During their migration through the pig's body, Ascaris suum larvae cause significant damage to the lungs. Little is known about the actual impact of this tissue damage on the occurrence and severity of respiratory problems in industrial pig fattening farms. In this study, we evaluated the link between the serological response to two different A. suum antigen preparations and respiratory or meat inspection outcomes. Two different serological tests were used that measure antibodies against either the A. suum haemoglobin molecule or complete homogenate of the 3rd stage larva that migrate through the lungs. Firstly, serum samples were analysed that were collected from 19 herds in which the cause of acute clinical respiratory symptoms was either Actinobacillus pleuropneumoniae, A. suum, or a miscellaneous cause. This was done to test whether serological results could confirm pathological findings. Secondly, serum samples from 60 herds of finishing pigs with a history of high or low frequency of pleuritis at meat inspection (MI), but without acute respiratory symptoms at the time of sampling, were also submitted for serological evaluation using both tests. Regression models were used to search for potential associations between the proportion of pigs testing seropositive with MI results, in particular pathological changes related to the lungs. The results of both ELISAs were strongly associated (P <0.001) with pigs belonging to a herd where the respiratory problems could be attributed to A. swim by histology, indicating that both tests can be used to diagnose clinical respiratory outbreaks due to A. suum. In the herds without acute clinical respiratory symptoms, a positive association was found between the proportion of pigs testing seropositive and the percentage of livers rejected due to milk spots and with whole carcass condemnations. No association was found between Ascaris serology and lung pathology (pneumonia and pleuritis) registered at MI, however, challenging the likely involvement of Ascaris in the development of these lesions.

These guidelines update the previous EANM 2009 guidelines on the diagnosis of pulmonary embolism (PE). Relevant new aspects are related to (a) quantification of PE and other ventilation/perfusion defects; (b) follow-up of patients with PE; (c) chronic PE; and (d) description of additional pulmonary physiological changes leading to diagnoses of left ventricular heart failure (HF), chronic obstructive pulmonary disease (COPD) and pneumonia. The diagnosis of PE should be reported when a mismatch of one segment or two subsegments is found. For ventilation, Technegas or krypton gas is preferred over diethylene triamine pentaacetic acid (DTPA) in patients with COPD. Tomographic imaging with V/P-SPECT has higher sensitivity and specificity for PE compared with planar imaging. Absence of contraindications makes V/P-SPECT an essential method for the diagnosis of PE. When V/P-SPECT is combined with a low-dose CT, the specificity of the test can be further improved, especially in patients with other lung diseases. Pitfalls in V/P-SPECT interpretation are discussed. In conclusion, V/P-SPECT is strongly recommended as it accurately establishes the diagnosis of PE even in the presence of diseases like COPD, HF and pneumonia and has no contraindications.

Avhandlingen är en litteraturöversikt om insjuknandet i och preventionen av Ventilator-associerad pneumoni (VAP). Avhandlingen redovisar mekanismerna för insjuknandet och vilka metoder som är effektiva för prevention av VAP. Fokusen är på den orala mikrobflorans betydelse för insjuknande i VAP. Avhandlingens material är valt från relevanta artiklar och läroböcker. Prevalensen för VAP är hög (10%) och VAP är den vanligaste av de infektioner som uppkommer på sjukhus. VAP är en mycket allvarlig komplikation som märkbart ökar längden på vården, dödligheten och kostnaderna. Kolonisering av orala biofilmer av patogener är centrala för insjuknandet i VAP. Avlossad biofilm kan aspireras till lungorna och orsaka infektion. Biofilmen skyddar patogenerna mot immunförsvaret och antibiotikavården, vilket gör infektionen mycket svårskött. Orsaken till att de orala biofilmerna lätt koloniseras av patogener under intensivvården är försämrad oralhygien. Normala försvarsmekanismer i munnen och lungorna är också försämrade på grund av endotrachala tuben. Preventionen fokuserar på att hindra kolonisering av patogener och förflyttande av patogener ner till lungorna. För att minska koloniseringen används det antiseptiska ämnet klorhexidin och mekaniskt renande av munhålan. För att minska aspirering används bland annat förhöjning av sängens huvudända och subglottiskt sug. De preventiva åtgärderna räcker inte till för att förhindra alla infektioner, men ökad skolning och implementering av protokoll har visat sig vara effektiva sätt att sänka prevalensen betydligt. Nya preventiva metoder, som t.ex. silvertäckta endotracheala tuber, har gett lovande resultat i minskandet av mängden VAP- fall.

Background and objectives Infections are the most common noncardiovascular causes of death after kidney transplantation. We analyzed the current infection-related mortality among kidney transplant recipients in a nationwide cohort in Finland. Design, setting, participants, & measurements Altogether, 3249 adult recipients of a first kidney transplant from 1990 to 2012 were included. Infectious causes of death were analyzed, and the mortality rates for infections were compared between two eras (1990-1999 and 2000-2012). Risk factors for infectious deaths were analyzed with Cox regression and competing risk analyses. Results Altogether, 953 patients (29%) died during the follow-up, with 204 infection-related deaths. Mortality rate (per 1000 patient-years) due to infections was lower in the more recent cohort (4.6; 95% confidence interval, 3.5 to 6.1) compared with the older cohort (9.1; 95% confidence interval, 7.6 to 10.7); the incidence rate ratio of infectious mortality was 0.51 (95% confidence interval, 0.30 to 0.68). The main causes of infectious deaths were common bacterial infections: septicemia in 38% and pulmonary infections in 45%. Viral and fungal infections caused only 2% and 3% of infectious deaths, respectively (such as individual patients with Cytomegalovirus pneumonia, Herpes simplex virus meningoencephalitis, Varicella zoster virus encephalitis, and Pneumocystis jirovecii infection). Similarly, opportunistic bacterial infections rarely caused death; only one deathwas caused by Listeria monocytogenes, and two were caused by Mycobacterium tuberculosis. Only 23 (11%) of infection-related deaths occurred during the first post-transplant year. Older recipient age, higher plasma creatinine concentration at the end of the first post-transplant year, diabetes as a cause of ESKD, longer pretransplant dialysis duration, acute rejection, low albumin level, and earlier era of transplantation were associated with increased risk of infectious death in multivariable analysis. Conclusions The risk of death due to infectious causes after kidney transplantation in Finland dropped by one half since the 1990s. Common bacterial infections remained the most frequent cause of infection-related mortality, whereas opportunistic viral, fungal, or unconventional bacterial infections rarely caused deaths after kidney transplantation.