Diagnostic studies in children with acute infections : Microbes and biomarkers

We did four distinct clinical studies, mainly in the emergency department (ED) setting, to pragmatically evaluate the accuracy, feasibility and characteristics of different diagnostic tests in children with acute infections, and documented the etiology of febrile pharyngitis. The results of this study show that point-of-care tests (POCTs) for white blood cell count and C-reactive protein (CRP) were feasible and relatively accurate in comparison with standard laboratory methods. The occurrence of discrepant plasma procalcitonin (PCT) and CRP levels in acutely ill children was 29%. We confirmed an earlier finding that PCT rises more rapidly than CRP in bacteremic patients and made a new observation that PCT increases also in patients with acute diabetic ketoacidosis. In addition, a multianalyte antigen detection POCT for respiratory viruses was proven user-friendly and specific. It gave an overall sensitivity of 83% for influenza viruses, 89% for respiratory syncytial virus but only 25% for adenovirus in comparison with the polymerase chain reaction method. Finally, we found that febrile pharyngitis was caused solely by viruses in 59%, by viruses together with group A streptococcus (GAS) in 13% and solely by GAS in 10% of the children. Blood myxovirus resistance protein A (MxA) levels were increased in most of the pharyngitis patients with virus detection further supporting the causative role of viruses. These results highlight the usefulness of POCTs in ED setting. In addition, we completed the etiological picture of febrile pharyngitis.Tutkimuksia lasten äkillisten infektioiden diagnostiikasta: mikrobeja ja merkkiaineita Kuumeisen lapsen lääketieteellinen arvio perustuu ensisijaisesti potilaan kliiniseen tutkimiseen. Arvion apuna voidaan tarvittaessa käyttää laboratoriotutkimuksia. Teimme neljä erillistä kliinistä tutkimusta selvittääksemme tiettyjen laboratoriokokeiden käytettävyyttä, tarkkuutta ja ominaisuuksia äkillisiä infektioita sairastavien lapsien diagnostiikassa. Tutkimukset tehtiin käytännönläheisesti ja ne toteutettiin pääsääntöisesti päivystyspoliklinikalla. Lisäksi selvitimme kuumeisen nielutulehduksen aiheuttajat. Tutkimuksen tulokset osoittavat, että valkosolujen ja C-reaktiivisen proteiinin (CRP) nopeat vieritestit olivat käytettävyydeltään hyviä ja suhteellisen tarkkoja laboratorion vakiomenetelmiin verrattuna. Totesimme myös, että 29 %:lla äkillisesti sairastuneista lapsista prokalsitoniinin (PCT) ja CRP:n pitoisuudet plasmassa ovat keskenään ristiriidassa. Vahvistimme samalla aiemmat havainnot siitä, että PCT-pitoisuus suurenee CRP:tä nopeammin baktereemisilla potilailla. Teimme uuden havainnon PCT:n noususta akuuttia ketoasidoosia sairastavilla lapsilla. Antigeenin osoitukseen perustuva monianalyyttinen hengitystievirusten pikatesti osoittautui käyttäjäystävälliseksi ja tarkaksi. Vertailussa nukleiinihapon osoitukseen perustuvaan menetelmään testin herkkyys influenssaviruksille oli 83 %, RS-virukselle 89 % mutta adenovirukselle vain 25 %. Nielutulehduksen aiheuttajaksi todettiin 59 %:lla lapsista virus, 13 %:lla virus ja A-ryhmän streptokokki (GAS) yhdessä ja 10 %:lla GAS yksinään. Veren myxovirus resistance protein A (MxA) -pitoisuus oli suurentunut suurimmalla osalla viruspositiivisista potilaista tukien ajatusta viruksesta kyseisen taudin aiheuttajana. Tuloksemme korostavat vieritestien käyttökelpoisuutta päivystyspoliklinikalla. Lisäksi täydensimme tietämystä lasten nielutulehduksen etiologiasta.Siirretty Doriast

Teinin sitkeä kurkkukipu - tapauksen ratkaisu

Kun teinitytön kurkkukipu ei alkanut helpottua antibioottikuurilla, hänet ohjattiin erikoissairaanhoidon päivystykseen

Teinin sitkeä kurkkukipu – tapauksen ratkaisu

Kun teinitytön kurkkukipu ei alkanut helpottua antibioottikuurilla, hänet ohjattiin erikoissairaanhoidon päivystykseen.</p

Macrolide Resistance in Bordetella pertussis: Current Situation and Future Challenges

Pertussis is a highly contagious respiratory infection caused by Bordetella pertussis bacterium. The mainstay of treatment is macrolide antibiotics that reduce transmissibility, shorten the duration of symptoms and decrease mortality in infants. Recently, the macrolide resistance of B. pertussis has been reported globally but is especially widespread in mainland China. In this review, we aim to summarise the current understanding of the epidemiology, resistance mechanisms and clinical implications of B. pertussis macrolide resistance. Since the first appearance of macrolide-resistant B. pertussis in Arizona, USA, in 1994, only sporadic cases have been reported outside China. In certain parts of China, on the other hand, up to 70-100% of the recent clinical isolates have been found to be macrolide resistant. Reasons for macrolide resistance being centred upon China during the last decade can only be speculated on, but the dominant B. pertussis lineage is different between China and most of the high-income countries. It seems evident that efforts to increase awareness, guide molecular epidemiological surveillance and carry out systematic screening of B. pertussis positive samples for macrolide resistance should be implemented globally. In addition, practices to improve the clinical care of infants with pertussis caused by resistant strains should be studied vigorously

Dermacoccus sp. isolated from a brain abscess in a 4-year-old child

Dermacoccus spp. have rarely been reported as human pathogens. We describe a case of a 4-year-old boywith congenital heart disease who was diagnosed with a brain abscess. The abscess was drained and thesample grew Streptococcus intermedius, Aggregatibacter aphrophilus and Dermacoccus sp..Dermacoccus grew after 5 days of incubation and the patient was treated with meropenem.</p

Lasten Mycoplasma pneumoniae -infektiot

Mycoplasma pneumoniae on pieni soluseinätön bakteeri, jonka aiheuttamat tautitapaukset painottuvat talvikauteen sekä isompiin epidemioihin. Edellinen laajempi epidemia Pohjois-Euroopassa oli vuosina 2010-2012. Keuhkokuumeen bakteeri aiheuttaa tavallisimmin kouluikäisille lapsille, ja sen suhteellinen osuus tautitapauksista on lisääntynyt yleisen pneumokokkirokottamisen myötä. M. pneumoniae aiheuttaa lapsille ennen kaikkea hengitystieinfektioita, joiden pääoireena on yskä, mutta myös iholöydökset ja neurologiset oireet ovat mahdollisia. M. pneumoniae -infektio voidaan diagnosoida nukleiinihaponosoitustestillä nielunäytteestä tai vasta-ainemäärityksellä mieluiten pariseeruminäytteistä. Diagnostisten testien tulkinta ei ole yksiselitteistä: nielukantajuus on mahdollista, ja positiiviset IgM-vasta-ainemääritykset ovat yleisiä myös oireettomilla. Mikrobilääkkeiden tehosta taudin hoidossa ei ole vahvaa tutkimusnäyttöä, mutta mikäli mikrobilääkitykseen päädytään, on atsitromysiini ensilinjan valinta.</p

Trekstuaaliset tilat : Käännöstieteen ja tekstuaalitieteiden rajavyöhykkeellä

Peer reviewe

Targeting beta 1-integrin inhibits vascular leakage in endotoxemia

Loss of endothelial integrity promotes capillary leakage in numerous diseases, including sepsis, but there are no effective therapies for preserving endothelial barrier function. Angiopoietin-2 (ANGPT2) is a context-dependent regulator of vascular leakage that signals via both endothelial TEK receptor tyrosine kinase (TIE2) and integrins. Here, we show that antibodies against beta 1-integrin decrease LPS-induced vascular leakage in murine endotoxemia, as either a preventative or an intervention therapy. beta 1-integrin inhibiting antibodies bound to the vascular endotheliumin vivo improved the integrity of endothelial cell-cell junctions and protected mice from endotoxemia-associated cardiac failure, without affecting endothelial inflammation, serum proinflammatory cytokine levels, or TIE receptor signaling. Moreover, conditional deletion of a single allele of endothelial beta 1-integrin protected mice from LPS-induced vascular leakage. In endothelial mono-layers, the inflammatory agents thrombin, lipopolysaccharide (LPS), and IL-1 beta decreased junctional vascular endothelial (VE)-cadherin and induced actin stress fibers via beta 1- and alpha 5-integrins and ANGPT2. Additionally, beta 1-integrin inhibiting antibodies prevented inflammation-induced endothelial cell contractility and monolayer permeability. Mechanistically, the inflammatory agents stimulated ANGPT2-dependent translocation of alpha 5 beta 1-integrin into tensin-1-positive fibrillar adhesions, which destabilized the endothelial monolayer. Thus, beta 1-integrin promotes endothelial barrier disruption during inflammation, and targeting beta 1-integrin signaling could serve as a novel means of blocking pathological vascular leak.Peer reviewe

Trekstuaaliset tilat: Käännöstieteen ja tekstuaalitieteiden rajavyöhykkeellä

Translation studies and textual scholarship have much common ground. In this paper, we set to explore how three of their central concepts, translation, transmission and text, can be approached from a multidisciplinary point of view. Combining these three central terms, we call this approach trextual. This paper is based on the workshop on trextuality held at the KäTu Symposium in Tampere in 2019. In the workshop, the discussion built upon an introduction, which examined the foundations of trextuality, and four papers, which addressed genetic translation criticism, retranslation, polyphony and translation of intertextuality, as well as multi-modality of audiovisual translation, respectively. The workshop revealed that the juxtaposing of two text-oriented disciplines, translation studies and textual studies, and comparing their similarities and differences reveals unexplored areas and weaknesses in their axiomatic fundaments. In particular, the papers presented in the workshop invited to reconsider transmission, definitions of text, and source text-target text pairs in different contexts. The workshop provided a starting point for further trextual studies exploring such cross-disciplinary questions.Translation studies and textual scholarship have much common ground. In this paper, we set to explore how three of their central concepts, translation, transmission and text, can be approached from a multidisciplinary point of view. Combining these three central terms, we call this approach trextual. This paper is based on the workshop on trextuality held at the KäTu Symposium in Tampere in 2019. In the workshop, the discussion built upon an introduction, which examined the foundations of trextuality, and four papers, which addressed genetic translation criticism, retranslation, polyphony and translation of intertextuality, as well as multi-modality of audiovisual translation, respectively. The workshop revealed that the juxtaposing of two text-oriented disciplines, translation studies and textual studies, and comparing their similarities and differences reveals unexplored areas and weaknesses in their axiomatic fundaments. In particular, the papers presented in the workshop invited to reconsider transmission, definitions of text, and source text-target text pairs in different contexts. The workshop provided a starting point for further trextual studies exploring such cross-disciplinary questions

Trekstuaaliset tilat: Käännöstieteen ja tekstuaalitieteiden rajavyöhykkeellä

Translation studies and textual scholarship have much common ground. In this paper, we set to explore how three of their central concepts, translation, transmission and text, can be approached from a multidisciplinary point of view. Combining these three central terms, we call this approach trextual. This paper is based on the workshop on trextuality held at the KäTu Symposium in Tampere in 2019. In the workshop, the discussion built upon an introduction, which examined the foundations of trextuality, and four papers, which addressed genetic trans-lation criticism, retranslation, polyphony and translation of intertextuality, as well as multi-modality of audiovisual translation, respectively. The workshop revealed that the juxtaposing of two text-oriented disciplines, translation studies and textual studies, and comparing their simi-larities and differences reveals unexplored areas and weaknesses in their axiomatic fundaments. In particular, the papers presented in the workshop invited to reconsider transmission, defini-tions of text, and source text-target text pairs in different contexts. The workshop provided a starting point for further trextual studies exploring such cross-disciplinary questions.</p