/day vitamin D seems adequate to prevent vitamin D deficiency. However, we believe that the program for preventing vitamin D deficiency in Turkey, needs to be reinforced to start immediately after birth, and to continue beyond 1 year of age at 400U regular daily dosage.</p

The severity of Puumala hantavirus induced nephropathia epidemica can be better evaluated using plasma interleukin-6 than C-reactive protein determinations

<p>Abstract</p> <p>Background</p> <p>Nephropathia epidemica (NE) is a Scandinavian type of hemorrhagic fever with renal syndrome caused by Puumala hantavirus. The clinical course of the disease varies greatly in severity. The aim of the present study was to evaluate whether plasma C-reactive protein (CRP) and interleukin (IL)-6 levels associate with the severity of NE.</p> <p>Methods</p> <p>A prospectively collected cohort of 118 consecutive hospital-treated patients with acute serologically confirmed NE was examined. Plasma IL-6, CRP, and creatinine, as well as blood cell count and daily urinary protein excretion were measured on three consecutive days after admission. Plasma IL-6 and CRP levels higher than the median were considered high.</p> <p>Results</p> <p>We found that high IL-6 associated with most variables reflecting the severity of the disease. When compared to patients with low IL-6, patients with high IL-6 had higher maximum blood leukocyte count (11.9 <it>vs </it>9.0 × 10⁹/l, <it>P </it>= 0.001) and urinary protein excretion (2.51 <it>vs </it>1.68 g/day, <it>P </it>= 0.017), as well as a lower minimum blood platelet count (55 <it>vs </it>80 × 10⁹/l, <it>P </it>< 0.001), hematocrit (0.34 <it>vs </it>0.38, <it>P </it>= 0.001), and urinary output (1040 <it>vs </it>2180 ml/day, <it>P </it>< 0.001). They also stayed longer in hospital than patients with low IL-6 (8 <it>vs </it>6 days, <it>P </it>< 0.001). In contrast, high CRP did not associate with severe disease.</p> <p>Conclusions</p> <p>High plasma IL-6 concentrations associate with a clinically severe acute Puumala hantavirus infection, whereas high plasma CRP as such does not reflect the severity of the disease.</p

Update of the tolerable upper intake level for vitamin D for infants

Following a request from the European Commission, the Panel&nbsp;on Dietetic Products, Nutrition and Allergies (NDA) was asked to revise the tolerable upper intake level (UL) for vitamin D for infants ( 64&nbsp;1&nbsp;year) set in 2012. From its literature review, the Panel&nbsp;concluded that the available evidence on daily vitamin D intake and the risk of adverse health outcomes (hypercalciuria, hypercalcaemia, nephrocalcinosis and abnormal growth patterns) cannot be used alone for deriving the UL for infants. The Panel&nbsp;conducted a meta-regression analysis of collected data, to derive a dose\u2013response relationship between daily supplemental intake of vitamin D and mean achieved serum 25(OH)D concentrations. Considering that a serum 25(OH)D concentration of 200&nbsp;nmol/L or below is unlikely to pose a risk of adverse health outcomes in infants, the Panel&nbsp;estimated the percentage of infants reaching a concentration above this value at different intakes of vitamin D. Based on the overall evidence, the Panel&nbsp;kept the UL of 25&nbsp;\u3bcg/day for infants aged up to 6 months and set a UL of 35&nbsp;\u3bcg/day for infants 6\u201312&nbsp;months. The Panel&nbsp;was also asked to advise on the safety of the consumption of infant formulae with an increased maximum vitamin D content of 3&nbsp;\u3bcg/100&nbsp;kcal (Commission Delegated Regulation (EU) 2016/127 repealing Directive 2006/141/EC in 2020). For infants aged up to 4&nbsp;months, the intake assessment showed that the use of infant formulae containing vitamin D at 3&nbsp;\u3bcg/100&nbsp;kcal may lead some infants to receive an intake above the UL of 25&nbsp;\u3bcg/day from formulae alone without considering vitamin D supplemental intake. For infants aged 4\u201312&nbsp;months, the 95th percentile of vitamin D intake (high consumers) estimated from formulae and foods fortified or not with vitamin&nbsp;D does not exceed the ULs, without considering vitamin D supplemental intake