Terveydenhuollon henkilöstön asenteet influenssarokotusta kohtaan

Lähtökohdat Terveydenhuollon henkilöstö on tärkeässä roolissa influenssatartuntojen ehkäisemisessä. Selvitimme henkilöstön asenteita influenssarokotusta kohtaan, jotta voisimme paremmin ymmärtää rokotuskäyttäytymistä.Menetelmät TYKS:n kyselytutkimuksissa vuosina 2010 ja 2015 selvitettiin henkilökunnan halukkuutta ja perusteita ottaa kausi-influenssarokote. Raision terveyskeskussairaalan kysely vuonna 2017 selvitti hoitohenkilökunnan asenteita kausi-influenssarokotuksiin.Tulokset TYKS:ssa tärkeimpiä syitä rokotteen ottamiseen olivat suojautuminen influenssalta ja tartunnan levittämisen estäminen. Tärkein este rokotukselle oli huoli haitoista. Raision tutkimuksessa suurin osa henkilökunnasta suhtautui rokotukseen myönteisesti, ja vastaajilla oli myös realistinen näkemys rokotteen tehosta.Päätelmät Terveydenhuollon henkilöstön rokotusmyönteisyys Varsinais-Suomen sairaanhoitopiirin alueella on ajan mittaan lisääntynyt. Henkilökunta tuntee kuitenkin huolta rokotteen haittavaikutuksista ja epävarmuutta sen hyödyistä.</p

Suspicion of Lyme borreliosis in patients referred to an infectious diseases clinic : what did the patients really have?

Objective: To evaluate the conditions behind the symptoms in patients with suspected Lyme borreliosis (LB) who were referred to an infectious diseases clinic. Methods: In this retrospective, population-based study, we collected data from the medical records of all patients referred for infectious disease consultations in 2013 due to presumed LB from a population of 1.58 million. The patients were classified according to the certainty of LB on the basis of their symptoms, signs and laboratory results. Data on the outcomes and subsequent alternative diagnoses during the 4-year follow-up period were reviewed from all of the available patient records from public, private and occupational healthcare providers. Results: A total of 256 patients (16/100 000) were referred as a result of suspicion of LB; 30 (12%) of 256 were classified with definite, 36 (14%) with probable and 65 (25%) with possible LB. LB was unlikely in 121 (47%) patients. A novel diagnosis was discovered in the background symptoms in 73 (29%) of pa-tients. Previously diagnosed comorbidities caused at least some of the symptoms in 48 (19%) patients. Other explanations for symptoms were found in 81 (67%) of 121 of unlikely and 22 (34%) of 65 of possible LB patients. The spectrum of conditions behind the symptoms was quite broad and most often were musculoskeletal, neurological, psychological or functional disorders. Conclusions: LB was unlikely in half of the patients with presumed LB. In most cases the patients had other conditions that explained their symptoms. Elisa Kortela, Clin Microbiol Infect 2021;27:1022 (c) 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Bacterial meningitis in adults : a retrospective study among 148 patients in an 8-year period in a university hospital, Finland

BackgroundBacterial meningitis (BM) causes significant morbidity and mortality. We investigated predisposing factors, clinical characteristics, spectrum of etiological bacteria, and clinical outcome of community-acquired and nosocomial BM.MethodsIn this retrospective study we analyzed data of 148 adults (age > 16 years) with BM treated in Turku University Hospital, Southwestern Finland, from 2011 to 2018. Besides culture- or polymerase chain reaction (PCR)-positive cases we also included culture-negative cases with laboratory parameters strongly suggestive of BM and those with meningitis-related findings in imaging. We used Glasgow Outcome Scale (GOS) score 1-4 to determine unfavorable outcome.ResultsThe median age of patients was 57 years and 48.6% were male. Cerebrospinal fluid (CSF) culture for bacteria showed positivity in 50 (33.8%) cases, although pre-diagnostic antibiotic use was frequent (85, 57.4%). The most common pathogens in CSF culture were Streptococcus pneumoniae (11, 7.4%), Staphylococcus epidermidis (7, 4.7%), Staphylococcus aureus (6, 4.1%) and Neisseria meningitidis (6, 4.1%). Thirty-nine patients (26.4%) presented with the triad of fever, headache, and neck stiffness. A neurosurgical procedure or an acute cerebral incident prior BM was recorded in 74 patients (50%). Most of the patients had nosocomial BM (82, 55.4%) and the rest (66, 44.6%) community-acquired BM. Ceftriaxone and vancomycin were the most used antibiotics. Causative pathogens had resistances against the following antibiotics: cefuroxime with a frequency of 6.8%, ampicillin (6.1%), and tetracycline (6.1%). The case fatality rate was 8.8% and the additional likelihood of unfavorable outcome 40.5%. Headache, decreased general condition, head computed tomography (CT) and magnetic resonance imaging (MRI), hypertension, altered mental status, confusion, operative treatment, neurological symptoms, pre-diagnostic antibiotic use and oral antibiotics on discharge were associated with unfavorable outcome.ConclusionsThe number of cases with nosocomial BM was surprisingly high and should be further investigated. The usage of pre-diagnostic antibiotics was also quite high. Headache was associated with unfavorable outcome. The frequency of unfavorable outcome of BM was 40.5%, although mortality in our patients was lower than in most previous studies.Peer reviewe

Clostridioides difficile -infektion hoito

• C. difficile -infektion tärkeimmät hoitovaihtoehdot ovat vankomysiini ja fidaksomisiini. Metronidatsolia tulee nykysuositusten mukaan käyttää vain nuorehkojen potilaiden lievien tai kohtalaisen lievien infek­tioiden hoidossa.• Suurin riski infektion uusimiseen on iäkkäillä ja/tai immunosuprimoiduilla potilailla. Heillä voidaan käyttää standardihoidon rinnalla uusimisriskiä vähentämään betslotoksumabi-infuusiota (monoklonaalinen toksiini B:n vasta-aine).• Ulosteensiirto on tehokkain hoitokeino. Sitä suositellaan harkittavaksi jo kolmannen perättäisen infektion yhteydessä.</p

Toisintokuume : Infektio, joka tulee huomioida maahantulijan kuumetaudin erotusdiagnostiikassa

English summaryPeer reviewe

Clostridioides difficile -infektion hoito

Vertaisarvioitu. English abstract.• C. difficile -infektion tärkeimmät hoitovaihtoehdot ovat vankomysiini ja fidaksomisiini. Metronidatsolia tulee nykysuositusten mukaan käyttää vain nuorehkojen potilaiden lievien tai kohtalaisen lievien infek¬tioiden hoidossa. • Suurin riski infektion uusimiseen on iäkkäillä ja/tai immunosuprimoiduilla potilailla. Heillä voidaan käyttää standardihoidon rinnalla uusimisriskiä vähentämään betslotoksumabi-infuusiota (monoklonaalinen toksiini B:n vasta-aine). • Ulosteensiirto on tehokkain hoitokeino. Sitä suositellaan harkittavaksi jo kolmannen perättäisen infektion yhteydessä.Peer reviewe

Neuroborrelioosin oireet, diagnostiikka ja hoito

Neuroborrelioosin yleisimmät oireet ja löydökset ovat kivulias meningoradikuliitti, ­kasvohermohalvaus ja lymfosytaarinen meningiitti.Oireisto ilmaantuu yleensä muutaman viikon kuluessa infektion alusta.Diagnostiikka perustuu kliinisen kuvan lisäksi seerumin borreliavasta-aineisiin sekä ­aivo-selkäydinneste­löydöksiin.Neuroborrelioosi voidaan hoitaa 2–4 viikon doksisykliinihoidolla suun kautta tai 2–3 viikon ­suonensisäisellä keftriaksonihoidolla.</p

Borrelia burgdorferi specific serum and cerebrospinal fluid antibodies in Lyme neuroborreliosis

Publisher Copyright: © 2022 The Author(s)We used definite Lyme neuroborreliosis (LNB) adult patient acute and convalescent phase serum (n = 63 and 61, respectively) and cerebrospinal fluid (CSF; acute n = 63, 3 weeks timepoint n = 41) samples to characterize Borrelia burgdorferi specific antibody responses in patient subgroups categorized by demographics, infection manifestation and phase, infecting B. burgdorferi genospecies, received antibiotic treatments, and treatment outcome. B. burgdorferi antibodies were analyzed using 4 different assays incorporating a large array of antigens. We observed that B. burgdorferi specific serum antibodies show a universal, antigen independent declining trend after antibiotic treatment of LNB at 1 year. Antibodies declined similarly among women and men over time, and the decline was independent of patient age. The antibody responses were independent of the predominant LNB manifestation, treatment received by the patient, infecting B. burgdorferi genospecies, or the subjective improvement experienced by the patients. Finally, the antibody specificities in CSF reflected the specificities observed in serum samples.Peer reviewe

C6 peptide enzyme immunoassay in Lyme borreliosis serology

The cut-off values used in C6 peptide-based enzyme immunoassay (EIA), a widely used test in Lyme borreliosis (LB) serology, have not been thoroughly analysed. The objective of the study was to examine the performance of the C6 EIA, and to determine optimal cut-off values for the test. The analysed data contained results of 1368 serum samples. C6 EIA index values were compared statistically with the immunoblot (IB) test results. The identified cut-off values were further tested in a well-defined LB patient cohort. Cut-off value 1.6 appeared to be optimal when C6 EIA was used as a stand-alone test. When using C6 EIA as the first-tier test, the optimal cut-off values were 0.9 and 2.4 for negative and positive results. When C6 EIA was used as a second-tier test, samples yielding C6 index values >= 3.0 could be considered positive. The identified cut-off values had also a high sensitivity to identify seropositivity among definite LB patients. The identified cut-off values refine the role of C6 EIA in LB serology. Importantly, the use of C6 EIA leads to a reduction in the number of samples that need to be analysed using an IB, thus also reducing the costs. Two alternative workflows for LB serology including the C6 EIA are suggested.Peer reviewe

Neuroborrelioosin oireet, diagnostiikka ja hoito

Vertaisarvioitu. English summary.• Neuroborrelioosin yleisimmät oireet ja löydökset ovat kivulias meningoradikuliitti, ¬kasvohermohalvaus ja lymfosytaarinen meningiitti. • Oireisto ilmaantuu yleensä muutaman viikon kuluessa infektion alusta. • Diagnostiikka perustuu kliinisen kuvan lisäksi seerumin borreliavasta-aineisiin sekä ¬aivo-selkäydinneste¬löydöksiin. • Neuroborrelioosi voidaan hoitaa 2–4 viikon doksisykliinihoidolla suun kautta tai 2–3 viikon ¬suonensisäisellä keftriaksonihoidolla.Peer reviewe