Heikki Kauma

Pneumococcal carriage is more common in asthmatic than in non-asthmatic young men.

Introduction:u2002 The aim was to investigate the prevalence of oropharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitidis and beta‐haemolytic streptococci among asthmatic and non‐asthmatic young Finnish men and to identify putative risk factors.

Central nervous system-related symptoms and findings are common in acute Puumala hantavirus infection.

Abstract Background. Puumala hantavirus (PUUV) causes a hemorrhagic fever with renal syndrome (HFRS) also called nephropathia epidemica (NE). Recent case reports and retrospective studies suggest that NE may damage the pituitary gland. Based on these observations, our goal was to explore the nature of this complication prospectively. Methods. A total of 58 hospitalized patients with acute NE volunteered to participate. Central nervous system (CNS) symptoms were recorded, cerebrospinal fluid (CSF) samples were collected, human leukocyte antigen (HLA) haplotype was analyzed, brain magnetic resonance imaging (MRI) was acquired, and electroencephalography (EEG) was recorded. Patients with abnormal pituitary MRI finding were examined by an endocrinologist. Results. Most patients experienced CNS symptoms, and half of the CSF samples were positive for PUUV IgM, elevated protein level, or leukocyte count. CSF of patients negative for DR15(2)-DQ6 haplotype was less frequently affected. MRI revealed pituitary hemorrhage in two patients; these two patients suffered sudden loss of vision associated with headache, and they both developed hypopituitarism. Only one patient required long-term hormonal replacement therapy. Conclusion. CNS-related symptoms and inflammation in the CSF are common in acute NE. Genetic properties of the host may predispose to CNS involvement. It does seem that pituitary injury and subsequent hormonal insufficiency may complicate the recovery.

Prospective study on ocular findings in acute Puumala hantavirus infection in hospitalised patients

Aims To appraise the ocular manifestations of Puumala hantavirus evoked haemorrhagic fever with renal syndrome nephropathia epidemica (NE) and to clarify the mechanisms of ocular changes in the largest series of patients examined to date. Methods 92 eyes of 46 patients with serologically proven NE were examined during the acute phase and after clinical recovery. Ocular symptoms were recorded, and visual acuity, refraction, intraocular pressure and ocular dimensions were evaluated. Results 88% of the patients experienced decreased intraocular pressure (IOP) (p<0.001), 87% reduced visual acuity, 87% conjunctival chemosis, 82% thickening of the lens (p<0.05), 78% myopic shift (p<0.001), 64% shallowing of the anterior chamber (p<0.05) and 52% shallowing of vitreous length (p<0.05) during the acute phase compared with that measured after clinical recovery. In all, 70% of the patients reported ocular symptoms. Conclusion Ocular symptoms and disturbances are common in acute NE, and the symmetry of the ocular changes reflects the systemic nature of the disease. A decrease in IOP and myopic shift mainly due to thickening of the lens are evident in acute disease. The myopic shift only partially explains the visual disturbances supporting the possible multifactorial origin of the ocular findings in patients with NE.

Chest imaging findings in hospitalized patients with H1N1 influenza.

Background Previous studies have reported chest radiographic findings of consolidation and ground-glass opacity in patients with swine-origin influenza A (H1N1). However, most of these studies include both hospitalized and outpatients. Purpose To evaluate initial chest radiographic and CT findings of hospitalized swine flu patients, adults and children, confirmed with a real-time reverse transcriptase polymerase chain reaction (PCR) assay for H1N1 virus. Material and Methods All PCR-verified swine flu patients admitted to the Department of Emergency Medicine (October 1 to December 15, 2009) at Oulu University Hospital, in Northern Finland, who underwent frontal chest radiography within 24 hours of presentation and who were hospitalized, were included. The radiographs and CT scans were assessed for the presence of pneumonia and characterized by pattern and distribution. The patients medical records were analyzed for demographics, underlying medical conditions, the admission to the intensive care unit (ICU), initiation of mechanical ventilation or non-invasive ventilation support (NIV) and death. Results Of 159 H1N1 influenza patients, 135 (85%) underwent chest radiographs at admission; 113 adults and 22 children. Findings of pulmonary infiltrates were detected in 62% (70/113) of adults and 64% (14/22) of children, being bilateral in 67% of adults and 64% of the children. The anatomic location of infiltrates was more often peripheral in adults; 42/70 (60%) vs. 4/14 (29%), P = 0.041, and diffuse among children; 9/14 (64%) vs. 26/70 (37%), P = 0.078. When the ICU and NIV patients were compared to less severe cases, on their chest radiographs four or five lobes were more often affected (65%, 11/17 vs. 34% 23/67, P = 0.029 ). The predominant radiographic findings were consolidation (93% of all patients, 91% of adults and 100% of children) and ground-glass opacity (74% of all, 77% of adults and 57% of children). Pulmonary emboli were detected by CT in 2/9 (22%) patients. Conclusion The pandemic 2009 swine influenza causes common and widely distributed infiltrates on chest radiographs among hospitalized patients, which are not peculiar to usual respiratory viral infections, and these findings can not be differentiated from usual bacterial pneumonia.

Young male patients are at elevated risk of developing serious central nervous system complications during acute Puumala hantavirus infection

BackgroundOur aim was to characterize clinical properties and laboratory parameters in patients with or without cerebrospinal fluid (CSF) findings suggestive of central nervous system (CNS) involvement, and especially those who developed serious CNS complications during acute nephropathia epidemica (NE) caused by Puumala hantavirus (PUUV) infection.MethodsA prospective cohort of 40 patients with acute NE and no signs of major CNS complications was analyzed. In addition, 8 patients with major CNS complications associated with NE were characterized. We collected data of CNS symptoms, CSF analysis, brain magnetic resonance imaging (MRI) results, electroencephalography (EEG) recordings, kidney function, and a number of laboratory parameters. Selected patients were evaluated by an ophthalmologist.ResultsPatients with a positive CSF PUUV IgM finding or major CNS complications were more often males (p < 0.05) and they had higher plasma creatinine values (p < 0.001) compared to those with negative CSF PUUV IgM. The degree of tissue edema did not explain the CSF findings. Patients with major CNS complications were younger than those with negative CSF PUUV IgM finding (52.9 vs. 38.5 years, p < 0.05). Some patients developed permanent neurological and ophthalmological impairments.ConclusionsCNS and ocular involvement during and after acute NE can cause permanent damage and these symptoms seem to be attributable to true infection of the CNS rather than increased tissue permeability. The possibility of this condition should be borne in mind especially in young male patients.

Non-alcoholic fatty liver disease with and without metabolic syndrome: Different long-term outcomes.

BACKGROUNDnNon-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS) are both shown to increase the risk of cardiovascular diseases and type 2 diabetes. However, there is a great overlap between these two diseases. The present study was aimed to examine the cardiovascular and metabolic prognosis of non-alcoholic fatty liver disease with and without metabolic syndrome.nnnMETHODSnMiddle-aged subjects (n=958) were divided into four subgroups, those with NAFLD and MetS, those with NAFLD or MetS, and healthy controls. The baseline characteristics of the subgroups were analyzed. The follow-up time for cardiovascular events was about 16years. After approximately 21years the cardiac ultrasound and laboratory parameters were re-analyzed and new type 2 diabetes cases were recorded.nnnRESULTSnThose with both diseases were at the greatest risk for cardiovascular events (p<0.001). Compared to healthy controls, only those with MetS, with or without NAFLD, were at increased risk for the development of type 2 diabetes (p<0.001) and for an increase in left ventricular mass index (p=0.001 and p=0.005, respectively). The cardiovascular and metabolic risk in subjects with NAFLD only was quite similar to that in healthy controls. The I148M variant of the patatin-like phospholipase domain-containing 3 gene (PNPLA3 polymorphism) was most present in those with NAFLD only (p=0.008).nnnCONCLUSIONSnNAFLD with MetS implies a considerable risk for cardiovascular diseases, type 2 diabetes and the increase of left ventricular mass index whereas NAFLD without MetS does not.

Signs of general inflammation and kidney function are associated with the ocular features of acute Puumala hantavirus infection.

Abstract Background: Puumala hantavirus (PUUV) causes nephropathia epidemica (NE), a type of viral haemorrhagic fever with renal syndrome (HFRS). This febrile infection may affect the kidneys, central nervous system (CNS), and the eye. Acute illness is associated with increased tissue permeability and tissue oedema, and many patients experience reduced vision. The aim of this study was to explore the physiological events associated with the ocular features of acute NE. Methods: This was a prospective study of 46 NE patients who were examined during the acute infection and 1 month after hospitalization. Visual acuity, refraction, intraocular pressure (IOP), and ocular dimensions were evaluated. Cerebrospinal fluid and blood samples were collected, brain magnetic resonance imaging and electroencephalography were recorded, and HLA haplotype was analyzed. The degrees of tissue oedema and fluid imbalance were evaluated. Results: CNS examinations did not reveal the source of the ocular changes in acute NE. The plasma C-reactive protein concentration correlated with the lens thickness and the IOP. The plasma creatinine level was associated with the change in anterior chamber depth. However, oliguric and polyuric patients displayed similar ocular findings. Patients positive for the DR3-DQ2 haplotype experienced the least diminished visual acuity. Conclusions: The level of systemic inflammation rather than CNS involvement appears to account for the ocular changes during acute PUUV infection, and the severity of kidney dysfunction may also have a significant role. In addition, the genetic properties of the host may well explain the ocular features of acute hantavirus infection.

Late‐presenting vascular graft infection caused by Aspergillus in an immunocompetent patient

Marko Rahkonen, Timo Hautala, Erkki Syväniemi, Reijo Takalo and Heikki Kauma Department of Internal Medicine, Oulu University Hospital, Oulu, Finland, Department of Pathology, Oulu University Hospital, Oulu, Finland, Department of Radiology, Oulu University Hospital, Oulu, Finland, Institute of Diagnostics, Department of Medical Microbiology, University of Oulu, Oulu, Finland and Institute of Diagnostics, Department of Pathology, University of Oulu, Oulu, Finland

Respiratory diphtheria in an asylum seeker from Afghanistan arriving to Finland via Sweden, December 2015.

In December 2015, an asylum seeker originating from Afghanistan was diagnosed with respiratory diphtheria in Finland. He arrived in Finland from Sweden where he had already been clinically suspected and tested for diphtheria. Corynebacterium diphtheriae was confirmed in Sweden and shown to be genotypically and phenotypically toxigenic. The event highlights the importance of early case detection, rapid communication within the country and internationally as well as preparedness plans of diphtheria antitoxin availability.

Long-term hormonal follow-up after human Puumala hantavirus infection.

Nephropathia epidemica (NE) is a haemorrhagic fever with renal syndrome (HFRS) caused by Puumala hantavirus (PUUV). Pituitary haemorrhage and hypopituitarism may complicate recovery from acute NE.