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T Lillebaek

Publications and source records attributed to T Lillebaek.

At least 19 recordsLinked to original sources
PubMed2004

Tuberculosis not verified by culture in a low incidence country.

The objective was to evaluate the magnitude, diagnostic basis and characteristics of patients notified with tuberculosis (TB) not verified by culture. All patients in Denmark notified with TB between 1995 and 1999 were identified through the national TB register. Nationwide culture results were obtained from the International Reference Laboratory of Mycobacteriology. The proportion of culture verification decreased from 91% in 1995 to 80% in 1999. A total of 2518 patients were notified, of which 374 (14.9%) were not verified by culture. For 80 (3.2%) patients no specimens were submitted. Instead the diagnosis was mainly based on X-ray (72.6%) for patients with pulmonary TB and histology (38.3%) for patients with extrapulmonary TB. For 216 patients aged 0-14 y, 74 (34.3%) were not verified by culture. The proportion of TB not verified by culture in Denmark is low compared to other European countries. Some cases may be well explained, e.g. children with a close contact suffering from TB or patients with extrapulmonary TB with limited number of specimens. However, for a minority group of patients with pulmonary TB there were no obvious reasons why specimens were not submitted for culture. Culture verification should remain a priority when possible.

Adolescent↗
PubMed2004

Tuberculosis in Greenland--current situation and future challenges.

OBJECTIVE: To describe the tuberculosis (TB) epidemiology in Greenland in 1998-2002 and to identify possible obstacles for reducing the TB incidence. STUDY DESIGN/METHODS: TB notification data were collected from the annual reports of the Chief Medical Officer, and culture verification data were collected from the International Reference Laboratory of Mycobacteriology at Statens Serum Institut, Denmark. RESULTS: The TB incidence in Greenland reached a peak of 185/100,000 in 2001. In 1999-2001, the majority of cases were related to an outbreak in the Southern districts. In 1998-2002, 0.5% drug-resistance was found among patients living in Greenland in contrast to 13.1% drug-resistance found previously among Inuit patients in Denmark. In 1998-2001, microscopy positive cases made up 65% of all culture confirmed cases and DNA subtyping demonstrated the emergence of Mycobacterium tuberculosis strains that were previously infrequently found. CONCLUSION: It is important to eliminate factors that fuel the epidemic and to improve general living conditions in Greenland. Treatment seems effective as limited drug-resistance is detected. TB reduction will therefore depend on early detection of active disease and thorough contact tracing. Greenland will face a pool of persons latently infected some of whom will progress to active disease. Sufficient resources need to be allocated for TB control in the years to come.

Antitubercular Agents↗
PubMed2004

A dominant Mycobacterium tuberculosis strain emerging in Denmark.

SETTING: Denmark, a high-income country with a low prevalence of tuberculosis. OBJECTIVE AND DESIGN: Molecular epidemiological studies of Mycobacterium tuberculosis strains are conducted worldwide, and distinct strains have been associated with large outbreaks of tuberculosis. This is the first systematic population-based search for distinct strains of M. tuberculosis in Denmark among 4102 strains DNA fingerprinted nationwide from 1992 to 2001. RESULTS: A specific strain of M. tuberculosis has emerged rapidly in Denmark: in 1992, the Danish Cluster 2 strain accounted for 5.8% of all culture-positive Danish-born cases, increasing to 29.0% in 2001. The Cluster 2 cases were on average younger (41.8 vs. 51.4 years), more likely to be male (81.4% vs. 64.1%), and more likely to have pulmonary involvement only (90.3% vs. 64.6%) than other Danish-born cases. During the first 4 observation years, they were mainly found in the capital city, Copenhagen, but were later increasingly observed in the provinces. CONCLUSION: The reasons for the increasing dominance and change in geographical distribution of Cluster 2 strains in Denmark is unknown, but may be partly explained by the fact that Cluster 2 is associated with younger males with pulmonary disease manifestation. We consider it as an outbreak and believe the situation requires increased focus on early tuberculosis diagnosis and control of transmission in Denmark.

Adult↗
PubMed2003

[Molecular epidemiology of tuberculosis among prisoners].

The subject of the investigation is a group of 27 strains of Mycobacterium tuberculosis isolated in 2000 from prisoners with the diagnosis of tuberculosis, 19 Czechs and 8 foreigners (mean age 41 and 35 years resp.). The molecular-epidemiological examination of these strains was made using the RFLP fingerprint technique (Restriction Fragment Length Polymorphism) with evidence of the insertive sequence IS6110 and the technique of spoligotyping, based on detection of hybridization of spacer oligonucleotides. DNA fingerprinting revealed a high polymorphism in the number and molecular weight of sequence IS6110 which is common in Czech and other European strains of M. tuberculosis. All strains with the exception of two had mutually different fingerprint profiles. In the two with identical fingerprints probably a duplicit examination of the same material was involved which occurred by mistake during transport or in the laboratory. The fingerprint method thus did not prove interhuman transmission of tuberculosis between the examined prisoners. The technique of spoligotyping revealed the finding of genotype Beijing M. tuberculosis in two sick prisoners, one Algerian and one Albanese, and in one Czech prisoner. This genotype found in a high percentage of patients in southeastern Asia and in migrants from this area was detected for the first time in the Czech Republic. The findings are evidence of a satisfactory standard of the programme of tuberculosis control in the Czech prison system and at the same time draw attention to the potential possibility of the spread of tuberculosis from migrants coming from areas with a high prevalence.

Adult↗
PubMed2003

Prevalence of Beijing genotype in Latvian multidrug-resistant Mycobacterium tuberculosis isolates.

SETTING: Predominant genotypes of Mycobacterium tuberculosis include the Beijing family, which has caused large tuberculosis outbreaks and has been associated with increased virulence and multidrug resistance (MDR). OBJECTIVE: To search for the Beijing genotype among Latvian MDR patients to characterise their DNA isolates at the molecular level. DESIGN: MDR isolates were spoligotyped and tested for gene mutations by automatic nucleotide sequencing. RESULTS: Of 109 isolates examined, 95 were located in six clusters of 2 to 63 isolates each. The 63 isolates in the largest cluster had an identical pattern corresponding to the Beijing genotype. The remaining isolates were of a non-Beijing genotype and formed another large group whose similarity ranged from 72% to 100%. Mutations in the rpoB and katG genes were compared in the Beijing and non-Beijing strains. In both groups, the rpoB gene mutations predominated in codons S531L (52.2%) and D516V (14.7%). Double mutations in the rpoB gene were observed in 8.2% of the isolates, most of them located among Beijing-type isolates. The katG gene mutation S315T (98.4%) was prevalent among all isolates. CONCLUSION: Molecular analysis of MDR isolates of M. tuberculosis demonstrates that the Beijing genotype, most likely due to recent transmission, is prevalent in Latvia among MDR patients and that this genotype can be associated with double mutations.

Bacterial Proteins↗
PubMed2001

[Resistant tuberculosis in Denmark].

INTRODUCTION: Increased rates of multidrug-resistant (MDR) tuberculosis (TB) has been reported from countries close to Denmark. We evaluated the incidence of drug resistance in Denmark in order to determine the magnitude of the problem. MATERIALS AND METHODS: Susceptibility testing was performed in isolates from 85.4% of all notified patients during 1991-1998. Epidemiological information was retrieved from the mandatory notification forms. RESULTS: Total drug resistance remained largely constant, although a minor increase was observed in 1997-1998. Monoresistance was observed in 7.3% of the isolates. Among 3.6% polyresistant isolates, resistance to isoniazid and streptomycin accounted for 2.8%, whereas MDR accounted for 0.5%. The MDR strains displayed different restriction fragment length polymorphism (RFLP) patterns, and no matches were identified in the international MDR database. Drug resistance in untreated Danes and foreigners were 5.9% and 14.6%, respectively. Among Danes and foreigners with previous TB, 6.2% and 22.7% had drug resistance, respectively. Increased drug resistance was found among untreated Danes aged 25-54 years mainly due to a single isoniazid- and streptomycin-resistant RFLP-cluster. Among all patients with isoniazid- and streptomycin-resistance, 77.0% had clustered strains. DISCUSSION: In conclusion, although drug resistance among untreated Danes was close to the rate estimated in good national programmes, close monitoring is needed in future years, as active transmission of isoniazid- and streptomycin-resistant Mycobacterium tuberculosis was demonstrated.

Adolescent↗
PubMed2001

Ganser syndrome after solitary confinement in prison: a short review and a case report.

A short review of the Ganser syndrome is given. The condition is a rare, probably dissociative, disorder with transient Vorbeireden as the central symptom. The case of a middle-aged man developing a transient Ganser syndrome after long-term solitary confinement in a remand prison is presented. Systematic investigation of 268 remand prisoners confirms the rarity of the syndrome, as only the case subject had this disorder.

Attention↗
PubMed2001

Risk of Mycobacterium tuberculosis transmission in a low-incidence country due to immigration from high-incidence areas.

Does immigration from a high-prevalence area contribute to an increased risk of tuberculosis in a low-incidence country? The tuberculosis incidence in Somalia is among the highest ever registered. Due to civil war and starvation, nearly half of all Somalis have been forced from their homes, causing significant migration to low-incidence countries. In Denmark, two-thirds of all tuberculosis patients are immigrants, half from Somalia. To determine the magnitude of Mycobacterium tuberculosis transmission between Somalis and Danes, we analyzed DNA fingerprint patterns of isolates collected in Denmark from 1992 to 1999, comprising >97% of all culture-positive patients (n = 3,320). Of these, 763 were Somalian immigrants, 55.2% of whom shared identical DNA fingerprint patterns; 74.9% of these were most likely infected before their arrival in Denmark, 23.3% were most likely infected in Denmark by other Somalis, and 1.8% were most likely infected by Danes. In the same period, only 0.9% of all Danish tuberculosis patients were most likely infected by Somalis. The Somalian immigrants in Denmark could be distributed into 35 different clusters with possible active transmission, of which 18 were retrieved among Somalis in the Netherlands. This indicated the existence of some internationally predominant Somalian strains causing clustering less likely to represent recent transmission. In conclusion, M. tuberculosis transmission among Somalis in Denmark is limited, and transmission between Somalis and Danes is nearly nonexistent. The higher transmission rates between nationalities found in the Netherlands do not apply to the situation in Denmark and not necessarily elsewhere, since many different factors may influence the magnitude of active transmission.

Adolescent↗
PubMed2001

Spacer oligonucleotide typing of bacteria of the Mycobacterium tuberculosis complex: recommendations for standardised nomenclature.

Spacer oligonucleotide typing (spoligotyping) is widely used for differentiation of bacteria of the Mycobacterium tuberculosis complex. However, the absence of any standardised method for concise description of spoligotypes makes it difficult to compare the results from different laboratories. This paper describes unambiguous, interconvertible systems for the designation of spoligotype patterns, the adoption of which will be beneficial to mycobacterial research.

Databases, Factual↗
PubMed2000

Results from 8 yrs of susceptibility testing of clinical Mycobacterium tuberculosis isolates in Denmark.

Increased rates of multidrug-resistant (MDR) tuberculosis (TB) has been reported from countries close to Denmark. This study evaluated the incidence of drug resistance in Denmark in order to determine the magnitude of the problem. Susceptibility testing was performed in isolates from 85.4% of all notified patients during 1991-1998. Epidemiological information was retrieved from the mandatory notification forms. Total drug resistance remained largely constant, although a minor increase was observed in 1997-1998. Monoresistance was observed in 7.3%, of the isolates. Among 3.6% polyresistant isolates, resistance to isoniazid and streptomycin accounted for 2.8%, whereas MDR accounted for 0.5%. The MDR strains displayed different restriction fragment length polymorphism (RFLP) patterns, and no matches were identified in the international MDR database. Drug resistance in untreated Danes and foreigners were 5.9% and 14.6%, respectively. Among Danes and foreigners with previous TB, 6.2% and 22.7% had drug resistance, respectively. Increased drug-resistance was found among untreated Danes aged 25-54 yrs mainly due to a single isoniazid and streptomycin-resistant RFLP-cluster. Among all patients with isoniazid and streptomycin-resistance, 77.0% had clustered strains. In conclusion, although drug resistance among untreated Danes was close to the rate estimated in good national programmes, close monitoring is needed in future years, as active transmission of isoniazid- and streptomycin-resistant Mycobacterium tuberculosis was demonstrated.

Adolescent↗
PubMed2000

A longitudinal study of prisoners on remand: psychiatric prevalence, incidence and psychopathology in solitary vs. non-solitary confinement.

OBJECTIVE: To compare two levels of stress (solitary confinement (SC) and non-SC) among remand prisoners as to incidence of psychiatric disorders in relation to prevalent disorders. METHOD: Longitudinal repeated assessments were carried out from the start and during the remand phase of imprisonment. Both interview-based and self-reported measures were applied to 133 remand prisoners in SC and 95 remand prisoners in non-SC randomly selected in a parallel study design. RESULTS: Incidence of psychiatric disorders developed in the prison was significantly higher in SC prisoners (28%) than in non-SC prisoners (15%). Most disorders were adjustment disorders, with depressive disorders coming next. Incident psychotic disorders were rare. The difference regarding incidence was primarily explained by level of stress (i.e. prison form) rather than confounding factors. Quantitative measures of psychopathology (Hamilton Scales and General Health Questionnaire) were significantly higher in subjects with prevalent and incident disorders compared to non-disordered subjects. CONCLUSION: Different levels of stress give rise to different incidence of psychiatric morbidity among remand prisoners. The surplus of incident disorders among SC prisoners is related to SC, which may act as a mental health hazard.

Adult↗
PubMed2000

A patient with suspected sarcoidosis died from miliary tuberculosis.

In Western Europe, awareness of tuberculous lymphadenitis (TLA) has declined. This report describes a patient who had suspected sarcoidosis for 3.5 y, who eventually died from miliary tuberculosis due to delay in diagnosis. The report includes a discussion of the differential diagnosis of TLA and sarcoidosis.

Adult↗
PubMed1999

Psychopathy and psychopathological profiles in prisoners on remand.

A total of 178 Danish male remand prisoners were examined using comprehensive interviews and questionnaires on psychopathological, personality and social measures, and file data. These data were compared with scores on the Hare Psychopathy Checklist - Revised (PCL-R). Subjects were divided into four groups according to quartile PCL-R scores. In general there were high rates of psychiatric morbidity in all PCL-R quartile groups. The medium-high scorers represent a more vulnerable group with a high prevalence of dependence disorders, relatively high neuroticism score and relatively high prevalence of neurotic and stress-related disorders. The high scorers were more psychosocially maladjusted, had more often made previous suicidal attempts, and had a higher psychoticism score. Chronic psychotic disorders did occur, mostly in the high-scoring group. The population had lower scores on the PCL-R than in most previous studies, suggesting a lower prevalence of psychopathic features among Danish criminals and possibly a lower cut-off point when using the PCL-R as a categorical measure. Both findings are consistent with the results of other European studies. Further studies on cross-cultural differences with regard to PCL-R psychopathic features and on psychic vulnerability related to PCL-R scores and factor 1/factor 2 of the PCL-R are suggested.

Adolescent↗
PubMed1999

Tuberculosis treatment in Denmark: treatment outcome for all Danish patients in 1992.

SETTING: Denmark. OBJECTIVE: To evaluate tuberculosis (TB) treatment outcome using treatment indicators recommended by the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD). DESIGN: Retrospective cohort analysis of all TB patients notified in 1992 (n = 350). TB related information was registered and analyzed using hospital case records and laboratory data from Statens Serum Institut, Copenhagen. RESULTS: Among the 350 TB patients, cure rate was 25.7%, treatment completion rate 36.0%, death rate 12.9%, failure rate 0.9%, defaulter rate 3.1% and transfer out rate 2.3%. The remaining 19.1% 'other cases' did not fulfil any of the WHO indicators, but could be included in the treatment completion rate. During the 4 year follow-up period, 3% of all patients relapsed and 15% died. CONCLUSION: The aim set by the WHO of a cure rate of at least 95% was not achieved. The two main reasons were 1) the fact that sputum samples were not taken late during treatment, and 2) the death rate. In the future sputum examination for M. tuberculosis late during treatment will be encouraged to obtain evidence of cure, but only if the patient can produce sputum, as examination of saliva is of no interest. Death from causes other than TB accounted for 8.3%, making it impossible to attain the desired cure rate in Denmark, and possibly also in other industrialized countries with many elderly TB patients. Additional information on risk factors and methodological issues in performing a TB cohort analysis in a low incidence country is presented.

Adolescent↗
PubMed1996

[Heroin abuse among Danish prisoners on remand. I. Prevalence related to form of administration].

Two groups of Danish prisoners on remand (in solitary confinement and not in solitary confinement) were examined by interview on reception (n = 133 & n = 95) in order to evaluate the prevalence and form of administration of opioid abuse/dependence. About 50% had abused opioids during their lifetime; one third were dependent at the time of reception. Twenty percent of opioid dependent prisoners administered opioids by smoking. More intravenous users were treated with methadone before and during imprisonment than those who were dependent on smoking opioids. Few were objectively suffering from withdrawal symptoms. The psycho-social impact of dependence on smoking heroin and intravenous heroin one month prior to imprisonment was at the same level and substantial as measured by the Global Assessment Scale.

Administration, Inhalation↗