Clinical characteristics and evaluation of the incidence of cryptococcosis in Finland 2004-2018

Background Cryptococcosis is one of the major causes of mortality among HIV patients worldwide. Though most often associated with late stage HIV infection/AIDS, a significant number of cases occur in other immunocompromised patients such as solid organ transplant recipients and patients with hematological malignancies. Immunocompromised patients are a heterogeneous group and their number increases constantly. Since little is known about the incidence and the clinical features of cryptococcosis in Northern Europe, our aim was to investigate the clinical characteristics of cryptococcosis patients in Finland. Methods We retrospectively reviewed the laboratory confirmed cryptococcosis cases in Finland during 2004-2018. Only those who were treated for cryptococcosis were included in the study. Initial laboratory findings and medical records were also collected. Results A total of 22 patients with cryptococcosis were included in our study. The annual incidence of cryptococcosis was 0.03 cases per 100,000 population. Ten patients were HIV-positive and 12 out of 22 were HIV-negative. Hematological malignancy was the most common underlying condition among HIV-negative patients. Conclusions To our knowledge, this is the first study of the clinical presentation and incidence of cryptococcosis in Finland. We demonstrate that invasive cryptococcal infection occurs not only in HIV/AIDS patients or otherwise immunocompromised patients but also in immunocompetent individuals. Even though cryptococcosis is extremely rare in Finland, its recognition is important since the prognosis depends on rapid diagnostics and early antifungal therapy.Peer reviewe

How to: interpret MICs of antifungal compounds according to the revised clinical breakpoints v. 10.0 European committee on antimicrobial susceptibility testing (EUCAST)

BACKGROUND: EUCAST has revised the definition of the susceptibility category "I" from "Intermediate" to "Susceptible, Increased exposure". This implies that "I" can be used where the drug-concentration at the site of infection is high, either because of dose escalation or through other means to ensure efficacy. Consequently, "I" is no longer used as a buffer-zone to prevent technical fact

Bakteerien mikrobilääkeherkkyyden tuloksen tulkinta muuttuu

Bakteerien mikrobilääkeherkkyysmäärityksissä herkän (S) ja resistentin (R) tuloksen määritelmät pysyvät ennallaan, mutta välimuotoisesti herkän (I) tuloksen tulkinta on muuttumassa. Jatkossa I-tulos tarkoittaa sitä, että bakteerin aiheuttama infektio on hoidettavissa kyseisellä lääkkeellä, mutta annostuksen on oltava riittävän suuri. Suomessa uusi määritelmä otetaan käyttöön asteittain vuoden 2021 aikana

Clinical characteristics and evaluation of the incidence of cryptococcosis in Finland 2004-2018

Background: Cryptococcosis is one of the major causes of mortality among HIV patients worldwide. Though most often associated with late stage HIV infection/AIDS, a significant number of cases occur in other immunocompromised patients such as solid organ transplant recipients and patients with hematological malignancies. Immunocompromised patients are a heterogeneous group and their number increases constantly. Since little is known about the incidence and the clinical features of cryptococcosis in Northern Europe, our aim was to investigate the clinical characteristics of cryptococcosis patients in Finland.Methods: We retrospectively reviewed the laboratory confirmed cryptococcosis cases in Finland during 2004-2018. Only those who were treated for cryptococcosis were included in the study. Initial laboratory findings and medical records were also collected.Results: A total of 22 patients with cryptococcosis were included in our study. The annual incidence of cryptococcosis was 0.03 cases per 100,000 population. Ten patients were HIV-positive and 12 out of 22 were HIV-negative. Hematological malignancy was the most common underlying condition among HIV-negative patients.Conclusions: To our knowledge, this is the first study of the clinical presentation and incidence of cryptococcosis in Finland. We demonstrate that invasive cryptococcal infection occurs not only in HIV/AIDS patients or otherwise immunocompromised patients but also in immunocompetent individuals. Even though cryptococcosis is extremely rare in Finland, its recognition is important since the prognosis depends on rapid diagnostics and early antifungal therapy.</p

Quantitative and qualitative evaluations of impacts and benefits of nine INHERIT case studies

The INHERIT report Quantitative and Qualitative Evaluations of Impacts and Benefits of Nine INHERIT Case Studies documents the findings relevant to potential impacts and benefits of nine case studies for health, equity and a more sustainable environment. It uses a mixed method approach with quantitative methods augmented in some cases by written responses to survey questions, or by focus group discussions on impacts, as appropriate. Each case study evaluation was led by a different INHERIT partner. In each case, partners formulated the research design appropriate to their case studies and the associated research questions identified within the framework of INHERIT. The coordinating partner, University College London (UCL), developed an evaluation framework to suit the range of case studies examined for impacts and benefits, the case specific logic models developed, and the research questions identified. The nine chapters describe the impact evaluations and findings from the nine case studies using the following format: Background; Overall aims; Context; Research Questions; Methodology; Results; Discussion; Limitations; Learning points for future research; Learning points for potential scale up and transferability

Creating triple-wins for health, equity and environmental sustainability: elements of good practice based on learning from the INHERIT case studies

This report draws out dimensions of good practice for building this triple-win, based on learning from the INHERIT project’s 15 case studies. In the context of the project, good practice refers to ways that support changing contexts and create conditions to enable behaviour change to reach the triple-win. This report summarises key information for consideration by governmental and non-governmental policy-makers and practitioners planning to work across sectors to achieve the triple-win through behaviour change at every level. INHERIT researchers have focused their evaluations of the 15 INHERIT case studies on implementation, intersectoral cooperation, impacts and cost benefits. The researchers have taken dimensions of good practice from INHERIT research to be those elements that appear to be promising or necessary in the contexts in which the INHERIT cases studies are implemented. The extent to which these elements of good practice can be generalised to other contexts merits consideration in developing future initiatives towards creating synergies across sectors. INHERIT researchers have drawn out lessons learned from information gathered in evaluations about triggers for the initiatives, key elements for implementation, success factors in intersectoral cooperation, what could have been done better, what should be done in the future, and the most important learnings from the evaluation of outcomes, costs and benefits

Interspecific competition delays recovery of Daphnia spp. populations from pesticide stress

Xenobiotics alter the balance of competition between species and induce shifts in community composition. However, little is known about how these alterations affect the recovery of sensitive taxa. We exposed zooplankton communities to esfenvalerate (0.03, 0.3, and 3 μg/L) in outdoor microcosms and investigated the long-term effects on populations of Daphnia spp. To cover a broad and realistic range of environmental conditions, we established 96 microcosms with different treatments of shading and periodic harvesting. Populations of Daphnia spp. decreased in abundance for more than 8 weeks after contamination at 0.3 and 3 μg/L esfenvalerate. The period required for recovery at 0.3 and 3 μg/L was more than eight and three times longer, respectively, than the recovery period that was predicted on the basis of the life cycle of Daphnia spp. without considering the environmental context. We found that the recovery of sensitive Daphnia spp. populations depended on the initial pesticide survival and the related increase of less sensitive, competing taxa. We assert that this increase in the abundance of competing species, as well as sub-lethal effects of esfenvalerate, caused the unexpectedly prolonged effects of esfenvalerate on populations of Daphnia spp. We conclude that assessing biotic interactions is essential to understand and hence predict the effects and recovery from toxicant stress in communities

Creating triple-wins for health, equity and environmental sustainability: elements of good practice based on learning from the INHERIT case studies

This report draws out dimensions of good practice for building this triple-win, based on learning from the INHERIT project’s 15 case studies. In the context of the project, good practice refers to ways that support changing contexts and create conditions to enable behaviour change to reach the triple-win. This report summarises key information for consideration by governmental and non-governmental policy-makers and practitioners planning to work across sectors to achieve the triple-win through behaviour change at every level. INHERIT researchers have focused their evaluations of the 15 INHERIT case studies on implementation, intersectoral cooperation, impacts and cost benefits. The researchers have taken dimensions of good practice from INHERIT research to be those elements that appear to be promising or necessary in the contexts in which the INHERIT cases studies are implemented. The extent to which these elements of good practice can be generalised to other contexts merits consideration in developing future initiatives towards creating synergies across sectors. INHERIT researchers have drawn out lessons learned from information gathered in evaluations about triggers for the initiatives, key elements for implementation, success factors in intersectoral cooperation, what could have been done better, what should be done in the future, and the most important learnings from the evaluation of outcomes, costs and benefits

Quantitative and qualitative evaluations of impacts and benefits of nine INHERIT case studies

The INHERIT report Quantitative and Qualitative Evaluations of Impacts and Benefits of Nine INHERIT Case Studies documents the findings relevant to potential impacts and benefits of nine case studies for health, equity and a more sustainable environment. It uses a mixed method approach with quantitative methods augmented in some cases by written responses to survey questions, or by focus group discussions on impacts, as appropriate. Each case study evaluation was led by a different INHERIT partner. In each case, partners formulated the research design appropriate to their case studies and the associated research questions identified within the framework of INHERIT. The coordinating partner, University College London (UCL), developed an evaluation framework to suit the range of case studies examined for impacts and benefits, the case specific logic models developed, and the research questions identified. The nine chapters describe the impact evaluations and findings from the nine case studies using the following format: Background; Overall aims; Context; Research Questions; Methodology; Results; Discussion; Limitations; Learning points for future research; Learning points for potential scale up and transferability