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Search Results: 1 - 10 of 314 matches for " Constance Schultsz "
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Streptococcus suis Meningitis: A Systematic Review and Meta-analysis
Anusha van Samkar?,Matthijs C. Brouwer?,Constance Schultsz,Arie van der Ende?,Diederik van de Beek
PLOS Neglected Tropical Diseases , 2015, DOI: 10.1371/journal.pntd.0004191
Abstract: Background Streptococcus suis is the most common cause of meningitis in pork consuming and pig rearing countries in South-East Asia. We performed a systematic review of studies on S. suis meningitis to define the clinical characteristics, predisposing factors and outcome. Methodology Studies published between January 1, 1980 and August 1, 2015 were identified from main literature databases and reference lists. Studies were included if they were written in West-European languages and described at least 5 adult patients with S. suis meningitis in whom at least one clinical characteristic was described. Findings We identified 913 patients with S. suis meningitis included in 24 studies between 1980 and 2015. The mean age was 49 years and 581 of 711 patients were male (82%). Exposure to pigs or pork was present in 395 of 648 patients (61%) while other predisposing factors were less common. 514 of 528 patients presented with fever (97%), 429 of 451 with headache (95%), 462 of 496 with neck stiffness (93%) and 78 of 384 patients (20%) had a skin injury in the presence of pig/pork contact. The case fatality rate was 2.9% and hearing loss was a common sequel occurring in 259 of 489 patients (53%). Treatment included dexamethasone in 157 of 300 (52%) of patients and was associated with reduced hearing loss in S. suis meningitis patients included in a randomized controlled trial. Conclusion S. suis meningitis has a clear association with pig and pork contact. Mortality is low, but hearing loss occurs frequently. Dexamethasone was shown to reduce hearing loss.
How Group-Based Cardiovascular Health Education Affects Treatment Adherence and Blood Pressure Control among Insured Hypertensive Nigerians: A Pre-Test, Post-Test Study  [PDF]
Aina Olufemi Odusola, Heleen Nelissen, Marleen Hendriks, Constance Schultsz, Ferdinand Wit, Oladimeji Akeem Bolarinwa, Tanimola Akande, Charles Agyemang, Gbenga Ogedegbe, Kayode Agbede, Peju Adenusi, Akin Osibogun, Karien Stronks, Joke Haafkens
World Journal of Cardiovascular Diseases (WJCD) , 2015, DOI: 10.4236/wjcd.2015.57021
Abstract: In sub Saharan Africa (SSA), access to affordable hypertension care through health insurance is increasing. But due to poor adherence, hypertension treatment outcomes often remain poor. Patient-centered educational interventions may reverse this trend. Using a pre-test/post-test design, in this study we investigated the effects of a structured cardiovascular health education program (CHEP) on treatment adherence, blood pressure (BP) control and body mass index (BMI) among Nigerian hypertensive patients who received guideline-based care in a rural primary care facility, in the context of a community based health insurance program. Study participants included 149 insured patients with uncontrolled BP and/or poor self-reported medication adherence after 12 months of guideline-based care. All patients received three group-based educational sessions and usual primary care over 6 months. We evaluated changes in self-reported adherence to prescribed medications and behavioral advice (primary outcomes); systolic BP (SBP) and/or diastolic BP (DBP) and BMI (secondary outcomes); and beliefs about hypertension and medications (explora- tory outcomes). Outcomes were analyzed with descriptive statistics and regression analysis. 140 patients completed the study (94%). At 6 months, more participants reported high adherence to medications and behavioral advice than at baseline: respectively, 101 (72%) versus 70 (50%), (p < 0.001) and 126 (90%) versus 106 (76%), (p < 0.001). Participants with controlled BP doubled from 34 (24%) to 65 (46%), (p = 0.001). The median SBP and DBP decreased from 129.0 to 122.0 mmHg, (p = 0.002) and from 80.0 to 73.5 mmHg, (p < 0.001), respectively. BMI did not change (p = 0.444). Improved medication adherence was associated with a decrease in medication concerns (p = 0.045) and improved medication self-efficacy (p < 0.001). By positively influencing patient perceptions of medications, CHEP strengthened medication adherence and, consequently, BP reduction among insured hypertensive Nigerians. This educational approach can support cardiovascular disease prevention programs for Africa’s growing hypertensive population.
Differences in the Population Structure of Invasive Streptococcus suis Strains Isolated from Pigs and from Humans in the Netherlands
Constance Schultsz, Ewout Jansen, Wendy Keijzers, Anja Rothkamp, Birgitta Duim, Jaap A. Wagenaar, Arie van der Ende
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0033854
Abstract: Streptococcus suis serotype 2 is the main cause of zoonotic S. suis infection despite the fact that other serotypes are frequently isolated from diseased pigs. Studies comparing concurrent invasive human and pig isolates from a single geographical location are lacking. We compared the population structures of invasive S. suis strains isolated between 1986 and 2008 from human patients (N = 24) and from pigs with invasive disease (N = 124) in the Netherlands by serotyping and multi locus sequence typing (MLST). Fifty-six percent of pig isolates were of serotype 9 belonging to 15 clonal complexes (CCs) or singleton sequence types (ST). In contrast, all human isolates were of serotype 2 and belonged to two non-overlapping clonal complexes CC1 (58%) and CC20 (42%). The proportion of serotype 2 isolates among S. suis strains isolated from humans was significantly higher than among strains isolated from pigs (24/24 vs. 29/124; P<0.0001). This difference remained significant when only strains within CC1 and CC20 were considered (24/24 vs. 27/37,P = 0.004). The Simpson diversity index of the S. suis population isolated from humans (0.598) was smaller than of the population isolated from pigs (0.765, P = 0.05) indicating that the S. suis population isolated from infected pigs was more diverse than the S. suis population isolated from human patients. S. suis serotype 2 strains of CC20 were all negative in a PCR for detection of genes encoding extracellular protein factor (EF) variants. These data indicate that the polysaccharide capsule is an important correlate of human S. suis infection, irrespective of the ST and EF encoding gene type of S. suis strains.
Three Adult Cases of Listeria monocytogenes Meningitis in Vietnam
Tran Thi Hong Chau,James I. Campbell,Constance Schultsz,Nguyen Van Vinh Chau,To Song Diep,Stephen Baker,Nguyen Tran Chinh,Jeremy J. Farrar,H. Rogier van Doorn
PLOS Medicine , 2010, DOI: 10.1371/journal.pmed.1000306
Cardiovascular disease prevention in rural Nigeria in the context of a community based health insurance scheme: QUality Improvement Cardiovascular care Kwara-I (QUICK-I)
Marleen Hendriks, Lizzy Brewster, Ferdinand Wit, Oladimeji Bolarinwa, Aina Odusola, William Redekop, Navin Bindraban, Albert Vollaard, Shade Alli, Peju Adenusi, Kayode Agbede, Tanimola Akande, Joep Lange, Constance Schultsz
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-186
Abstract: Design: prospective observational hospital based cohort study.Setting: a primary health care centre in rural Nigeria.Study population: 300 patients at risk for development of CVD (patients with hypertension, diabetes, renal disease or established CVD) who are enrolled in the Hygeia Community Health Plan.Measurements: demographic and socio- economic data, physical and laboratory examination, CVD risk profile including screening for target organ damage. Measurements will be done at 3 month intervals during 1 year. Direct and indirect costs of CVD prevention care will be estimated.Outcomes: 1) The adjusted cardiovascular quality of care indicator scores based on the "United Kingdom National Health Services Quality and Outcome Framework". 2) The average costs of CVD prevention and treatment per patient per year for patients, the clinic and the insurance company. 3) The estimated net health care costs of standard CVD prevention care per quality-adjusted life year gained.Analysis: The primary outcomes, the score on CVD quality indicators and cost data will be descriptive. The quality scores and cost data will be used to describe the feasibility of CVD prevention care according to international guidelines. A cost-effectiveness analysis will be done using a Markov model.Results of QUICK-I can be used by policy makers and professionals who aim to implement CVD prevention programs in settings with limited resources. The context of the insurance program will provide insight in the opportunities community health insurance may offer to attain sustainable chronic disease management programs in low resource settings.This protocol has been registered at ISRCTN, ID number: ISRCTN47894401.Cardiovascular diseases (CVD) are well established as a leading contributor to the burden of disease in low-income and middle-income countries (LMIC). Over 80% of global CVD mortality occurs in LMIC [1]. The burden of non-communicable diseases in LMIC is likely to increase substantially over the nex
Development and evaluation of a patient centered cardiovascular health education program for insured patients in rural Nigeria (QUICK - II)
Aina Odusola, Marleen Hendriks, Constance Schultsz, Karien Stronks, Joep Lange, Akin Osibogun, Tanimola Akande, Shade Alli, Peju Adenusi, Kayode Agbede, Joke Haafkens
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-171
Abstract: Design: The study has two parts. Part 1 will develop a cardiovascular health education program, using qualitative interviews with stakeholders. Part 2 will evaluate the effectiveness of the program in patients, using a prospective (pre-post) observational design.Setting: A rural primary health center in Kwara State, Nigeria.Population: For part 1: 40 patients, 10 healthcare professionals, and 5 insurance managers. For part 2: 150 patients with uncontrolled hypertension or other cardiovascular risk factors after one year of treatment.Intervention: Part 2: patient-centered cardiovascular health education program.Measurements: Part 1: Semi-structured interviews to identify stakeholder perspectives. Part 2: Pre- and post-intervention assessments including patients' demographic and socioeconomic data, blood pressure, body mass index and self-reporting measures on medication adherence and perception of care. Feasibility of the intervention will be measured using process data.Outcomes: For program development (part 1): overview of healthcare professionals' perceptions on barriers and facilitators to care, protocol for patient education, and protocol implementation plan.For program evaluation (part 2): changes in patients' scores on adherence to medication and life style changes, blood pressure, and other physiological and self-reporting measures at six months past baseline.Analysis: Part 1: content analytic technique utilizing MAXQDA software. Part 2: univariate and multilevel analysis to assess outcomes of intervention.Diligent implementation of patient-centered education should enhance adherence to cardiovascular disease prevention and management programs in low income countries.ISRCTN47894401Sub Saharan African (SSA) countries are currently experiencing a rapid increase in the incidence of cardiovascular diseases (CVD) [1,2]. Hypertension is an important risk factor for CVD. Poor adherence to prescribed medication regimens or lifestyle advices can severely compromise th
Genetic diversity of Streptococcus suis isolates as determined by comparative genome hybridization
Astrid de Greeff, Henk J Wisselink, Freddy M de Bree, Constance Schultsz, Christoph G Baums, Hoa Thi, Norbert Stockhofe-Zurwieden, Hilde E Smith
BMC Microbiology , 2011, DOI: 10.1186/1471-2180-11-161
Abstract: In this study, the correlation between gene content, serotype, phenotype and virulence among 55 S. suis strains was studied using Comparative Genome Hybridization (CGH). Clustering of CGH data divided S. suis isolates into two clusters, A and B. Cluster A isolates could be discriminated from cluster B isolates based on the protein expression of extracellular factor (EF). Cluster A contained serotype 1 and 2 isolates that were correlated with virulence. Cluster B mainly contained serotype 7 and 9 isolates. Genetic similarity was observed between serotype 7 and serotype 2 isolates that do not express muramidase released protein (MRP) and EF (MRP-EF-), suggesting these isolates originated from a common founder. Profiles of 25 putative virulence-associated genes of S. suis were determined among the 55 isolates. Presence of all 25 genes was shown for cluster A isolates, whereas cluster B isolates lacked one or more putative virulence genes. Divergence of S. suis isolates was further studied based on the presence of 39 regions of difference. Conservation of genes was evaluated by the definition of a core genome that contained 78% of all ORFs in P1/7.In conclusion, we show that CGH is a valuable method to study distribution of genes or gene clusters among isolates in detail, yielding information on genetic similarity, and virulence traits of S. suis isolates.Streptococcus suis forms a problem in the swine industry. Clinically healthy sows carry S. suis in their nasal cavities and on their tonsils, and transmit the bacteria to their piglets [1], that develop a variety of infections, such as septicaemia, meningitis, polyarthritis, and endocarditis, and often do not survive [2]. S. suis occasionally causes meningitis, arthritis or endocarditis in humans. However, recently several large human outbreaks of S. suis have been described in China [3,4], and Thailand [5], whilst S. suis meningitis has become endemic in Vietnam [6,7], suggesting that isolates that are more virulent t
The Co-Selection of Fluoroquinolone Resistance Genes in the Gut Flora of Vietnamese Children
Le Thi Minh Vien, Ngo Ngoc Quang Minh, Tang Chi Thuong, Huynh Duy Khuong, Tran Vu Thieu Nga, Corinne Thompson, James I. Campbell, Menno de Jong, Jeremy J. Farrar, Constance Schultsz, H. Rogier van Doorn, Stephen Baker
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0042919
Abstract: Antimicrobial consumption is one of the major contributing factors facilitating the development and maintenance of bacteria exhibiting antimicrobial resistance. Plasmid-mediated quinolone resistance (PMQR) genes, such as the qnr family, can be horizontally transferred and contribute to reduced susceptibility to fluoroquinolones. We performed an observational study, investigating the copy number of PMQR after antimicrobial therapy. We enrolled 300 children resident in Ho Chi Minh City receiving antimicrobial therapy for acute respiratory tract infections (ARIs). Rectal swabs were taken on enrollment and seven days subsequently, counts for Enterobacteriaceae were performed and qnrA, qnrB and qnrS were quantified by using real-time PCR on metagenomic stool DNA. On enrollment, we found no association between age, gender or location of the participants and the prevalence of qnrA, qnrB or qnrS. Yet, all three loci demonstrated a proportional increase in the number of samples testing positive between day 0 and day 7. Furthermore, qnrB demonstrated a significant increase in copy number between paired samples (p<0.001; Wilcoxon rank-sum), associated with non-fluoroquinolone combination antimicrobial therapy. To our knowledge, this is the first study describing an association between the use of non-fluoroquinolone antimicrobials and the increasing relative prevalence and quantity of qnr genes. Our work outlines a potential mechanism for the selection and maintenance of PMQR genes and predicts a strong effect of co-selection of these resistance determinants through the use of unrelated and potentially unnecessary antimicrobial regimes.
Slaughterhouse Pigs Are a Major Reservoir of Streptococcus suis Serotype 2 Capable of Causing Human Infection in Southern Vietnam
Ngo Thi Hoa,Tran Thi Bich Chieu,Tran Thi Thu Nga,Nguyen Van Dung,James Campbell,Pham Hong Anh,Huynh Huu Tho,Nguyen Van Vinh Chau,Juliet E. Bryant,Tran Tinh Hien,Jeremy Farrar,Constance Schultsz
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0017943
Abstract: Streptococcus suis is a pathogen of major economic significance to the swine industry and is increasingly recognized as an emerging zoonotic agent in Asia. In Vietnam, S. suis is the leading cause of bacterial meningitis in adult humans. Zoonotic transmission is most frequently associated with serotype 2 strains and occupational exposure to pigs or consumption of infected pork. To gain insight into the role of pigs for human consumption as a reservoir for zoonotic infection in southern Vietnam, we determined the prevalence and diversity of S. suis carriage in healthy slaughterhouse pigs. Nasopharyngeal tonsils were sampled from pigs at slaughterhouses serving six provinces in southern Vietnam and Ho Chi Minh City area from September 2006 to November 2007. Samples were screened by bacterial culture. Isolates of S. suis were serotyped and characterized by multi locus sequence typing (MLST) and pulse field gel electrophoresis (PFGE). Antibiotic susceptibility profiles and associated genetic resistance determinants, and the presence of putative virulence factors were determined. 41% (222/542) of pigs carried S. suis of one or multiple serotypes. 8% (45/542) carried S. suis serotype 2 which was the most common serotype found (45/317 strains, 14%). 80% of serotype 2 strains belonged to the MLST clonal complex 1,which was previously associated with meningitis cases in Vietnam and outbreaks of severe disease in China in 1998 and 2005. These strains clustered with representative strains isolated from patients with meningitis in PFGE analysis, and showed similar antimicrobial resistance and virulence factor profiles. Slaughterhouse pigs are a major reservoir of S. suis serotype 2 capable of causing human infection in southern Vietnam. Strict hygiene at processing facilities, and health education programs addressing food safety and proper handling of pork should be encouraged.
The antimicrobial resistance patterns and associated determinants in Streptococcus suis isolated from humans in southern Vietnam, 1997-2008
Ngo T Hoa, Tran TB Chieu, Ho DT Nghia, Nguyen TH Mai, Pham H Anh, Marcel Wolbers, Stephen Baker, James I Campbell, Nguyen VV Chau, Tran T Hien, Jeremy Farrar, Constance Schultsz
BMC Infectious Diseases , 2011, DOI: 10.1186/1471-2334-11-6
Abstract: S. suis strains isolated between 1997 and 2008 were investigated for their susceptibility to six antimicrobial agents. Strains were screened for the presence and expression of tetracycline and erythromycin resistance determinants and the association of tet(M) genes with Tn916- like transposons. The localization of tetracycline resistance gene tet(L) was determined by pulse field gel electrophoresis and Southern blotting.We observed a significant increase in resistance to tetracycline and chloramphenicol, which was concurrent with an increase in multi-drug resistance. In tetracycline resistance strains, we identified tet(M), tet(O), tet(W) and tet(L) and confirmed their expression. All tet(M) genes were associated with a Tn916-like transposon. The co-expression of tet(L) and other tetracycline resistance gene(s) encoding for ribosomal protection protein(s) was only detected in strains with a minimum inhibitory concentration (MIC) of tetracycline of ≥ 64 mg/LWe demonstrated that multi-drug resistance in S. suis causing disease in humans in southern Vietnam has increased over the 11-year period studied. We report the presence and expression of tet(L) in S. suis strains and our data suggest that co-expression of multiple genes encoding distinct mechanism is required for an MIC ≥ 64 mg/L to tetracycline.Streptococcus suis is an emerging zoonotic pathogen associated with pigs and can cause severe systemic infections in humans. Up to date approximately 800 human S. suis infections have been reported from over twenty countries [1]. The most noticeable incident was a single outbreak in China affecting 215 individuals, of whom 38 died [2]. S. suis serotype 2 is the most common serotype associated with human disease [3] and is the most common cause of acute bacterial meningitis in adults in Vietnam [1,4,5].Antimicrobial susceptibility profiles and the corresponding resistance determinants of S. suis have been reported in strains isolated from pigs, but there are only limited d
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