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Granlund, Margareta
Publications (10 of 12) Show all publications
Åberg, E., Ottosson, A., Granlund, M., Saeedi, B., Stamm, C., Brune, T., . . . Johansson, S. (2019). Harbouring group B streptococci in a neonatal intensive care unit led to an outbreak among preterm infants. Acta Paediatrica, 108(1), 58-61
Open this publication in new window or tab >>Harbouring group B streptococci in a neonatal intensive care unit led to an outbreak among preterm infants
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2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 1, p. 58-61Article in journal (Refereed) Published
Abstract [en]

We report a nosocomial outbreak with group B streptococci (GBS) in a level two neonatal intensive care unit (NICU) at Sachs' Children and Youth Hospital, Stockholm, Sweden, in 2014. There were five very preterm infants with severe late-onset septicaemia, and 10 further infants were colonised. Pulsed-field gel electrophoresis and multilocus sequence typing genetic characterisation showed that one GBS strain was the cause: serotype Ia, sequence type 23, clonal complex 23. The NICU environment cultures revealed GBS reservoirs on surfaces near sick and colonised patients. We identified workflows and guidelines that could increase the risks of nosocomial infections. Conclusion: This nosocomial GBS outbreak among preterm infants demonstrates that GBS can be harboured in the NICU environment.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Group B streptococci, Neonatal intensive care unit, Nosocomial outbreak, Preterm infants, pticaemia
National Category
Infectious Medicine
Identifiers
urn:nbn:se:umu:diva-154804 (URN)10.1111/apa.14558 (DOI)000452620600011 ()30152878 (PubMedID)2-s2.0-85053660677 (Scopus ID)
Available from: 2019-02-28 Created: 2019-02-28 Last updated: 2019-02-28Bibliographically approved
Klingspor, L., Ullberg, M., Rydberg, J., Kondori, N., Serrander, L., Swanberg, J., . . . Ozenci, V. (2018). Epidemiology of fungaemia in Sweden: a nationwide retrospective observational survey. Mycoses (Berlin), 61(10), 777-785
Open this publication in new window or tab >>Epidemiology of fungaemia in Sweden: a nationwide retrospective observational survey
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2018 (English)In: Mycoses (Berlin), ISSN 0933-7407, E-ISSN 1439-0507, Vol. 61, no 10, p. 777-785Article in journal (Refereed) Published
Abstract [en]

Objectives:

To identify the epidemiology and antifungal susceptibilities of Candida spp. among blood culture isolates to identify the epidemiology and antifungal susceptibilities of Candida spp. among blood culture isolates in Sweden.

Methods: The study was a retrospective, observational nationwide laboratory-based surveillance for fungaemia and fungal meningitis and was conducted from September 2015 to August 2016.

Results: In total, 488 Candida blood culture isolates were obtained from 471 patients (58% males). Compared to our previous study, the incidence of candidaemia has increased from 4.2/100000 (2005-2006) to 4.7/100000 population/year (2015-2016). The three most common Candida spp. isolated from blood cultures were Candida albicans (54.7%), Candida glabrata (19.7%) and species in the Candida parapsilosis complex (9.4%). Candida resistance to fluconazole was 2% in C.albicans and between 0% and 100%, in non-albicans species other than C.glabrata and C.krusei. Resistance to voriconazole was rare, except for C.glabrata, C.krusei and C.tropicalis. Resistance to anidulafungin was 3.8% while no Candida isolate was resistant to amphotericin B.

Conclusions: We report an overall increase in candidaemia but a minor decrease of C.albicans while C.glabrata and C.parapsilosis remain constant over this 10-year period.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
Keywords
antifungal susceptibility, Candida, candidaemia, Cryptococcus, fungaemia epidemiology, fungal meningitis epidemiology, incidence
National Category
Microbiology in the medical area Infectious Medicine
Identifiers
urn:nbn:se:umu:diva-153718 (URN)10.1111/myc.12816 (DOI)000445333300010 ()29920785 (PubMedID)
Available from: 2018-11-27 Created: 2018-11-27 Last updated: 2018-11-27Bibliographically approved
Claesson, R., Sjögren, U., Esberg, A., Brundin, M. & Granlund, M. (2017). Actinomyces radicidentis and Actinomyces haliotis, coccoid Actinomyces species isolated from the human oral cavity. Anaerobe, 48, 19-26
Open this publication in new window or tab >>Actinomyces radicidentis and Actinomyces haliotis, coccoid Actinomyces species isolated from the human oral cavity
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2017 (English)In: Anaerobe, ISSN 1075-9964, E-ISSN 1095-8274, Vol. 48, p. 19-26Article in journal (Refereed) Published
Abstract [en]

There are few reports on the bacterial species Actinomyces radicidentis in the literature. In this study, putative A. radicidentis isolates were collected from 16 root canal samples from 601 examined patients. The isolates were examined by biochemical tests, 16S rRNA gene sequencing, Arbitrarily-primed (AP-) PCR, antibiotic susceptibility testing, and MALDI-TOF analyses. In parallel, two A. radicidentis reference strains and two putative A. radicidentis isolates from United Kingdom were tested. Sixteen of the 18 isolates were confirmed as A. radicidentis. The remaining two isolates, both of which were isolated from root canals (one from Sweden and the other from the UK), but were identified as Actinomyces haliotis by sequencing ∼ 1300 base pairs of the 16S rRNA-gene. This isolates had a divergent, but between them similar, AP-PCR pattern, and a common distribution of sequence signatures in the 16S rRNA gene, but were not identified by MALDI-TOF. A. haliotis is a close relative to A. radicidentis, hitherto only been described from a sea-snail. The identity of A. haliotis was confirmed by a phylogenetic tree based on 16S rRNA gene sequences with species specific sequences included, and by additional biochemical tests. The examined bacteria exhibited similar antibiotic susceptibility patterns when tested for 10 separate antibiotic classes with E-tests (bioMérieux). The MIC90 for β-lactams (benzylpenicillin and cefuroxime) and vancomycin was 0.5 mg/L, for colistin and ciprofloxacin 8 mg/mL and for the other antibiotic classes ≤ 25 mg/mL The isolation of A. haliotis from infected dental root canals cast doubt on the accepted opinion that all Actinomyces infections have an endogenous source.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
AP-PCR phylogenetic tree, actinomyces species, MALDI-TOF, root canal infections
National Category
Microbiology in the medical area
Identifiers
urn:nbn:se:umu:diva-139074 (URN)10.1016/j.anaerobe.2017.06.011 (DOI)000419417700004 ()28647397 (PubMedID)
Available from: 2017-09-06 Created: 2017-09-06 Last updated: 2018-06-09Bibliographically approved
Forsell, J., Bengtsson-Palme, J., Angelin, M., Johansson, A., Evengård, B. & Granlund, M. (2017). The relation between Blastocystis and the intestinal microbiota in Swedish travellers. BMC Microbiology, 17, Article ID 231.
Open this publication in new window or tab >>The relation between Blastocystis and the intestinal microbiota in Swedish travellers
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2017 (English)In: BMC Microbiology, ISSN 1471-2180, E-ISSN 1471-2180, Vol. 17, article id 231Article in journal (Refereed) Published
Abstract [en]

Background: Blastocystis sp. is a unicellular eukaryote that is commonly found in the human intestine. Its ability to cause disease is debated and a subject for ongoing research. In this study, faecal samples from 35 Swedish university students were examined through shotgun metagenomics before and after travel to the Indian peninsula or Central Africa. We aimed at assessing the impact of travel on Blastocystis carriage and seek associations between Blastocystis and the bacterial microbiota.

Results: We found a prevalence of Blastocystis of 16/35 (46%) before travel and 15/35 (43%) after travel. The two most commonly Blastocystis subtypes (STs) found were ST3 and ST4, accounting for 20 of the 31 samples positive for Blastocystis. No mixed subtype carriage was detected. All ten individuals with a typable ST before and after travel maintained their initial ST. The composition of the gut bacterial community was not significantly different between Blastocystis-carriers and non-carriers. Interestingly, the presence of Blastocystis was accompanied with higher abundances of the bacterial genera Sporolactobacillus and Candidatus Carsonella. Blastocystis carriage was positively associated with high bacterial genus richness, and negatively correlated to the Bacteroides-driven enterotype. These associations were both largely dependent on ST4 – a subtype commonly described from Europe – while the globally prevalent ST3 did not show such significant relationships.

Conclusions: The high rate of Blastocystis subtype persistence found during travel indicates that long-term carriage of Blastocystis is common. The associations between Blastocystis and the bacterial microbiota found in this study could imply a link between Blastocystis and a healthy microbiota as well as with diets high in vegetables. Whether the associations between Blastocystis and the microbiota are resulting from the presence of Blastocystis, or are a prerequisite for colonization with Blastocystis, are interesting questions for further studies.

Keywords
Blastocystis; subtype; persistence; travel; microbiota; Sporolactobacillus; Candidatus Carsonella; transmission
National Category
Infectious Medicine Microbiology in the medical area
Research subject
Clinical Bacteriology
Identifiers
urn:nbn:se:umu:diva-132437 (URN)10.1186/s12866-017-1139-7 (DOI)000418138200001 ()29228901 (PubMedID)
Note

Originally included in thesis in manuscript form

Available from: 2017-03-14 Created: 2017-03-14 Last updated: 2018-06-09Bibliographically approved
Forsell, J., Granlund, M., Samuelsson, L., Koskiniemi, S., Edebro, H. & Evengård, B. (2016). High occurrence of Blastocystis sp subtypes 1-3 and Giardia intestinalis assemblage B among patients in Zanzibar, Tanzania. Parasites & Vectors, 9, Article ID 370.
Open this publication in new window or tab >>High occurrence of Blastocystis sp subtypes 1-3 and Giardia intestinalis assemblage B among patients in Zanzibar, Tanzania
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2016 (English)In: Parasites & Vectors, ISSN 1756-3305, E-ISSN 1756-3305, Vol. 9, article id 370Article in journal (Refereed) Published
Abstract [en]

Background: Blastocystis is a common intestinal parasite with worldwide distribution but the distribution of Blastocystis and its subtypes in East Africa is largely unknown. In this study, we investigate the distribution of Blastocystis subtypes in Zanzibar, Tanzania and report the prevalence of intestinal parasites using both molecular methods and microscopy.

Methods: Stool samples were collected from both diarrhoeic and non-diarrhoeic outpatients in Zanzibar. In addition to microscopy, real-time PCR for Blastocystis, Entamoeba histolytica and E. dispar, Giardia intestinalis, Cryptosporidium spp., and Dientamoeba fragilis was used. Blastocystis subtypes were determined by a conventional PCR followed by partial sequencing of the SSU-rRNA gene. Genetic assemblages of Giardia were determined by PCR with assemblage specific primers.

Results: Intestinal parasites were detected in 85 % of the 174 participants, with two or more parasites present in 56 %. Blastocystis sp. and Giardia intestinalis were the most common parasites, identified by PCR in 61 and 53 % of the stool samples respectively, but no correlation between carriage of Blastocystis and Giardia was found. The Blastocystis subtype distribution was ST1 34.0 %, ST2 26.4 %, ST3 25.5 %, ST7 0.9 %, and 13.2 % were positive only by qPCR (non-typable). The Giardia genetic assemblages identified were A 6.5 %, B 85 %, A + B 4.3 %, and non-typable 4.3 %. The detection rate with microscopy was substantially lower than with PCR, 20 % for Blastocystis and 13.8 % for Giardia. The prevalence of Blastocystis increased significantly with age while Giardia was most prevalent in children two to five years old. No correlation between diarrhoea and the identification of Giardia, Blastocystis, or their respective genetic subtypes could be shown and, as a possible indication of parasite load, the mean cycle threshold values in the qPCR for Giardia were equal in diarrhoeic and non-diarrhoeic patients.

Conclusions: Carriage of intestinal parasites was very common in the studied population in Zanzibar. The most commonly detected parasites, Blastocystis and Giardia, had different age distributions, possibly indicating differences in transmission routes, immunity, and/or other host factors for these two species. In the Blastocystis subtype analysis ST1-3 were common, but ST4, a subtype quite common in Europe, was completely absent, corroborating the geographical differences in subtype distributions previously reported.

Keywords
Zanzibar, Tanzania, Blastocystis, Subtype, Giardia, Assemblage, Real-time PCR, Genotyping
National Category
Microbiology in the medical area
Identifiers
urn:nbn:se:umu:diva-124236 (URN)10.1186/s13071-016-1637-8 (DOI)000378838200001 ()27356981 (PubMedID)
Available from: 2016-07-28 Created: 2016-07-28 Last updated: 2018-06-07Bibliographically approved
Forsell, J., Koskiniemi, S., Hedberg, I., Edebro, H., Evengård, B. & Granlund, M. (2015). Evaluation of factors affecting real-time PCR performance for diagnosis of Entamoeba histolytica and Entamoeba dispar in clinical stool samples. Journal of Medical Microbiology, 64, 1053-1062
Open this publication in new window or tab >>Evaluation of factors affecting real-time PCR performance for diagnosis of Entamoeba histolytica and Entamoeba dispar in clinical stool samples
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2015 (English)In: Journal of Medical Microbiology, ISSN 0022-2615, E-ISSN 1473-5644, Vol. 64, p. 1053-1062Article in journal (Refereed) Published
Abstract [en]

Although PCR offers the potential for sensitive detection of parasites:there are several pitfalls for optimal performance, especially when DNA is extracted from a complex sample material such as stool. With the aid of a sensitive inhibitor control in a duplex real-time PCR (qPCR) for identification of Entamoeba histolytica and Entamoeba dispar we have evaluated factors that influenced the performance of the qPCR and have suggested a rationale to be used in the analysis of clinical samples. Pre-PCR processing was found to be of outmost importance for an optimal amplification since inhibitors caused false-negative results when higher amounts of sample were used. Stool sampling with a flocked swab (ESwab, Copan), yielding on average 173 mg, gave positive qPCR results in samples with cysts of E. dispar that were negative in serially diluted stool samples. The degree of inhibition found varied between samples and was not an on-off phenomenon. Even low-grade inhibition, shown as an increase of two cycles in the qPCR for the inhibitor control, could lead to false negativity in samples with low amounts of parasites. Lack of amplification in the qPCR due to inhibition could be overcome by dilution of the extracted DNA by 1/10-1/20. We also describe the use of guanidinium thiocyanate buffer for transport and storage of samples as well as a time-saving semi-automated DNA extraction method in an Arrow instrument (Nordiag) preceded by bead beating.

Place, publisher, year, edition, pages
Microbiology Society, 2015
National Category
Microbiology in the medical area
Identifiers
urn:nbn:se:umu:diva-111507 (URN)10.1099/jmm.0.000129 (DOI)000363356800016 ()26296348 (PubMedID)
Available from: 2015-12-01 Created: 2015-11-13 Last updated: 2018-06-07Bibliographically approved
Angelin, M., Forsell, J., Granlund, M., Evengård, B., Palmgren, H. & Johansson, A. (2015). Risk factors for colonization with extended-spectrum beta-lactamase producing Enterobacteriaceae in healthcare students on clinical assignment abroad: A prospective study. Travel Medicine and Infectious Disease, 13(3), 223-229
Open this publication in new window or tab >>Risk factors for colonization with extended-spectrum beta-lactamase producing Enterobacteriaceae in healthcare students on clinical assignment abroad: A prospective study
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2015 (English)In: Travel Medicine and Infectious Disease, ISSN 1477-8939, E-ISSN 1873-0442, Vol. 13, no 3, p. 223-229Article in journal (Refereed) Published
Abstract [en]

Background: The increase of antibiotic resistance in clinically important bacteria is a worldwide threat, especially in healthcare environments. International travel is a risk factor for gut colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). The risk for healthcare students of being colonized with ESBL-PE when participating in patient-related work abroad has not been previously investigated. Methods: Swedish healthcare students travelling for pre-clinical and clinical courses outside Scandinavia submitted faecal samples and survey data before and after travel. The faecal samples were screened for ESBL-PE and carbapenemase-producing Enterobacteriaceae (CPE). Screening results and survey data were analysed to identify risk factors for colonization. Results: In the 99 subjects who submitted a full set of samples, 35% were colonized with a new ESBL-PE strain during travel. No CPE was found. The most important risk factor for ESBL-PE colonization was travel destination, and the highest colonization rate was found in the South East Asia region. Antibiotic treatment during travel was an independent risk factor for ESBL-PE colonization but patient-related work was not significantly associated with an increased risk. Conclusions: Patient-related work abroad was not a risk factor for ESBL-PE suggesting that transmission from patients is uncommon. Pre-travel advice on avoiding unnecessary antibiotic treatment during travel is recommended.

Keywords
Anti-bacterial agents, Drug resistance, Beta-lactamases, Enterobacteriaceae, Travel
National Category
Infectious Medicine
Identifiers
urn:nbn:se:umu:diva-106613 (URN)10.1016/j.tmaid.2015.04.007 (DOI)000357348200005 ()25982453 (PubMedID)
Available from: 2015-07-28 Created: 2015-07-24 Last updated: 2018-06-07Bibliographically approved
Stylianou, M., Kulesskiy, E., Lopes, J. P., Granlund, M., Wennerberg, K. & Urban, C. F. (2014). Antifungal Application of Nonantifungal Drugs. Antimicrobial Agents and Chemotherapy, 58(2), 1055-1062
Open this publication in new window or tab >>Antifungal Application of Nonantifungal Drugs
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2014 (English)In: Antimicrobial Agents and Chemotherapy, ISSN 0066-4804, E-ISSN 1098-6596, Vol. 58, no 2, p. 1055-1062Article in journal (Refereed) Published
Abstract [en]

Candida species are the cause of 60% of all mycoses in immunosuppressed individuals, leading to similar to 150,000 deaths annually due to systemic infections, whereas the current antifungal therapies either have toxic side effects or are insufficiently efficient. We performed a screening of two compound libraries, the Enzo and the Institute for Molecular Medicine Finland (FIMM) oncology collection library, for anti-Candida activity based on the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. From a total of 844 drugs, 26 agents showed activity against Candida albicans. Of those, 12 were standard antifungal drugs (SADs) and 7 were off-target drugs previously reported to be active against Candida spp. The remaining 7 off-target drugs, amonafide, tosedostat, megestrol acetate, melengestrol acetate, stanozolol, trifluperidol, and haloperidol, were identified with this screen. The anti-Candida activities of the new agents were investigated by three individual assays using optical density, ATP levels, and microscopy. The antifungal activities of these drugs were comparable to those of the SADs found in the screen. The aminopeptidase inhibitor tosedostat, which is currently in a clinical trial phase for anticancer therapy, displayed a broad antifungal activity against different Candida spp., including Candida glabrata. Thus, this screen reveals agents that were previously unknown to be anti-Candida agents, which allows for the design of novel therapies against invasive candidiasis.

National Category
Microbiology
Identifiers
urn:nbn:se:umu:diva-86824 (URN)10.1128/AAC.01087-13 (DOI)000330637500053 ()
Available from: 2014-03-17 Created: 2014-03-11 Last updated: 2018-09-12Bibliographically approved
Manser, M., Granlund, M., Edwards, H., Saez, A., Petersen, E., Evengård, B. & Chiodini, P. (2014). Detection of Cryptosporidium and Giardia in clinical laboratories in Europe-a comparative study. Clinical Microbiology and Infection, 20(1), O65-O71
Open this publication in new window or tab >>Detection of Cryptosporidium and Giardia in clinical laboratories in Europe-a comparative study
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2014 (English)In: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 20, no 1, p. O65-O71Article in journal (Refereed) Published
Abstract [en]

To determine the routine diagnostic methods used and compare the performance in detection of oocysts of Cryptosporidium species and cysts of Giardia intestinalis in faecal samples by European specialist parasitology laboratories and European clinical laboratories. Two sets of seven formalin-preserved faecal samples, one containing cysts of Giardia intestinalis and the other, containing oocysts of Cryptosporidium, were sent to 18 laboratories. Participants were asked to examine the specimens using their routine protocol for detecting these parasites and state the method(s) used. Eighteen laboratories answered the questionnaire. For detection of Giardia, 16 of them used sedimentation/concentration followed by light microscopy. Using this technique the lower limit of detection of Giardia was 17.2cysts/mL of faeces in the best performing laboratories. Only three of 16 laboratories used fluorescent-conjugated antibody-based microscopy. For detection of Cryptosporidium acid-fast staining was used by 14 of the 17 laboratories that examined the samples. With this technique the lower limit of detection was 976oocysts/mL of faeces. Fluorescent-conjugated antibody-based microscopy was used by only five of the 17 laboratories. There was variation in the lower limit of detection of cysts of Giardia and oocysts of Cryptosporidium between laboratories using the same basic microscopic methods. Fluorescent-conjugated antibody-based microscopy was not superior to light microscopy under the conditions of this study. There is a need for a larger-scale multi-site comparison of the methods used for the diagnosis of these parasites and the development of a Europe-wide laboratory protocol based upon its findings.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
Keywords
Cryptosporidium, direct fluorescent-antibody tests, enzyme immunoassay, formalin-ethyl acetate faecal concentrate, Giardia intestinalis, modified Ziehl-Neelsen, oocysts
National Category
Medical Biotechnology
Identifiers
urn:nbn:se:umu:diva-84756 (URN)10.1111/1469-0691.12297 (DOI)000328530900025 ()
Available from: 2014-02-10 Created: 2014-01-20 Last updated: 2018-06-08Bibliographically approved
Forsell, J., Granlund, M., Stensvold, C. R., Clark, G. C. & Evengård, B. (2012). Subtype analysis of Blastocystis isolates in Swedish patients. European Journal of Clinical Microbiology and Infectious Diseases, 31(7), 1689-1696
Open this publication in new window or tab >>Subtype analysis of Blastocystis isolates in Swedish patients
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2012 (English)In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 31, no 7, p. 1689-1696Article in journal (Refereed) Published
Abstract [en]

Blastocystis is a genetically diverse and widespread intestinal parasite of animals and humans with controversial pathogenic potential. At least nine subtypes of Blastocystis have been found in humans. The genetic diversity of Blastocystis was examined in stool samples from 68 patients from the Stockholm area, Sweden. Blastocystis was identified by light microscopy, and subtyped by sequencing the 5'-end of the small subunit ribosomal RNA gene. Five Blastocystis subtypes were identified in the 63 patients whose samples were successfully subtyped: ST1 (15.9%), ST2 (14.3%), ST3 (47.6%), ST4 (20.6%), and ST7 (1.6%). ST3 was more common in males compared to females (P = 0.049). Comparative molecular analysis of Blastocystis sequences revealed intra-subtype variations within the identified subtypes with the exception of ST4. Among ST4 sequences in this study, as well as in the majority of human GenBank sequences, a limited genetic diversity was found compared to what was found among the other common subtypes (ST1, ST2 and ST3). The relative prevalence of ST4 in this study was comparable to the overall distribution of ST4 in European cohorts (16.5%). This contrasts with the sparse reports of ST4 in studies from other continents, which may indicate that the distribution of this subtype is geographically heterogeneous.

Place, publisher, year, edition, pages
Heidelberg: Springer Berlin/Heidelberg, 2012
National Category
Microbiology in the medical area
Identifiers
urn:nbn:se:umu:diva-56679 (URN)10.1007/s10096-011-1416-6 (DOI)000304652800052 ()22350386 (PubMedID)
Available from: 2012-06-27 Created: 2012-06-25 Last updated: 2018-06-08Bibliographically approved
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