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Hans Holmberg

Publications and source records attributed to Hans Holmberg.

15 recordsLinked to original sources
PubMed2006

C-reactive protein in diagnosis of community-acquired pneumonia in adult patients in primary care.

The usefulness of non-specific inflammatory parameters for the diagnosis of community- acquired pneumonia (CAP) in primary care is not settled. The aim of this study was to assess the value of serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell count (WBC) for this purpose. These inflammatory parameters, as well as the aetiological agents, were studied in 82 patients with radiologically confirmed CAP. CRP was elevated (>5 mg/l) in 76 patients, with a median value of 65 mg/l. 25 patients had a value of over 100 mg/l. In 32 patients the CRP levels were <50 mg/l and in 17 patients they were <20 mg/l. ESR varied from 5 to 100 mm/h, with a median value of 53 mm/h; in 21 patients the value was <30 mm/h. WBC varied from 4.4 to 21.4x10(9)/l, with a median value of 9.8x10(9)/l. No associations between the levels of the inflammatory parameters and the various aetiologies were found. It is concluded that the examined inflammatory parameters did not contribute notably in the routine diagnosis of CAP established by clinical measures.

Adolescent↗
PubMed2006

Etiologic diagnosis of adult bacterial pneumonia by culture and PCR applied to respiratory tract samples.

Respiratory culture and multiplex PCR for Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, and Chlamydophila pneumoniae were applied to sputum, nasopharyngeal swabs, and nasopharyngeal aspirates from 235 adult patients with community-acquired pneumonia and 113 controls. Both culture and multiplex PCR performed well with the different samples and appear to be useful as diagnostic tools.

Adolescent↗
PubMed2005

Swedish guidelines for the management of community-acquired pneumonia in immunocompetent adults.

This document presents the evidence-based guidelines of the Swedish Society of Infectious Diseases for the management of adult immunocompetent patients with community-acquired pneumonia (CAP), who are assessed at hospital. The prognostic score 'CURB-65' is recommended for all CAP patients in the emergency room. The score provides an assessment tool for the decision regarding outpatient treatment or level of hospital supervision, the choice of microbiological investigations, and empirical antibiotic treatment. In patients with non-severe CAP (CURB-65 score 0-2) we recommend initial narrow-spectrum antibiotic treatment, orally or intravenously, primarily directed at Streptococcus pneumoniae. In those with CURB-65 score 3, penicillin G or a cephalosporin intravenously is recommended. For CURB-65 score 0-3 atypical pathogens should be covered only when they are suspected on clinical or epidemiological grounds. In patients with CURB-65 score 4-5 intravenous combination therapy with either cephalosporin/macrolide or penicillin G/fluoroquinolone is recommended. Efforts should be made to identify the CAP aetiology in order to support the ongoing antibiotic treatment or to suggest treatment alterations. Recommended measures for prevention of CAP include influenza -- and pneumococcal -- vaccination to risk groups and efforts for smoking cessation.

Adult↗
PubMed2005

Design of a multiplex PCR for Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae and Chlamydophila pneumoniae to be used on sputum samples.

A multiplex PCR (mPCR) was developed for simultaneous detection of specific genes for Streptococcus pneumoniae (lytA), Mycoplasma pneumoniae (P1), Chlamydophila pneumoniae (ompA), and Haemophilus influenzae (16S rRNA, with verification PCR for P6). When the protocol was tested on 257 bacterial strains belonging to 37 different species, no false negatives and only one false positive were noted. One Streptococcus mitis out of thirty was positive for lytA. In a pilot application study of 81 sputum samples from different patients with suspected lower respiratory tract infection (LRTI), mPCR identified S. pneumoniae in 25 samples, H. influenzae in 29, M. pneumoniae in 3, and C. pneumoniae in 1. All samples culture positive for S. pneumoniae (n=15) and H. influenzae (n=15) were mPCR positive for the same bacteria. In a pilot control study with nasopharyngeal swabs and aspirates from 10 healthy adults, both culture and mPCR were negative. No PCR inhibition was found in any of the mPCR-negative sputum or nasopharyngeal samples. Whether all samples identified as positive by mPCR are truly positive in an aetiological perspective regarding LRTI remains to be evaluated in a well-defined patient material. In conclusion, the mPCR appears to be a promising tool in the aetiological diagnostics of LRTI.

Adolescent↗
PubMed2004

Comparison of two urinary antigen tests for establishment of pneumococcal etiology of adult community-acquired pneumonia.

The Binax NOW immunochromatographic test (ICT) detecting the pneumococcal C polysaccharide and a serotype-specific latex agglutination (LA) test detecting 23 pneumococcal capsular antigens were evaluated for establishing pneumococcal etiology in community-acquired pneumonia (CAP) by use of nonconcentrated urine. ICT was considered to be strongly positive for result lines at least as intense as the control line and weakly positive for less intense result lines. When 215 adult CAP patients were tested, strong ICT, weak ICT, and LA positivity were found in 28, 24, and 16 patients, respectively; of these patients, 13 (46%), 6 (25%), and 13 (81%), respectively, had pneumococcal bacteremia and 27 (96%), 17 (71%), and 15 (94%), respectively, had Streptococcus pneumoniae isolated from blood, sputum, and/or nasopharynx. Among 108 controls tested, 2 (1.9%) were weakly ICT positive. When weak positivity was considered negative, the sensitivity of ICT decreased from 79% (19 of 24) to 54% (13 of 24), while the specificity increased from 83% (158 of 191) to 92% (176 of 191); no controls were false positive. The sensitivity and specificity of LA were 54% (13 of 24) and 98% (188 of 191), respectively. Eight of nine LA serotypes corresponded to culture serotypes. In conclusion, using nonconcentrated urine and dividing ICT-positive results into strongly and weakly positive results is a suitable way of performing ICT. While weak ICT positivity should be interpreted with caution, strong ICT positivity and LA positivity should be considered supportive of pneumococcal etiology in adult CAP. As such, these assays might have implications for antibiotic use in CAP. LA has promising potential for pneumococcal serotyping, although further evaluation is required.

Adult↗
PubMed2004

Sputum specimens can be obtained from patients with community-acquired pneumonia in primary care.

OBJECTIVE: To improve the aetiological diagnosis in community-acquired pneumonia (CAP) increased efforts were made to obtain expectorated sputum specimens from patients with CAP. DESIGN: A prospective, clinical study. Patients were encouraged to cough spontaneously and to expectorate a sputum specimen. If unsuccessful, they were asked to inhale nebulized hypertonic saline to induce secretion and cough. SETTING: One primary health care centre in Orebro, Sweden. SUBJECTS: Patients attending the Health Centre with acute symptoms of CAP. MAIN OUTCOME MEASURES: Availability and quality of sputum specimen from patients with CAP in primary care. RESULTS: 177 patients were included, 63% were women and the mean age was 51 years. 28% were smokers and 46% showed infiltrates on chest X-ray. Sputum specimens were obtained from 125 patients. Fifty-nine were expectorated spontaneously and 66 were induced. Ninety-one of the specimens were found to be acceptable, whereas 34 were discarded. Potential pathogens were found in 57% of the 91 specimens. CONCLUSION: Acceptable sputum specimens can be obtained with some effort from approximately half of the patients in primary care. Sputum culture might improve the knowledge of the bacterial aetiology of CAP in selected patients and in epidemiological studies.

Adolescent↗
PubMed2002

Spinal sensorimotor transformation: relation between cutaneous somatotopy and a reflex network.

The projection of primary afferents onto spinal interneurons constitutes the first step in sensorimotor transformations performed by spinal reflex systems. Despite extensive studies on spinal somatotopy, uncertainties remain concerning the extent and significance of representational overlap and relation to spinal reflex circuits. To address these issues, the cutaneous projection from the hindpaw and its relation to the topography of lamina V neurons encoding withdrawal reflex strength ("reflex encoders") was studied in rats. Thin and coarse primary afferent terminations in laminas II and III-IV, respectively, were mapped by wheat germ agglutinin-horseradish peroxidase and choleragenoid tracing. The functional weights of these projections were characterized by mapping nociceptive and tactile field potentials and compared with the topography of reflex encoders. Both anatomical and physiological data indicate that thin and coarse skin afferent input is spatially congruent in the horizontal plane. The representation of the hindpaw in the spinal cord was found to be intricate, with a high degree of convergence between the projections from different skin sites. "Somatotopic disruptions" such as the representation of central pads medial to that of the digits were common. The weight distribution of the cutaneous convergence patterns in laminas III-IV was similar to that of lamina V reflex encoders. This suggests that the cutaneous convergence and features such as somatotopic disruptions have specific relations to the sensorimotor transformations performed by reflex interneurons in the deep dorsal horn. Hence, the spinal somatotopic map may be better understood in light of the topography of such reflex systems.

Action Potentials↗
PubMed2002

Management of patients with community-acquired pneumonia treated in hospital in Sweden.

To investigate the management of patients with community-acquired pneumonia (CAP) treated in hospital in Sweden, a multicentre retrospective cohort study was performed with medical record review of 982 patients (mean age 63 y) at 17 departments of infectious diseases at hospitals in Sweden. Information on antimicrobial therapy, demographic characteristics, comorbid conditions, physical examination findings, and laboratory and microbiological test results were recorded. Outcome measures were in-hospital mortality and length of hospital stay (LOS). Cultures were obtained from blood in 80% and from sputum in 22% of the patients. A microbiological aetiology was determined for 23% of the patients, with Streptococcus pneumoniae as the dominating agent (9%). The initial antibiotic treatment was mostly given intravenously (78%). Penicillin (50%) or a cephalosporin (30%) was the most common choice. Both of these drugs were usually given as a single agent. The overall mortality was 3.5% and the mean LOS was 6.4 d. Thus, the outcome was favourable despite the empirical antibiotic treatment having a narrow spectrum compared with the broader approach recommended in most recent guidelines on the management of CAP. These findings suggest that a majority of patients who are hospitalized with moderately severe pneumonia can be treated initially with penicillin alone.

Adolescent↗
PubMed1998

Cytokine response to staphylococcal exotoxins in Staphylococcus aureus septicemia.

OBJECTIVE: To investigate if exposure to exotoxins results in augmented serum cytokine response of patients with Staphylococcus aureus septicemia. METHODS: Serum samples and strains from 63 patients with S. aureus septicemia were collected in a prospective study. Toxin production by strains in vitro was determined by enzyme immunoassay (EIA) or reversed passive latex agglutination (RPLA). Antibodies against the toxins and cytokine levels in serum on admission were analyzed with EIA. RESULTS: Patients infected with strains producing staphylococcal enterotoxins (SEs) A, B, C and D and/or toxic shock syndrome toxin-1 (TSST-1) in vitro (n=37) showed higher serum TNF-alpha levels than those infected with non-toxigenic strains (p=0.04). A significant titer rise against the corresponding SE and/or TSST-1 produced by the isolate (14/35), indirectly reflecting exposure to the antigen, was associated with higher TNF-alpha concentrations on admission than in those without titer rise (p=0.03). Patients with low antibody titers against SE and/or TSST-1 on admission (19/37) were found to have higher serum TNF-alpha concentrations on admission than those with elevated antibody titers on admission (p=0.03). CONCLUSION: Patients infected with toxigenic S. aureus strains produce significantly higher levels of serum TNF-alpha on admission compared to patients infected with non-toxigenic strains.

Journal Article↗
PubMed1998

Production of tumor necrosis factor-alpha and interleukin-6 in whole blood stimulated by live Gram-negative and Gram-positive bacteria.

OBJECTIVE: To investigate the production of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) induced by live Gram-negative and Gram-positive bacteria in whole blood in vitro. METHODS: In all, 49 different isolates were studied. Each of the 49 different isolates was incubated for 4 h with whole blood at a ratio of one monocyte per 1--5 bacteria. Plasma was then separated and frozen, and the concentrations of TNF-alpha and IL-6 were measured by enzyme immunoassays. RESULTS: There was a positive correlation between TNF-alpha and IL-6 values, r=0.9. Gram-negative bacteria induced higher levels of both TNF-alpha and IL-6 than Gram-positive bacteria. Group G streptococci (GGS) induced higher levels of TNF-alpha than Streptococcus pneumoniae, Staphylococcus aureus, Staphylococcus epidermidis and group A streptococci (GAS). Klebsiella pneumoniae induced higher levels of TNF-alpha than Haemophilus influenzae, Escherichia coli and Neisseria meningitidis. GGS induced higher levels of IL-6 than Staphylococcus epidermidis, Staphylococcus aureus and GAS. When the relative amounts of cytokine induced by the strains were compared to serum concentrations measured on admission in patients with bacteremia caused by the same bacterial isolates there was no significant correlation. CONCLUSION: Species- and strain-related differences in cytokine-inducing properties were found which may have significance in clinical infections.

Journal Article↗
PubMed1995

Granulocyte colony-stimulating factor (G-CSF) and interleukin (IL)-8 in sera from patients with Staphylococcus aureus septicemia.

OBJECTIVE: To determine the concentrations of granulocyte colony-stimulating factor (G-CSF) and interleukin (IL)-8 in sera from patients with Staphylococcus aureus septicemia and to correlate the results to peripheral neutrophil counts and the clinical outcome. METHODS: Serum samples from 64 consecutive patients with S. aureus septicemia were sequentially collected in a prospective study. RESULTS: The mean plus minus standard deviation (SD) serum G-CSF value on admission was 348 plus minus 830 with a range of 8 to 5400 pg/mL. G-CSF concentrations were elevated (> 76 pg/mL) in 38/64 patients (59%) as were serum IL-8 concentrations (> 67 pg/mL) in 23/64 patients (36%) on admission. The mean plus minus SD IL-8 value was 266 plus minus 422 pg/mL with a range of 2 to 1366 pg/mL. A correlation was found between serum IL-8 and white blood cell count on admission (p=0.008). CONCLUSIONS: Patients with uncomplicated septicemia frequently have elevated G-CSF values (84%) in comparison to patients with complicated septicemia (49%; p=0.02), indicating a possible protective effect of G-CSF in septic complications.

Journal Article↗
PubMedDate not supplied

Antibody response to the patient's own Haemophilus influenzae isolate can support the aetiology in lower respiratory tract infections.

In order to understand the clinical importance of Haemophilus influenzae isolated from sputum samples, an indirect immunofluorescence (IF) assay was developed, using the patient's own isolate as the antigen. The method was tested on samples from six patients with lower respiratory tract infection (LRTI) and H. influenzae isolated from blood (n=2), sputum (n=3) or both (n=1), and on two healthy adults with H. influenzae isolated from the nasopharynx. Between acute and convalescent sera, a four-fold IgG antibody increase was achieved in five of six LRTI patients, including the three blood culture-positive patients. One LRTI patient and the two asymptomatic carriers showed stable antibody levels against their own isolate. Although small, the study indicates that indirect IF can be a promising tool for determining whether a H. influenzae strain represents the probable cause of infection or just a strain colonising the airways. More extensive studies should be performed in order to establish the usefulness of the assay.

Aged↗