Browsing by Subject "Infection"

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  • Siikamäki, Heli; Kivela, Pia; Fotopoulos, Mikael; Kantele, Anu (2017)
    Background: Although infections represent the most common health problem of travellers abroad, data on morbidity and incidences of various infections are scarce. Method: Data on infections of Finnish travellers during 2010-2012 were retrieved from the database of SOS International, an assistance organization covering 95% of Finns requiring aid abroad. The study included 30,086 cases. For incidence calculation, the data were linked to the numbers of Finns visiting these regions during the same period as recorded by the Official Statistics of Finland. Results: The incidence of infections was particularly high in Africa, southern Europe plus the eastern Mediterranean, and Asia plus Oceania. The most frequent diagnoses were acute gastroenteritis (38.0%) and respiratory-tract infections (RTI) (34.5%), followed by infections of the ear (12.6%), skin or subcutaneous tissue (5.1%), urogenital tract (4.2%), eye (3.1%), and systemic febrile infections (2.2%). Vaccinepreventable diseases (VPD) accounted for 0.8% of cases, with varicella as most (49%) and influenza as second-most (27%) common. Conclusions: Incidence of infections was higher in southern than in eastern and western Europe. Gastroenteritis and RTI proved the most frequent diagnoses, whereas systemic febrile infections were uncommon. Despite pre-travel immunizations, VPDs still occurred; pre-travel consultation should cover both varicella and influenza. (C) 2016 Elsevier Ltd. All rights reserved.
  • Udden, Fabian; Filipe, Matuba; Reimer, Ake; Paul, Maria; Matuschek, Erika; Thegerstrom, John; Hammerschmidt, Sven; Pelkonen, Tuula; Riesbeck, Kristian (2018)
    Background: Chronic suppurative otitis media (CSOM) is an important cause of hearing loss in children and constitutes a serious health problem globally with a strong association to resource-limited living conditions. Topical antibiotics combined with aural toilet is the first-hand treatment for CSOM but antimicrobial resistance and limited availability to antibiotics are obstacles in some areas. The goal of this study was to define aerobic pathogens associated with CSOM in Angola with the overall aim to provide a background for local treatment recommendations. Methods: Samples from ear discharge and the nasopharynx were collected and cultured from 152 patients with ear discharge and perforation of the tympanic membrane. Identification of bacterial species was performed with matrix-assisted laser desorption/ionization-time of flight mass spectrometry and pneumococci were serotyped using multiplex polymerase chain reactions. Antimicrobial susceptibility testing was done according to EUCAST. Results: One hundred eighty-four samples from ear discharge and 151 nasopharyngeal swabs were collected and yielded 534 and 289 individual isolates, respectively. In all patients, correspondence rate of isolates from 2 ears in patients with bilateral disease was 27.3% and 9.3% comparing isolates from the nasopharynx and ear discharge, respectively. Proteus spp. (14.7%), Pseudomonas aeruginosa (13.2%) and Enterococcus spp. (8.8%) were dominating pathogens isolated from ear discharge. A large part of the remaining species belonged to Enterobacteriaceoe (23.5%). Pneumococci and Staphylococcus aureus were detected in approximately 10% of nasopharyngeal samples. Resistance rates to quinolones exceeded 10% among Enterobacterioceae and was 30.8% in S. aureus, whereas 6.3% of P. aeruginosa were resistant. Conclusions: The infection of the middle ear in CSOM is highly polymicrobial, and isolates found in nasopharynx do not correspond well with those found in ear discharge. Pathogens associated with CSOM in Angola are dominated by gram-negatives including Enterobacteriaceoe and P. aeruginosa, while gram-positive enterococci also are common. Based on the results of antimicrobial susceptibility testing topical quinolones would be the preferred antibiotic therapy of CSOM in Angola. Topical antiseptics such as aluminium acetate, acetic acid or boric acid, however, may be more feasible options due to a possibly emerging antimicrobial resistance.
  • Jokelainen, Kalle (2017)
    Pitkittynyt eli yli neljä viikkoa kestänyt ripuli on yleinen vaiva ja yksi tavallisimmista syistä hakeutua lääkärin vastaanotolle. Merkittävä osa potilaista voidaan tutkia ja hoitaa perusterveydenhuollossa. Koska pitkäaikaisen ripulin syynä voi olla joko orgaaninen sairaus tai toiminnallinen vaiva, selvittelyssä on välttämätöntä edetä järjestelmällisesti ja potilaan ikä sekä yksilöllinen oirekuva huomioon ottaen. Mikäli potilaalla esiintyy hälytysoireita, kuten verenvuotoa peräaukosta, painonlaskua tai poikkeava vatsan palpaatiolöydös, tai laboratoriokokeissa ilmenee poikkeavaa, hänet on syytä lähettää gastroenterologin arvioon.
  • Palm, Frederick; Pussinen, Pirkko J.; Aigner, Annette; Becher, Heiko; Buggle, Florian; Bauer, Matthias F.; Grond-Ginsbach, Caspar; Safer, Anton; Urbanek, Christian; Grau, Armin J. (2016)
    Background and aims: Infectious diseases contribute to stroke risk, and are associated with socioeconomic status (SES). We tested the hypotheses that the aggregate burden of infections increases the risk of ischemic stroke (IS) and partly explains the association between low SES and ischemic stroke. Methods: In a case-control study with 470 ischemic stroke patients and 809 age- and sex-matched controls, randomly selected from the population, antibodies against the periodontal microbial agents Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, against Chlamydia pneumonia, Mycoplasma pneumoniae (IgA and IgG), and CagA-positive Helicobacter pylori (IgG) were assessed. Results: IgA seropositivity to two microbial agents was significantly associated with IS after adjustment for SES (OR 1.45 95% CI 1.01-2.08), but not in the fully adjusted model (OR 1.32 95% CI 0.86-2.02). By trend, cumulative IgA seropositivity was associated with stroke due to large vessel disease (LVD) after full adjustment (OR 1.88, 95% CI 0.96e3.69). Disadvantageous childhood SES was associated with higher cumulative seropositivity in univariable analyses, however, its strong impact on stroke risk was not influenced by seroepidemiological data in the multivariable model. The strong association between adulthood SES and stroke was rendered nonsignificant when factors of dental care were adjusted for. Conclusions: Infectious burden assessed with five microbial agents did not independently contribute to ischemic stroke consistently, but may contribute to stroke due to LVD. High infectious burden may not explain the association between childhood SES and stroke risk. Lifestyle factors that include dental negligence may contribute to the association between disadvantageous adulthood SES and stroke. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
  • Simonsen, Johan Rasmus; Järvinen, Asko; Hietala, Kustaa; Harjutsalo, Valma; Forsblom, Carol; Groop, Per-Henrik; Lehto, Markku (2021)
    Background/Aims Diabetic retinopathy (DR) is associated and shares many risk factors with other diabetic complications, including inflammation. Bacterial infections, potent inducers of inflammation have been associated with the development of diabetic complications apart from DR. Our aim was to investigate the association between bacterial infections and DR. Methods Adult individuals with type 1 diabetes (n=1043) were recruited from the Finnish Diabetic Nephropathy Study (FinnDiane), a prospective follow-up study. DR was defined as incident severe diabetic retinopathy (SDR), identified as first laser treatment. Data on DR were obtained through fundus photographs and medical records, data on bacterial infections from comprehensive national registries (1 January 1995 to 31 December 2015). Risk factors for DR and serum bacterial lipopolysaccharide (LPS) activity were determined at baseline. Results Individuals with incident SDR (n=413) had a higher mean number of antibiotic purchases/follow-up year compared with individuals without incident SDR (n=630) (0.92 [95% CI 0.82 to 1.02] vs 0.67 [0.62-0.73], p=0.02), as well as higher levels of LPS activity (0.61 [0.58-0.65] vs 0.56 [0.54-0.59] EU/mL, p=0.03). Individuals with on average >= 1 purchase per follow-up year (n=269) had 1.5 times higher cumulative incidence of SDR, compared with individuals with
  • Korhonen, Kati V. M.; Savolainen-Peltonen, Hanna; Mikkola, Tomi S.; Tiitinen, Aila E.; Unkila-Kallio, Leila S. (2016)
    Objectives: Many in vitro fertilization (IVF) complications are inflammatory by nature, some of which are even life-threatening. We evaluated the response of C-reactive protein (CRP) in IVF complications, especially in early and late ovarian hyperstimulation syndrome (OHSS), to support clinical decision making in gynecological emergency policlinics. Study design: In a prospective two-year study at Helsinki University Hospital, Finland, we recruited patients with IVF complications including moderate or severe OHSS (n = 47 patients: 36 early and 14 late OHSS cases), or other IVF complications (n = 13). As controls, we recruited women in an uncomplicated IVF cycle (n = 27). Serial blood samples (CRP, blood count, platelets, albumin, estradiol, creatinine, and electrolytes) were collected from patients upon admission to the emergency polyclinic and during and after treatment on the ward, and from the controls prior, during, and after the IVF protocol. All samples were categorized according to oocyte pick-up (OPU). The statistics included comparisons between and within the study groups, and receiver-operating characteristic (ROC) curve analysis for diagnostic accuracy of CRP for early OHSS at emergency polyclinics. Results: On admission, CRP did not differentiate OHSS from other IVF complications, but CRP was higher in early (median 21; IQR 8-33 mg/L) than in late (6; 3-9 mg/L, p = 0.001) OHSS. In ROC analysis for CRP (12 mg/L), the area under the curve (AUC) was 0.74 (p = 0.001) with sensitivity of 69% and specificity of 71% for early OHSS. CRP was significantly higher (28; 10-46 mg/L) in patients with early OHSS two days after oocyte pick-up (OPU) than in the controls (5; Conclusions: Early OHSS associates with a distinct rise in CRP level beyond that induced by uncomplicated oocyte pick-up, whereas the CRP levels in late OHSS are comparable to those in the control cycles. CRP identifies, but cannot distinguish IVF complications. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
  • Tapiovaara, Laura K.; Aro, Katri L. S.; Bäck, Leif J. J.; Koskinen, Anni I. M. (2019)
    Purpose In acute epiglottitis (AE) or acute supraglottitis (AS), the management of the airway is crucial. We hypothesized that tracheotomized patients recover faster than intubated patients do. Methods We retrospectively reviewed all adult AE and AS patients, who underwent intubation or tracheotomy between 2007 and 2018 in a tertiary care center. Patient demographics, treatment, and complications were analyzed. Results The cohort comprised 42 patients. The airway was secured with intubation in 50% and with tracheotomy in 50%. All intubated patients (n = 21) and three tracheotomized patients were treated in the intensive care unit (p <0.0001). Procedure-related complications were encountered in three intubated and eight tracheotomized patients (p = 0.892). Median overall treatment cost was 11.547 euro and 5.856 euro in the intubated and tracheotomized patient groups, respectively (p <0.001). The median duration of sick leave after discharge from hospital was 13 days in the tracheotomy group and 7 days in the intubation group (p = 0.097). Conclusion Tracheotomy resulted in a less expensive management in securing the airway in AE or AS, but tracheotomized patients had a trend towards more complications and longer sick leaves compared to intubated patients.
  • Tapiovaara, Laura; Back, Leif; Aro, Katri (2017)
    Possible airway compromise further complicates treatment of deep neck infections (DNI). Airway management is crucial, but factors affecting the method of choice are unclear. We retrospectively evaluated adult DNIs in a single tertiary center covering 10 years, with special attention on airway management. Patient data were retrieved from electronic data files from 2007 to 2016, and included adult patients with DNI operated through the neck. Of the 202 patients, 127 (63%) were male, with a median age of 47 years. Odontogenic (n = 74; 35%) infection was the most common etiology. Intubation was the most common method of airway management (n = 165; 82%), and most patients (n = 102; 50%) were extubated immediately after surgery. Tracheotomy was performed primarily for 35 (17%) patients, and secondarily for 25 (15%). Two patients were managed in local anesthesia. Altogether 80 (40%) patients required care in the intensive care unit for a median of 7 days. Median hospital stay was 6 days for intubated patients and 10 days for primarily tracheotomized (p = 0.036). DNI extended to the mediastinal space in 25 (12%) patients, most of whom with odontogenic infection (48%), and necrotizing fasciitis (32%). Odontogenic infection was the most common etiology for DNI with increased risk for mediastinal involvement. Intubation was most common type of airway management with high success in immediate extubation after surgery. The need for tracheotomy seemed to lead to a longer hospital care and was associated with a more severe clinical course.
  • Stevenson, Nathan J.; Vanhatalo, Sampsa (2018)
    Neonatal seizures are widely considered a neurological emergency with a need for prompt treatment, yet they are known to present a highly elusive target for bedside clinicians. Recent studies have suggested that the design of a neonatal seizure treatment trial will profoundly influence the sample size, which may readily increase to hundreds or even thousands as the achieved effect size diminishes to clinical irrelevance. The self-limiting and rapidly resolving nature of neonatal seizures diminishes the measurable treatment effect every hour after seizure onset and any effect may potentially be confused with spontaneous resolution, precluding the value of many observational studies. The large individual variability in seizure occurrence over time and between etiologies challenges group comparisons, while the absence of clinical signs mandates quantification of seizure occurrence with continuous multi-channel EEG monitoring. A biologically sound approach that views neonatal seizures as a functional cot-side biomarker rather than an object to treat can overcome these challenges. (C) 2018 Elsevier Ltd. All rights reserved.
  • Heinola, I.; Kantonen, I.; Jaroma, M.; Alback, A.; Vikatmaa, P.; Aho, P.; Venermo, M. (2016)
    Introduction: Aortic prosthetic graft infection (AGI) is a major challenge in vascular surgery. Eradicating the. infection requires prosthetic material removal, debridement, and lower limb revascularization. For the past 15 years, we have used femoral veins for aorto-iliac reconstruction and tensor fascia lata to strengthen the upper anastomosis. Objective: The purpose of this single institution retrospective study is to present results regarding in situ replacement of infected aortic grafts with autologous femoral veins (FVs). Methods: From October 2000 to March 2013, patients treated for AGI with graft removal and autologous FV reconstruction at Helsinki University Hospital were included. Primary outcome measures were 30 day mortality, long-term treatment related mortality, and re-infection rate. Secondary outcome measures were long-term all cause mortality and event free survival (graft rupture, re-intervention, major amputation). Results: During a 13 year period 55 patients (42 male, 13 female) were operated on using a venous neo-aorto-iliac system for AGI. The mean follow up was 32 months (1-157 months). The 30 day mortality rate was 9% (5) and overall treatment related mortality 18% (10). All cause mortality during follow up was 22 (40%) and overall Kaplan-Meier survival was 90.7% at 30 days, 81.5% at 1 year, and 59.3% at 5 years. Graft rupture occurred in three (5%) cases, two of which were caused by graft re-infection. (4%). Four patients required major amputation, one of them on arrival and three (5%) during the post-operative period. Nine (16%) patients needed interventions for the vein graft, and two graft limbs occluded during follow up. Conclusion: In situ reconstruction for aortic graft infection with autologous FV presents acceptable rates of morbidity and mortality, and remains the treatment of choice for AGI at Helsinki University Hospital. (C) 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
  • Jaakola, Anna; Roger, Michel; Faucher, Marie-Claude; Syrjanen, Kari; Grenman, Seija; Syrjänen, Stina; Louvanto, Karolina (2021)
    BackroundHuman leukocyte antigen (HLA)-G may have an important role in the natural history of human papillomavirus (HPV) infection. Our aim was to evaluate the role of HLA-G in the outcome of genital and oral HPV infections in women.MethodsAnalyses included 306 women from the Finnish Family HPV-study and were followed-up for six years. Genital and oral samples were tested for 24 different HPV types with multiplex HPV genotyping. HLA-G alleles were determined through direct DNA-sequencing. Unconditional logistic regression was used to determine the associations between HLA-G genotypes and HPV infection outcomes.ResultsTen HLA-G alleles were identified. Most common HLA-G genotypes were the wild type G*01:01:01/01:01:01 (31.3%) followed by G*01:01:01/01:01:02 (26.8%). G*01:01:01/01:01:01 genotype was associated with increased risk of oral HPV infections by any HPV type or single-type with OR=1.86 (95% CI 1.14-3.04, P=0.01) and 2.22 (95% CI 1.14-3.71, P=0.02), respectively. G*04:01+ allele and the G*01:01:01/01:04:01 genotype both protected from any and single oral HPV infections; OR=0.46 (95% CI 0.23-0.89, P=0.02) and 0.53 (95% CI 0.23-0.97, P=0.03), respectively. G*01:01:02/01:04:01 genotype increased significantly the risk of infertility and its treatments, with respective OR=5.06 (95% CI 1.22-21.02, P=0.03) and OR=9.07 (95% CI 1.22-39.50, P=0.03). Both HLA-G alleles and genotypes showed several significant associations with the outcomes of oral HPV infections, but none of them had any impact on the outcomes of genital HPV infections in these women.ConclusionsThe host HLA-G genotypes appear to impact the outcomes of oral HPV infections in women but have little if any effect on genital HPV status or infection outcomes.
  • Hodel, F.; Chong, A. Y.; Scepanovic, P.; Xu, Z. M.; Naret, O.; Thorball, C. W.; Rüeger, S.; Marques-Vidal, P.; Vollenweider, P.; Begemann, M.; Ehrenreich, H.; Brenner, N.; Bender, N.; Waterboer, T.; Mentzer, A. J.; Hill, A. V.S.; Hammer, C.; Fellay, J. (2021)
    Human polyomaviruses are widespread in humans and can cause severe disease in immunocompromised individuals. To identify human genetic determinants of the humoral immune response against polyomaviruses, we performed genome-wide association studies and meta-analyses of qualitative and quantitative immunoglobulin G responses against BK polyomavirus (BKPyV), JC polyomavirus (JCPyV), Merkel cellpolyomavirus (MCPyV), WU polyomavirus (WUPyV), and human polyomavirus 6 (HPyV6) in 15,660 individuals of European ancestry from three independent studies. We observed significant associations for all tested viruses: JCPyV, HPyV6, and MCPyV associated with human leukocyte antigen class II variation, BKPyV and JCPyV with variants in FUT2, responsible for secretor status, MCPyV with variants in STING1, involved in interferon induction, and WUPyV with a functional variant in MUC1, previously associated with risk for gastric cancer. These results provide insights into the genetic control of a family of very prevalent human viruses, highlighting genes and pathways that play a modulating role in human humoral immunity.
  • Martin-Loeches, I; Darmon, M; Demoule, A; Grp, Nine-I Study; Investigators, Efraim; Antonelli, M; Schellongowski, P; Pickkers, P; Soares, M; Rello, J; Bauer, P; van de Louw, A; Lemiale, V; Grimaldi, D; Balik, M; Mehta, S; Kouatchet, A; Barratt-Due, A; Valkonen, M; Reignier, J; Metaxa, V; Moreau, AS; Burghi, G; Mokart, D; Azoulay, E (2021)
    Objective: Intensive Care Units (ICU) acquired Pneumonia (ICU-AP) is one of the most frequent nosocomial infections in critically ill patients. Our aim was to determine the effects of having an ICU-AP in immunosuppressed patients with acute hypoxemic respiratory failure. Design: Post-hoc analysis of a multinational, prospective cohort study in 16 countries. Settings: ICU. Patients: Immunosuppressed patients with acute hypoxemic respiratory failure. Intervention: None. Measurements and main results: The original cohort had 1611 and in this post-hoc analysis a total of 1512 patients with available data on hospital mortality and occurrence of ICU-AP were included. ICU-AP occurred in 158 patients (10.4%). Hospital mortality was higher in patients with ICU-AP (14.8% vs. 7.1% p < 0.001). After adjustment for confounders and centre effect, use of vasopressors (Odds Ratio (OR) 2.22; 95%CI 1.46-.39) and invasive me-chanical ventilation at day 1 (OR 2.12 vs. high flow oxygen; 95%CI 1.07-4.20) were associated with increased risk of ICU-AP while female gender (OR 0.63; 95%CI 0.43-94) and chronic kidney disease (OR 0.43; 95%CI 0.22-0.88) were associated with decreased risk of ICU-AP. After adjustment for confounders and centre effect, ICU-AP was independently associated with mortality (Hazard Ratio 1.48; 95%CI 14.-1.91; P = 0.003). Conclusions: The attributable mortality of ICU-AP has been repetitively questioned in immunosuppressed pa-tients with acute respiratory failure. This manuscript found that ICU-AP represents an independent risk factor for hospital mortality.(c) 2020 Elsevier Inc. All rights reserved.
  • Pussinen, Pirkko J.; Malle, Ernst; Sattler, Wolfgang (2018)
  • Halonen, Lauri M.; Stenroos, Antti; Vasara, Henri; Huotari, Kaisa; Kosola, Jussi (2021)
    Background and purpose. Infections after intramedullary fixation of trochanteric femoral fractures are rare, but potentially life-threatening complications. There are limited data available to support decision making in these cases. Patients and methods. A retrospective study of 995 consecutive operatively treated trochanteric fractures was made to find out different risk factors for infection and to describe the results of treatment. Results. 28 patients developed a surgical site infection (2.8%) after intramedullary fixation of trochanteric fracture. 15 patients (1.5%) had a deep and 13 patients (1.3%) a superficial surgical site infection. Cigarette smoking ( p < 0.05) and prolonged operative time ( p < 0.05) were significant risk factors for an infection. 15 of 28 patients needed revision surgeries. Implant removal or exchange was needed only for 4 of 28 patients: 1 exchange of the blade, 1 removal of additional cable used to assist reduction and 2 removals of distal locking screws. None of the patients needed additional surgeries for problems with fracture healing. Mortality was not increased among patients with an infection. Interpretation. Infection after intramedullary fixation of trochanteric fractures can be successfully treated without removal or exchange of the fixation material. (c) 2020 Elsevier Ltd. All rights reserved.
  • Guillaume, O.; Perez-Tanoira, R.; Fortelny, R.; Redl, H.; Moriarty, T. F.; Richards, R. G.; Eglin, D.; Puchner, A. Petter (2018)
    The incidence of mesh-related infection after abdominal wall hernia repair is low, generally between 1 and 4%; however, worldwide, this corresponds to tens of thousands of difficult cases to treat annually. Adopting best practices in prevention is one of the keys to reduce the incidence of mesh-related infection. Once the infection is established, however, only a limited number of options are available that provides an efficient and successful treatment outcome. Over the past few years, there has been a tremendous amount of research dedicated to the functionalization of prosthetic meshes with antimicrobial properties, with some receiving regulatory approval and are currently available for clinical use. In this context, it is important to review the clinical importance of mesh infection, its risk factors, prophylaxis and pathogenicity. In addition, we give an overview of the main functionalization approaches that have been applied on meshes to confer anti-bacterial protection, the respective benefits and limitations, and finally some relevant future directions. (C) 2018 Elsevier Ltd. All rights reserved.
  • Kalalahti, Inari; Huotari, Kaisa; Erickson, Andrew M.; Petas, Anssi; Vasarainen, Hanna; Rannikko, Antti (2022)
    Purpose To compare infectious complications after transrectal systematic prostate biopsy (SB) and magnetic resonance imaging (MRI)-targeted biopsy (TB) in a large retrospective cohort to assess whether one technique is superior to the other regarding infectious complications. Methods A total of 4497 patients underwent 5288 biopsies, 2875 (54%) SB and 2413 (46%) MRI-TB only. On average, 12 SB cores and 3.7 MRI-TB cores were taken per biopsy session during the study period. Infection-related complications within 30 days were compared. The primary endpoint was a positive urine culture. Secondary endpoints were positive blood cultures, urine tests with elevated leukocytes >= 100 E6/L and elevated C-reactive protein (CRP) >= 100 mg/L. Chi-square test was used to compare the cohorts. Results Positive urine cultures were found in 77 (2.7%) after SB and in 42 (1.7%) after MRI-TB (p = 0.022). In total, 46 (0.9%) blood culture positive infections were found, 23 (0.9%) occurred after SB and 23 (1.0%) after MRI-TB, (p = 0.848). Urine tests with elevated leukocytes >= 100 E6/L were found in 111 (3.9%) after SB and in 61 (2.5%) after MRI-TB (p = 0.006). Elevated CRP >= 100 mg/L was found in 122 (4.2%) after SB and in 72 (3.0%) after MRI-TB (p = 0.015). Blood cultures were drawn more often after SB than after MRI-TB, but the difference was not statistically significant. However, urine cultures and CRP were taken more often after SB than MRI-TB. Conclusion Blood culture positive infections were equally rare after SB and MRI-TB. However, all other infectious complications were more common after SB than MRI-TB.
  • Lindahl, Jan (2017)