This page has only limited features, please log in for full access.

Dr. Anna Nilsson
Karolinska Institutet, Dept of Womens and Childrens Health, Pediatric Oncology

Basic Info


Research Keywords & Expertise

0 Children
0 Immunosuppression
0 pediatric cancer
0 vaccination
0 Infection and immunity

Fingerprints

Children
vaccination
Immunosuppression
pediatric cancer

Honors and Awards

The user has no records in this section


Career Timeline

The user has no records in this section.


Short Biography

The user biography is not available.
Following
Followers
Co Authors
The list of users this user is following is empty.
Following: 0 users

Feed

Original article
Published: 07 May 2021 in Journal for Specialists in Pediatric Nursing
Reads 0
Downloads 0

Purpose The blood sampling procedure is complex and prone to failure, as reflected by preanalytical errors in pediatric hospital care. The primary aim was to evaluate if the risk of preanalytical errors was higher with capillary blood sampling than with venous blood sampling, and secondary, explore specific factors associated with preanalytical errors, both overall and stratified by capillary and venous blood sampling. Design and Methods This observational pediatric hospital study collected outcomes from medical records and blood sampling surveys from year 2014 to 2016. The risk of preanalytical errors was analyzed with adjusted‐odds ratio (adj‐OR) by multivariable logistic regression with 95% confidence intervals (CIs). Results Overall, 128 (13%) preanalytical errors were identified among 951 blood samples. The proportion and adj‐OR of errors was significantly higher in capillary compared with venous blood samples, 72 (20%) of 354 versus 56 (9.4%) of 597, p = .001, adj‐OR 2.88 (CI 1.79–4.64). Blood collection with multiple sample tubes was significantly associated with increased risk of preanalytical errors (n = 97 of 601, 16%), while log weight (kg) significantly decreased the risk of preanalytical errors adj‐OR 0.66 (CI 0.50–0.86), indicating a protective effect of increasing weight. However, stratified analyses indicated a protective effect of increasing log weight for venous blood sampling adj‐OR 0.52 (CI 0.38–0.72), but not capillary blood sampling, adj‐OR 1.08 (CI 0.76–1.55). Conclusion This study indicates that capillary blood sampling collection increases the risk of preanalytical errors. Further, a child's increasing body weight reduced the risk of preanalytical errors, while multiple sample tube collections significantly increased the risk of preanalytical errors. Practice Implications This new information may help nurses improve their knowledge concerning blood sampling collection in pediatrics. Altogether, this study also indicates that implementing more venous blood sampling and improve the cases of capillary sampling could reduce the number of preanalytical errors in pediatric hospitals.

ACS Style

Henrik Hjelmgren; Anna Nilsson; Ida H. Myrberg; Nina Andersson; Britt‐Marie Ygge; Björn Nordlund. Capillary blood sampling increases the risk of preanalytical errors in pediatric hospital care: Observational clinical study. Journal for Specialists in Pediatric Nursing 2021, e12337 .

AMA Style

Henrik Hjelmgren, Anna Nilsson, Ida H. Myrberg, Nina Andersson, Britt‐Marie Ygge, Björn Nordlund. Capillary blood sampling increases the risk of preanalytical errors in pediatric hospital care: Observational clinical study. Journal for Specialists in Pediatric Nursing. 2021; ():e12337.

Chicago/Turabian Style

Henrik Hjelmgren; Anna Nilsson; Ida H. Myrberg; Nina Andersson; Britt‐Marie Ygge; Björn Nordlund. 2021. "Capillary blood sampling increases the risk of preanalytical errors in pediatric hospital care: Observational clinical study." Journal for Specialists in Pediatric Nursing , no. : e12337.

Journal article
Published: 13 March 2021 in Hemato
Reads 0
Downloads 0

Various subsets of bone marrow mesenchymal stromal cells (BM MSCs), including fibroblasts, endothelial, fat and reticular cells, are implicated in the regulation of the hematopoietic microenvironment and the survival of long-lived antibody-secreting cells (ASCs). Nowadays it is widely acknowledged that vaccine-induced protective antibody levels are diminished in adults and children that are treated for hematological cancers. A reason behind this could be damage to the BM MSC niche leading to a diminished pool of ASCs. To this end, we asked whether cell cytotoxic treatment alters the capacity of human BM MSCs to support the survival of ASCs. To investigate how chemotherapy affects soluble factors related to the ASC niche, we profiled a large number of cytokines and chemokines from in vitro-expanded MSCs from healthy donors or children who were undergoing therapy for acute lymphoblastic leukemia (ALL), following exposure to a widely used anthracycline called doxorubicin (Doxo). In addition, we asked if the observed changes in the measured soluble factors after Doxo exposure impacted the ability of the BM niche to support humoral immunity by co-culturing Doxo-exposed BM MSCs with in vitro-differentiated ASCs from healthy blood donors, and selective neutralization of cytokines. Our in vitro results imply that Doxo-induced alterations in BM MSC-derived interleukin 6 (IL-6), CXCL12 and growth and differentiation factor 15 (GDF-15) are not sufficient to disintegrate the support of IgG-producing ASCs by the BM MSC niche, and that serological memory loss may arise during later stages of ALL therapy.

ACS Style

Gintare Lasaviciute; Anna Höbinger; Dorina Ujvari; Daniel Salamon; Aisha Yusuf; Mikael Sundin; Eva Sverremark-Ekström; Rayan Chikhi; Anna Nilsson; Shanie Saghafian-Hedengren. Human Bone Marrow Mesenchymal Stromal Cell-Derived CXCL12, IL-6 and GDF-15 and Their Capacity to Support IgG-Secreting Cells in Culture Are Divergently Affected by Doxorubicin. Hemato 2021, 2, 154 -166.

AMA Style

Gintare Lasaviciute, Anna Höbinger, Dorina Ujvari, Daniel Salamon, Aisha Yusuf, Mikael Sundin, Eva Sverremark-Ekström, Rayan Chikhi, Anna Nilsson, Shanie Saghafian-Hedengren. Human Bone Marrow Mesenchymal Stromal Cell-Derived CXCL12, IL-6 and GDF-15 and Their Capacity to Support IgG-Secreting Cells in Culture Are Divergently Affected by Doxorubicin. Hemato. 2021; 2 (1):154-166.

Chicago/Turabian Style

Gintare Lasaviciute; Anna Höbinger; Dorina Ujvari; Daniel Salamon; Aisha Yusuf; Mikael Sundin; Eva Sverremark-Ekström; Rayan Chikhi; Anna Nilsson; Shanie Saghafian-Hedengren. 2021. "Human Bone Marrow Mesenchymal Stromal Cell-Derived CXCL12, IL-6 and GDF-15 and Their Capacity to Support IgG-Secreting Cells in Culture Are Divergently Affected by Doxorubicin." Hemato 2, no. 1: 154-166.

Immunology
Published: 04 March 2021 in Frontiers in Immunology
Reads 0
Downloads 0

The immune system plays a major role in recognizing and eliminating malignant cells, and this has been exploited in the development of immunotherapies aimed at either activating or reactivating the anti-tumor activity of a patient's immune system. A wide range of therapeutic approaches involving T lymphocytes, such as programmed cell death protein ligand-1 (PDL-1) inhibitors, cytotoxic T-lymphocyte-associated protein-4 (CTLA-4) blockers, and CD19-targeted T-cell therapy through chimeric antigen receptor (CAR)-T cells or CD19/CD3 bi-specific T-cell engagers, have been introduced to the field of oncology, leading to significant improvements in overall survival of adult cancer patients. During the past few years, the availability and approval of T-cell based immunotherapies have become a reality also for the treatment of childhood cancers. However, the distribution, ratio of regulatory to effector cells and the quality of T-cell responses early in life are distinct from those during adolescence and adulthood, raising the possibility that these differences impact the efficacy of immunotherapy. Herein we provide a brief overview of the properties of conventional T cell subsets during early life. Focusing on the most common cancer type during childhood, acute lymphoblastic leukemia (ALL), we describe how current conventional therapies used against ALL influence the T-cell compartment of small children. We describe early life T-cell responses in relation to immunotherapies engaging T-cell anticancer reactivity and present our opinion that it is not only immaturity of the adaptive immune system, but also the impact of an immunosuppressive environment that may prove disadvantageous in the setting of immunotherapies targeting pediatric cancer cells.

ACS Style

Shanie Saghafian-Hedengren; Eva Sverremark-Ekström; Anna Nilsson. T Cell Subsets During Early Life and Their Implication in the Treatment of Childhood Acute Lymphoblastic Leukemia. Frontiers in Immunology 2021, 12, 1 .

AMA Style

Shanie Saghafian-Hedengren, Eva Sverremark-Ekström, Anna Nilsson. T Cell Subsets During Early Life and Their Implication in the Treatment of Childhood Acute Lymphoblastic Leukemia. Frontiers in Immunology. 2021; 12 ():1.

Chicago/Turabian Style

Shanie Saghafian-Hedengren; Eva Sverremark-Ekström; Anna Nilsson. 2021. "T Cell Subsets During Early Life and Their Implication in the Treatment of Childhood Acute Lymphoblastic Leukemia." Frontiers in Immunology 12, no. : 1.

Journal article
Published: 16 December 2020 in Children
Reads 0
Downloads 0

Sequence variants in genes involved in the immune system have previously been linked to neutropenia as well as infections in cancer patients. Sequence variants in genes coding for TLR4, MBL, and IL-1Ra were investigated in relation to clinical utility of identifying severe episodes of febrile neutropenia (FN) in a cohort of children undergoing treatment for acute lymphoblastic leukemia. The study included 122 children, where data on FN and microbiological findings were retrospectively collected from medical records. Sequence variants in genes coding for MBL, TLR4, and IL-1Ra were identified by pyrosequencing, TaqMan SNP genotyping assay, and gel electrophoresis. A total of 380 episodes of FN were identified and in 139 episodes, there was a microbiological defined infection. Age and treatment intensity were all associated with the risk of developing FN. No sequence variant was associated to increased numbers of FN episodes. Two sequence variants in the TLR4 gene increased the risk of viral infection, whilst sequence variants in the IL-1Ra gene were associated to a decreased risk of bacterial blood-stream infection (BSI). The investigated sequence variants did not associate with increased risk for FN or to severe infections, as to why the clinical utility as a risk-stratification tool is low. Most episodes of FN were classified as fever with unknown origin, emphasizing the need for improved microbial detection methods.

ACS Style

Martina Wahlund; Malin Lindqvist Appell; Ida Hed Myrberg; Anna Berggren; Anna Nilsson. Genetic Sequence Variants in TLR4, MBL or IL-1 Receptor Antagonist is not Associated to Increased Risk for Febrile Neutropenia in Children with ALL. Children 2020, 7, 296 .

AMA Style

Martina Wahlund, Malin Lindqvist Appell, Ida Hed Myrberg, Anna Berggren, Anna Nilsson. Genetic Sequence Variants in TLR4, MBL or IL-1 Receptor Antagonist is not Associated to Increased Risk for Febrile Neutropenia in Children with ALL. Children. 2020; 7 (12):296.

Chicago/Turabian Style

Martina Wahlund; Malin Lindqvist Appell; Ida Hed Myrberg; Anna Berggren; Anna Nilsson. 2020. "Genetic Sequence Variants in TLR4, MBL or IL-1 Receptor Antagonist is not Associated to Increased Risk for Febrile Neutropenia in Children with ALL." Children 7, no. 12: 296.

Original studies
Published: 05 August 2020 in Pediatric Infectious Disease Journal
Reads 0
Downloads 0

Background: The etiology of bloodstream infections (BSIs) changes over time due to updated immunization programs, new antibiotic-use strategies, changes in patient mix and travel. Continuous surveillance can guide empiric therapy and identify targets for prevention. Method: We conducted a descriptive retrospective analysis among children <18 years of age who were detected with BSI between July 1998 and June 2018 for changes in the incidence, risk factors, and etiology of BSI in a Swedish tertiary hospital (Karolinska University Hospital). Results: We evaluated 2079 episodes of BSI. During the study period, the incidence of BSI in children 0–17 years of age decreased (τ = −0.45, P = 0.016), which was most evident among children 3 months to 2 years of age (τ = −0.59, P = 0.0006) and in early neonatal period (0–7 days; τ = −0.44, P = 0.0069). These were explained by the reduced occurrence of Streptococcus pneumoniae in children 3 months to 2 years of age and Streptococcus agalactiae and Candida spp. in neonates. Staphylococcus aureus was the commonest pathogen, accounting for 31.6% of episodes. The proportion of hospital-acquired infection was higher in patients with underlying risk factors (47.6% vs. 2.6%). The etiology of hospital-acquired infection BSI was more diverse than that of community-acquired infections and was related to underlying risk factors. The crude mortality rate was 5.7%. For children admitted to the neonatal ward, the mortality was 17.6%, but declined (τ = −0.469, P = 0.004) over the study period. Conclusions: There was a decreasing trend of pediatric BSI and mortality over last 20 years, which was associated with pneumococcal immunization and antimicrobial prophylaxis for high-risk patients.

ACS Style

Joachim Luthander; Rutger Bennet; Christian G. Giske; Margareta Eriksson; Anna Nilsson. Trends of Pediatric Bloodstream Infections in Stockholm, Sweden: A 20-year Retrospective Study. Pediatric Infectious Disease Journal 2020, 39, 1069 -1074.

AMA Style

Joachim Luthander, Rutger Bennet, Christian G. Giske, Margareta Eriksson, Anna Nilsson. Trends of Pediatric Bloodstream Infections in Stockholm, Sweden: A 20-year Retrospective Study. Pediatric Infectious Disease Journal. 2020; 39 (12):1069-1074.

Chicago/Turabian Style

Joachim Luthander; Rutger Bennet; Christian G. Giske; Margareta Eriksson; Anna Nilsson. 2020. "Trends of Pediatric Bloodstream Infections in Stockholm, Sweden: A 20-year Retrospective Study." Pediatric Infectious Disease Journal 39, no. 12: 1069-1074.

Journal article
Published: 26 July 2020 in International Journal of Molecular Sciences
Reads 0
Downloads 0

Infection is a common and serious complication of cancer treatment in children that often presents as febrile neutropenia (FN). Gene-expression profiling techniques can reveal transcriptional signatures that discriminate between viral, bacterial and asymptomatic infections in otherwise healthy children. Here, we examined whether gene-expression profiling was feasible in children with FN who were undergoing cancer treatment. The blood transcriptome of the children (n = 63) was investigated at time of FN diagnosed as viral, bacterial, co-infection or unknown etiology, respectively, and compared to control samples derived from 12 of the patients following the FN episode. RNA sequencing was successful in 43 (68%) of the FN episodes. Only two genes were significantly differentially expressed in the bacterial versus the control group. Significantly up-regulated genes in patients with the other three etiologies versus the control group were enriched with cellular processes related to proliferation and cellular stress response, with no clear enrichment with innate responses to pathogens. Among the significantly down-regulated genes, a few clustered into pathways connected to responses to infection. In the present study of children during cancer treatment, the blood transcriptome was not suitable for determining the etiology of FN because of too few circulating immune cells for reliable gene expression analysis.

ACS Style

Martina Wahlund; Indranil Sinha; Kristina Broliden; Shanie Saghafian-Hedengren; Anna Nilsson; Anna Berggren. The Feasibility of Host Transcriptome Profiling as a Diagnostic Tool for Microbial Etiology in Childhood Cancer Patients with Febrile Neutropenia. International Journal of Molecular Sciences 2020, 21, 5305 .

AMA Style

Martina Wahlund, Indranil Sinha, Kristina Broliden, Shanie Saghafian-Hedengren, Anna Nilsson, Anna Berggren. The Feasibility of Host Transcriptome Profiling as a Diagnostic Tool for Microbial Etiology in Childhood Cancer Patients with Febrile Neutropenia. International Journal of Molecular Sciences. 2020; 21 (15):5305.

Chicago/Turabian Style

Martina Wahlund; Indranil Sinha; Kristina Broliden; Shanie Saghafian-Hedengren; Anna Nilsson; Anna Berggren. 2020. "The Feasibility of Host Transcriptome Profiling as a Diagnostic Tool for Microbial Etiology in Childhood Cancer Patients with Febrile Neutropenia." International Journal of Molecular Sciences 21, no. 15: 5305.

Journal article
Published: 28 April 2020 in Vaccine
Reads 0
Downloads 0

The aims of this study are to validate infant vaccination data in the Swedish Vaccination Register (SVR) to the Swedish administrative coverage reports, and to assess differences in register-based vaccination coverage estimates between providers using different data reporting methods. The study population included all infants born in Sweden with a Swedish Personal Identity Number during 2014 and 2015 (n = 230,220). Data on all National Immunisation Programme vaccinations administered before 24 months of age were collected from the SVR and from administrative coverage reports. Information regarding data registration methods in the SVR were collected from national and regional authorities. Coverage from health care providers using single registration methods, where vaccination data were transferred automatically from the electronic health care record to the SVR, was compared to that from providers using double registration methods where data had to be added into the SVR in a separate process. For 98,4% of the study population at least one vaccination was recorded in the SVR. The coverage of 3-dose DTP-containing (87,1%) and 1 dose MMR (91,1%) in the register did not reach administrative data coverage (97,4% for 3-dose DTP-containing and 97,0% for MMR). Single registration procedures yielded significantly higher coverage than double registration procedures (92,24% vs 87,10%, p < 0,0001). A regional switch from double to single registration increased coverage from 80,0 to 95,2%. The SVR is a valuable data source for vaccination coverage monitoring. For research purposes, the SVR provides valuable data, since every health care provider is obliged to register all vaccine doses given within the national immunisation program. The SVR shows a high completeness validated by comparison to a very well-functioning administrative data system. Single-registration procedures give more complete data and should be supported by health systems while creating health care registers.

ACS Style

Cecilia Chrapkowska; Ilias Galanis; Malin Kark; Tiia Lepp; Ann Lindstrand; Adam Roth; Anna Nilsson. Validation of the new Swedish vaccination register – Accuracy and completeness of register data. Vaccine 2020, 38, 4104 -4110.

AMA Style

Cecilia Chrapkowska, Ilias Galanis, Malin Kark, Tiia Lepp, Ann Lindstrand, Adam Roth, Anna Nilsson. Validation of the new Swedish vaccination register – Accuracy and completeness of register data. Vaccine. 2020; 38 (25):4104-4110.

Chicago/Turabian Style

Cecilia Chrapkowska; Ilias Galanis; Malin Kark; Tiia Lepp; Ann Lindstrand; Adam Roth; Anna Nilsson. 2020. "Validation of the new Swedish vaccination register – Accuracy and completeness of register data." Vaccine 38, no. 25: 4104-4110.

Clinical and laboratory observations
Published: 13 April 2020 in Journal of Pediatric Hematology/Oncology
Reads 0
Downloads 0

Background: Extracorporeal membrane oxygenation (ECMO) is used in severe respiratory and/or circulatory failure when conventional critical care fails. Studies on patients with hematological malignancies on ECMO have shown contradictory results; immunosuppression and coagulopathy are relative contraindications to ECMO. Observations: This nationwide Swedish retrospective chart review identified 958 children with hematological malignancies of whom 12 (1.3%) required ECMO support. Eight patients survived ECMO, 7 the total intensive care period, and 6 survived the underlying malignancy. Conclusions: ECMO may be considered in children with hematological malignancy. Short-term and long-term survival, in this limited group, was similar to that of children on ECMO at large.

ACS Style

Susanna Ranta; Håkan Kalzén; Anna Nilsson; Katarina von Schewelov; Lars M. Broman; Jonas Berner; Urban Fläring; Ulrika Norén-Nyström; Johan E. Svahn; Josefine Palle; Lisa Törnudd; Lene Karlsson; Karin Mellgren; Jonas Abrahamsson; Arja Harila-Saari. Extracorporeal Membrane Oxygenation Support in Children With Hematologic Malignancies in Sweden. Journal of Pediatric Hematology/Oncology 2020, 43, e272 -e275.

AMA Style

Susanna Ranta, Håkan Kalzén, Anna Nilsson, Katarina von Schewelov, Lars M. Broman, Jonas Berner, Urban Fläring, Ulrika Norén-Nyström, Johan E. Svahn, Josefine Palle, Lisa Törnudd, Lene Karlsson, Karin Mellgren, Jonas Abrahamsson, Arja Harila-Saari. Extracorporeal Membrane Oxygenation Support in Children With Hematologic Malignancies in Sweden. Journal of Pediatric Hematology/Oncology. 2020; 43 (2):e272-e275.

Chicago/Turabian Style

Susanna Ranta; Håkan Kalzén; Anna Nilsson; Katarina von Schewelov; Lars M. Broman; Jonas Berner; Urban Fläring; Ulrika Norén-Nyström; Johan E. Svahn; Josefine Palle; Lisa Törnudd; Lene Karlsson; Karin Mellgren; Jonas Abrahamsson; Arja Harila-Saari. 2020. "Extracorporeal Membrane Oxygenation Support in Children With Hematologic Malignancies in Sweden." Journal of Pediatric Hematology/Oncology 43, no. 2: e272-e275.

Case report
Published: 18 February 2020 in Infectious Diseases
Reads 0
Downloads 0

A child with pre-B acute lymphoblastic leukaemia (ALL) developed fatal encephalitis associated with human coronavirus OC43 (HCoV-OC43). During chemotherapy the child had a persistent HCoV-OC43 respiratory infection and later developed progressive encephalitis. Cerebrospinal fluid was negative for pathogens including HCoV-OC43, but a brain biopsy was HCoV-OC43-positive by metagenomic next-generation sequencing.

ACS Style

Anna Nilsson; Niklas Edner; Jan Albert; Anders Ternhag. Fatal encephalitis associated with coronavirus OC43 in an immunocompromised child. Infectious Diseases 2020, 52, 419 -422.

AMA Style

Anna Nilsson, Niklas Edner, Jan Albert, Anders Ternhag. Fatal encephalitis associated with coronavirus OC43 in an immunocompromised child. Infectious Diseases. 2020; 52 (6):419-422.

Chicago/Turabian Style

Anna Nilsson; Niklas Edner; Jan Albert; Anders Ternhag. 2020. "Fatal encephalitis associated with coronavirus OC43 in an immunocompromised child." Infectious Diseases 52, no. 6: 419-422.

Journal article
Published: 01 January 2020 in The Journal of Pediatrics
Reads 0
Downloads 0

To evaluate the roles of thiopurine methyltransferase (TPMT), inosine triphosphatase (ITPA), and Nudix hydrolase 15 (NUDT15) in 6-mercaptopurine (6-MP) sensitivity during treatment of pediatric patients with acute lymphoblastic leukemia (ALL). The study included 102 pediatric patients with ALL subject to the Nordic society Of Paediatric Haematology and Oncology (NOPHO) ALL-2000 and ALL-2008 protocols. Episodes of neutropenia and febrile neutropenia, TPMT sequence variants, as well as 6-MP end doses, were collected retrospectively from medical records. TPMT, ITPA, and NUDT15 sequence variants were analyzed using pyrosequencing. TPMT variants were associated with a reduced risk of neutropenia and febrile neutropenia during the maintenance II period (P = .019 and P < .0001, respectively). In addition, a NUDT15 variant was associated with a lower end dose of 6-MP (P = .0097), but not with neutropenia and febrile neutropenia. ITPA variants were not associated with an increased risk of neutropenia, febrile neutropenia, nor lower end dose of 6-MP. However, when analyzing the entire treatment period, ITPA variants were associated with a decreased risk of febrile neutropenia. White blood cell count-based dose adjustments are regularly performed for known TPMT- deficient patients and results in a reduced risk of neutropenia and febrile neutropenia. Also in NUDT15-deficient patients dose adjustments are performed as indicated by low end dose of 6-MP. ITPA-deficient patients had a decreased risk of febrile neutropenia when analyzing the entire treatment period. Our data suggest that NUDT15 plays an important role in 6-MP treatment and the results should be confirmed in larger cohorts. Future studies should also follow up whether white blood cell count-based dose adjustments affect the risk of relapse.

ACS Style

Martina Wahlund; Anna Nilsson; Anna Zimdahl Kahlin; Kristina Broliden; Ida Hed Myrberg; Malin Lindqvist Appell; Anna Berggren. The Role of TPMT, ITPA, and NUDT15 Variants during Mercaptopurine Treatment of Swedish Pediatric Patients with Acute Lymphoblastic Leukemia. The Journal of Pediatrics 2020, 216, 150 -157.e1.

AMA Style

Martina Wahlund, Anna Nilsson, Anna Zimdahl Kahlin, Kristina Broliden, Ida Hed Myrberg, Malin Lindqvist Appell, Anna Berggren. The Role of TPMT, ITPA, and NUDT15 Variants during Mercaptopurine Treatment of Swedish Pediatric Patients with Acute Lymphoblastic Leukemia. The Journal of Pediatrics. 2020; 216 ():150-157.e1.

Chicago/Turabian Style

Martina Wahlund; Anna Nilsson; Anna Zimdahl Kahlin; Kristina Broliden; Ida Hed Myrberg; Malin Lindqvist Appell; Anna Berggren. 2020. "The Role of TPMT, ITPA, and NUDT15 Variants during Mercaptopurine Treatment of Swedish Pediatric Patients with Acute Lymphoblastic Leukemia." The Journal of Pediatrics 216, no. : 150-157.e1.

Original article
Published: 01 January 2020 in Clinical & Translational Immunology
Reads 0
Downloads 0

Objectives Loss of vaccine‐induced antibodies (Abs) after chemotherapy against paediatric acute lymphoblastic leukaemia (ALL) is common and often necessitates re‐immunisation after cessation of treatment. Even so, some ALL survivors fail to mount or to maintain protective Abs. Germinal centres (GCs) are clusters of proliferating B cells in follicles of secondary lymphoid tissues (SLTs) formed during adaptive immune responses and the origins of long‐lived memory B and plasma cells that are the source of Abs. Furthermore, productive GC reactions depend on T follicular helper (TFH) cells. To understand why chemotherapy induces deficits in Ab responses, we examined how SLTs were affected by chemotherapy. Methods Rhesus macaques were infused with either three cycles of the anthracycline doxorubicin or saline, followed by immunisation with a de novo and booster antigen. Spleen and lymph nodes were removed, and memory B, bulk T and TFH cells were examined. Results Despite adequate GC morphology, a diminished memory and IgG+ B‐cell population along with diminished total and booster vaccine‐specific IgG‐producing memory B cells were noted in the spleens of macaques with past doxorubicin exposure compared to the saline‐treated controls (P < 0.05). Intact bulk T and TFH cells were found in the SLTs of treated macaques, which displayed higher CD40L upregulation capacity by their splenic CXCR5+ helper T cells (P < 0.01). In contrast to the spleen, the immune cell populations studied were comparable between the lymph nodes of both saline‐ and doxorubicin‐treated macaques. Conclusion Our findings suggest that the splenic memory B‐cell subset, compared to its lymph node counterpart, is more severely altered by anthracycline treatment.

ACS Style

Gintare Lasaviciute; Andréas L Bricaud; Fredrika Hellgren; Hanna M Ingelman‐Sundberg; Staffan Eksborg; Margreet Jonker; Krista G Haanstra; Ida Hed Myrberg; Eva Sverremark‐Ekström; Karin Loré; Shanie Saghafian‐Hedengren; Anna Nilsson. Deficits in the IgG + memory B‐cell recovery after anthracycline treatment is confined to the spleen of rhesus macaques. Clinical & Translational Immunology 2020, 9, e1150 .

AMA Style

Gintare Lasaviciute, Andréas L Bricaud, Fredrika Hellgren, Hanna M Ingelman‐Sundberg, Staffan Eksborg, Margreet Jonker, Krista G Haanstra, Ida Hed Myrberg, Eva Sverremark‐Ekström, Karin Loré, Shanie Saghafian‐Hedengren, Anna Nilsson. Deficits in the IgG + memory B‐cell recovery after anthracycline treatment is confined to the spleen of rhesus macaques. Clinical & Translational Immunology. 2020; 9 (7):e1150.

Chicago/Turabian Style

Gintare Lasaviciute; Andréas L Bricaud; Fredrika Hellgren; Hanna M Ingelman‐Sundberg; Staffan Eksborg; Margreet Jonker; Krista G Haanstra; Ida Hed Myrberg; Eva Sverremark‐Ekström; Karin Loré; Shanie Saghafian‐Hedengren; Anna Nilsson. 2020. "Deficits in the IgG + memory B‐cell recovery after anthracycline treatment is confined to the spleen of rhesus macaques." Clinical & Translational Immunology 9, no. 7: e1150.

Journal article
Published: 23 December 2019 in The Journal of Infectious Diseases
Reads 0
Downloads 0
ACS Style

Anna Nilsson; Francesca Chiodi. Early Antiretroviral Therapy May Preserve Vaccine Responses in Human Immunodeficiency Virus-Infected Patients by Preventing Damage to Long-Lived Plasma Cells. The Journal of Infectious Diseases 2019, 222, 176 -179.

AMA Style

Anna Nilsson, Francesca Chiodi. Early Antiretroviral Therapy May Preserve Vaccine Responses in Human Immunodeficiency Virus-Infected Patients by Preventing Damage to Long-Lived Plasma Cells. The Journal of Infectious Diseases. 2019; 222 (2):176-179.

Chicago/Turabian Style

Anna Nilsson; Francesca Chiodi. 2019. "Early Antiretroviral Therapy May Preserve Vaccine Responses in Human Immunodeficiency Virus-Infected Patients by Preventing Damage to Long-Lived Plasma Cells." The Journal of Infectious Diseases 222, no. 2: 176-179.

Article
Published: 01 December 2019 in Pediatric Infectious Disease Journal
Reads 0
Downloads 0

Several studies have shown an increasing trend in pediatric Clostridium difficile infection (CDI). However, the Public Health Agency in Sweden reports a decreasing incidence of CDI in the Swedish population since 2007. The main aim of this study is to analyze the epidemiology of CDI in children. Retrospective chart-review of patients 1 to difficile Three hundred twenty-eight positive tests in 206 patients were included of which 259 (79.0%) tests were new episodes and 69 (21.0%) recurrences. In 63/206 (30.6%) children, >1 episode of CDI was recorded. The mean infection rate was 8.5/100,000 children. There was an overall increasing trend in CDI-rate July 2010–June 2018, however not statistically significant (P = 0.061) nor for the incidence in HA-CDI (P = 0.720) or CA-CDI (P = 0.179). Underlying medical conditions were present in 226/259 (87.3%) new episodes of which the most common was malignancy. Of the new episodes, 188/259 (72.6%) were HA-CDI and 46/259 (17.8%) were CA-CDI. There was an increasing trend in CDI in children in Sweden from 2010 to 2018, although not statistically significant. CDI was associated with comorbid conditions and repeated episodes were common.

ACS Style

Lovisa Malmqvist; Måns Ullberg; Ida Hed Myrberg; Anna Nilsson. Clostridium difficile Infection in Children. Pediatric Infectious Disease Journal 2019, 38, 1208 -1213.

AMA Style

Lovisa Malmqvist, Måns Ullberg, Ida Hed Myrberg, Anna Nilsson. Clostridium difficile Infection in Children. Pediatric Infectious Disease Journal. 2019; 38 (12):1208-1213.

Chicago/Turabian Style

Lovisa Malmqvist; Måns Ullberg; Ida Hed Myrberg; Anna Nilsson. 2019. "Clostridium difficile Infection in Children." Pediatric Infectious Disease Journal 38, no. 12: 1208-1213.

Regular article
Published: 20 October 2019 in Acta Paediatrica
Reads 0
Downloads 0

Aim To identify the incidence, etiology and prognosis of acute peripheral facial nerve palsy in children in the Borrelia high‐endemic region of Stockholm. Methods The present study identified children from 0‐18 years of age who visited a pediatric emergency department for acute peripheral facial nerve palsy during a one‐year period from 2014‐2015. Data was collected retrospectively. The Sunnybrook and House‐Brackmann facial grading systems were used to measure clinical outcome. Results A total of 77 children were identified with facial nerve palsy; an estimated incidence of 30 per 100,000 children/year. Forty‐five children (58 %) were diagnosed with neuroborreliosis, 28 (36 %) with idiopathic facial nerve palsy and four (6 %) with other rarer causes. Neuroborreliosis was common from June‐November and mainly seen in children below 10 years of age. Six patients (8 %) had remaining symptoms at least 3 months after onset; three had idiopathic facial palsy and were all older than 10 years, one had neuroborreliosis and two had other causes. Conclusion Neuroborreliosis and idiopathic facial palsy were the major causes of facial nerve palsy during the study period. Neuroborreliosis associated facial palsy had a seasonal variation and dominated in younger ages.

ACS Style

Sigurdur Arnason; Malou Hultcrantz; Anna Nilsson; Åsa Laestadius. Peripheral facial nerve palsy in children in a Borrelia high‐endemic area, a retrospective follow‐up study. Acta Paediatrica 2019, 109, 1229 -1235.

AMA Style

Sigurdur Arnason, Malou Hultcrantz, Anna Nilsson, Åsa Laestadius. Peripheral facial nerve palsy in children in a Borrelia high‐endemic area, a retrospective follow‐up study. Acta Paediatrica. 2019; 109 (6):1229-1235.

Chicago/Turabian Style

Sigurdur Arnason; Malou Hultcrantz; Anna Nilsson; Åsa Laestadius. 2019. "Peripheral facial nerve palsy in children in a Borrelia high‐endemic area, a retrospective follow‐up study." Acta Paediatrica 109, no. 6: 1229-1235.

Article
Published: 01 September 2019 in Pediatric Infectious Disease Journal
Reads 0
Downloads 0

Antimicrobial resistance is increasing, and data on antimicrobial use in Swedish children are limited. We evaluated trends in antimicrobial use and attempted to identify targets for improving the quality of antimicrobial prescribing in a tertiary care center. One-day hospital-wide point prevalence surveys were conducted 8 times during 2003–2017 at Astrid Lindgren Children’s Hospital. Children Among 946 admitted patients, 36% (336/946) received antimicrobial treatment. The total number of prescriptions increased (P = 0.031), but the proportion of patients treated remained unchanged. The proportion of patients receiving prophylactic treatment increased from 11% to 43% (P = 0.005). The rate of hospital-acquired infections remained unchanged. The primary indication for antimicrobial therapy was sepsis, fever of unknown origin, or fever in neutropenia, followed by intra-abdominal infections and pneumonia. The most frequently used antibiotics were cephalosporins, but consumption decreased, and in 2017 piperacillin-tazobactam was the most frequently used. Antimicrobial use was generally appropriate, although guidelines were often missing. The number of pediatric hospital beds decreased, and the bed occupancy was 71% (101/142) in 2003 and 121% (110/91) in 2017. The patient mix changed toward more patients with underlying risk factors for infectious diseases. Antimicrobial use changed during the study period, mainly due to increased prophylactic use in at-risk patients. Antimicrobial stewardship programs including infection control interventions and increasing the availability of guidelines may reduce and improve antimicrobial therapy.

ACS Style

Joachim Luthander; Rutger Bennet; Anna Nilsson; Margareta Eriksson. Antimicrobial Use in a Swedish Pediatric Hospital. Pediatric Infectious Disease Journal 2019, 38, 929 -933.

AMA Style

Joachim Luthander, Rutger Bennet, Anna Nilsson, Margareta Eriksson. Antimicrobial Use in a Swedish Pediatric Hospital. Pediatric Infectious Disease Journal. 2019; 38 (9):929-933.

Chicago/Turabian Style

Joachim Luthander; Rutger Bennet; Anna Nilsson; Margareta Eriksson. 2019. "Antimicrobial Use in a Swedish Pediatric Hospital." Pediatric Infectious Disease Journal 38, no. 9: 929-933.

Journal article
Published: 01 June 2019 in Vaccine
Reads 0
Downloads 0

Biological therapy options for the treatment of rheumatic disease target molecules that can affect the cross-talk between innate and adaptive immune responses upon vaccination. Influenza vaccination in children with rheumatic disease has been recommended, but there are only sparse data on the quality of vaccine responses from pediatric patients treated with biological therapy. We conducted an influenza vaccine study over 3 consecutive seasons where the antibody response to TIV was evaluated in children with PRD (n = 78), including both non-treated (n = 17) and treated (with methotrexate, TNF-inhibitors with or without methotrexate, or IL-inhibitors, n = 61) children as well as healthy age-matched controls (n = 24). Peripheral B cells, T and NK cell populations, as well as CXCR5+ (follicular) helper T cells (TFH) and chemokines involved in antibody responses were assessed prior to immunization in the same cohort. Data on disease duration, therapy and data on previous influenza vaccinations were retrieved. The proportion of circulating TFH cells were significantly lower in non-treated children with PRD compared to treated patients and healthy controls. The significantly lower proportion of TFH cells was mirrored by a marked significant increase in CXCL13 serum level, the ligand for CXCR5, with higher levels in non-treated children with PRD compared to treated patients and healthy controls. However, the proportion of TFH cells or CXCL13 level at the time of vaccination was not a predictor of the antibody response to TIV in this cohort of children. Children with PRD had an overall similar response to TIV as healthy children. Although not significant, children treated with TNF-inhibitors differed as a few children remained seronegative towards H3N2- and influenza B viruses after immunization. Our data show that children with PRD respond to TIV as healthy children. Furthermore, plasma CXCL13 levels did not correlate to the proportion of TFH cells in blood prior to immunisation, or to antibody responses following immunization.

ACS Style

Åsa Laestadius; Hanna M. Ingelman-Sundberg; Ida Hed Myrberg; Anna Verme; Erik Sundberg; Brunhilde Schweiger; Shanie Saghafian-Hedengren; Anna Nilsson. Altered proportions of circulating CXCR5+ helper T cells do not dampen influenza vaccine responses in children with rheumatic disease. Vaccine 2019, 37, 3685 -3693.

AMA Style

Åsa Laestadius, Hanna M. Ingelman-Sundberg, Ida Hed Myrberg, Anna Verme, Erik Sundberg, Brunhilde Schweiger, Shanie Saghafian-Hedengren, Anna Nilsson. Altered proportions of circulating CXCR5+ helper T cells do not dampen influenza vaccine responses in children with rheumatic disease. Vaccine. 2019; 37 (28):3685-3693.

Chicago/Turabian Style

Åsa Laestadius; Hanna M. Ingelman-Sundberg; Ida Hed Myrberg; Anna Verme; Erik Sundberg; Brunhilde Schweiger; Shanie Saghafian-Hedengren; Anna Nilsson. 2019. "Altered proportions of circulating CXCR5+ helper T cells do not dampen influenza vaccine responses in children with rheumatic disease." Vaccine 37, no. 28: 3685-3693.

Regular article
Published: 01 April 2019 in Acta Paediatrica
Reads 0
Downloads 0

Aim To determine the urinary tetranor‐prostaglandin E2 metabolite in healthy infants and in hospitalized infants with upper and lower respiratory tract as well as gastrointestinal infections. Methods A prospective cross‐sectional study to determine baseline concentrations of urinary tetranor‐prostaglandin E2 metabolite was conducted in 81 healthy infants aged 1 week to 1 year and in 142 hospitalized infants with infections. Prostaglandin metabolite levels were measured by liquid chromatography tandem mass spectrometry. Results In healthy infants, urinary prostaglandin E2 metabolite levels decreased with age and did not differ between girls and boys. Infections of the lower respiratory (n=78) and gastrointestinal tract (n=12) correlated with increased levels of the prostaglandin E2 metabolite. In contrast, infants hospitalized with upper respiratory tract infections (n=23) exhibited similar levels as healthy, age‐matched controls. Lower prostaglandin E2 levels were found after treatment with acetaminophen in hospitalized children. Prostaglandin E2 metabolite levels did not correlate with length of hospitalization or need for respiratory support. Conclusion This study first provides normal levels of urinary prostaglandin E2 metabolite in infants and secondly demonstrates elevated levels in hospitalized children with lower respiratory tract and gastrointestinal infections. This article is protected by copyright. All rights reserved.

ACS Style

Johan Hamrin; Monica Perez‐Manzo; Helena Idborg; Per‐Johan Jakobsson; Lars Björk; Margareta Eriksson; Anna Nilsson; Eric Herlenius; M Monica Perez‐Manzo. Urinary PGE 2 metabolite levels in hospitalised infants with infections compared to age‐matched controls. Acta Paediatrica 2019, 108, 1879 -1886.

AMA Style

Johan Hamrin, Monica Perez‐Manzo, Helena Idborg, Per‐Johan Jakobsson, Lars Björk, Margareta Eriksson, Anna Nilsson, Eric Herlenius, M Monica Perez‐Manzo. Urinary PGE 2 metabolite levels in hospitalised infants with infections compared to age‐matched controls. Acta Paediatrica. 2019; 108 (10):1879-1886.

Chicago/Turabian Style

Johan Hamrin; Monica Perez‐Manzo; Helena Idborg; Per‐Johan Jakobsson; Lars Björk; Margareta Eriksson; Anna Nilsson; Eric Herlenius; M Monica Perez‐Manzo. 2019. "Urinary PGE 2 metabolite levels in hospitalised infants with infections compared to age‐matched controls." Acta Paediatrica 108, no. 10: 1879-1886.

Journal article
Published: 23 March 2019 in Vaccine
Reads 0
Downloads 0

Successful vaccinations rely on antibody responses. Chemokine receptors play an important role in B cell homing to differentiation niches. We assessed CXCR4, CXCR5 and CCR6 expression on B cells during HIV-1 infection and relate it to antibody responses against a HBV vaccine. Blood was obtained from 54 healthy controls and 38 ART-treated HIV-1 infected children, aviremic (n = 25) or viremic (n = 13). Frequency of naïve and memory B cell subsets was studied by immunostaining. Homing capacity of blood B cells to lymphoid and inflamed tissues was evaluated through CXCR4, CXCR5 and CCR6 expression. Plasma CXCL12 and CXCL13 levels and antibody titers to HBV antigen were determined by ELISA. The frequency of naïve and resting memory (RM) B cells in ART treated children was comparable to control subjects. Profound defects in the homing phenotypes of naïve and memory B cells were identified, with lower CXCR4 and CXCR5 expression. Increased CXCL13 levels were observed in infected children, inversely correlating to CXCR5 expressing B cell subpopulations. Antibody titers to HBV vaccine correlated with frequency of resting and switched memory B cells in HIV-1 infected children. Homing defects of B cells to germinal center may underlie impaired vaccine responses during HIV-1 infection.

ACS Style

Yonas Bekele; Mahlet Lemma; Kidist Bobosha; Desalegn Yibeltal; Aikaterini Nasi; Meseret Gebre; Anna Nilsson; Abraham Aseffa; Rawleigh Howe; Francesca Chiodi. Homing defects of B cells in HIV-1 infected children impair vaccination responses. Vaccine 2019, 37, 2348 -2355.

AMA Style

Yonas Bekele, Mahlet Lemma, Kidist Bobosha, Desalegn Yibeltal, Aikaterini Nasi, Meseret Gebre, Anna Nilsson, Abraham Aseffa, Rawleigh Howe, Francesca Chiodi. Homing defects of B cells in HIV-1 infected children impair vaccination responses. Vaccine. 2019; 37 (17):2348-2355.

Chicago/Turabian Style

Yonas Bekele; Mahlet Lemma; Kidist Bobosha; Desalegn Yibeltal; Aikaterini Nasi; Meseret Gebre; Anna Nilsson; Abraham Aseffa; Rawleigh Howe; Francesca Chiodi. 2019. "Homing defects of B cells in HIV-1 infected children impair vaccination responses." Vaccine 37, no. 17: 2348-2355.

Editorial
Published: 12 October 2018 in Acta Paediatrica
Reads 0
Downloads 0
ACS Style

Anna Nilsson. What benefits do immunocompromised children get from the varicella zoster virus vaccination? Acta Paediatrica 2018, 107, 2046 -2047.

AMA Style

Anna Nilsson. What benefits do immunocompromised children get from the varicella zoster virus vaccination? Acta Paediatrica. 2018; 107 (12):2046-2047.

Chicago/Turabian Style

Anna Nilsson. 2018. "What benefits do immunocompromised children get from the varicella zoster virus vaccination?" Acta Paediatrica 107, no. 12: 2046-2047.

Regular article
Published: 01 August 2018 in Acta Paediatrica
Reads 0
Downloads 0

Aim Blood analyses containing pre‐analytical errors (PAEs) are hazardous for patients. This study investigated the frequency of PAEs in blood analysis and the corresponding quality indicators of the sampling process in Swedish paediatric tertiary care. Methods Data was retrieved from the laboratory at Astrid Lindgren Children's Hospital between 2013 and 2014. Pre‐analytical blood sampling performance was analysed according to the Six Sigma scale, ranging from 0‐6 (933,137 ‐ 3.4 defects per million). Results Of the 1,148,716 analyses, 61,656 (5.4%) were rejected due to PAEs. The PAEs ranged between hospital specialities from 1.9% to 9.4% (p < 0.001) and work shift times, from 6.0% in the day to 5.7% in the evening and 4.3% at night (p values < 0.001). Clotting was the most prominent error (51.3%), affecting mostly haematology and coagulation analyses. Incorrectly filled samples represented almost 25% of all PAEs, with effects on chemistry, haematology and coagulation analyses. The sigma score for the overall pre‐analytical phase (3.2) corresponded to 44,565 defects per million. Conclusion Samples with PAEs were frequently clotted and insufficiently filled and the distribution of errors varied within working shifts and specific analyses. The overall quality control in paediatric blood sampling was barely acceptable. This article is protected by copyright. All rights reserved.

ACS Style

Henrik Hjelmgren; Anna Nilsson; Nina Andersson-Papadogiannakis; Carina Ritzmo; Britt-Marie Ygge; Björn Nordlund. Retrospective study showed that blood sampling errors risked children's well-being and safety in a Swedish paediatric tertiary care. Acta Paediatrica 2018, 108, 522 -528.

AMA Style

Henrik Hjelmgren, Anna Nilsson, Nina Andersson-Papadogiannakis, Carina Ritzmo, Britt-Marie Ygge, Björn Nordlund. Retrospective study showed that blood sampling errors risked children's well-being and safety in a Swedish paediatric tertiary care. Acta Paediatrica. 2018; 108 (3):522-528.

Chicago/Turabian Style

Henrik Hjelmgren; Anna Nilsson; Nina Andersson-Papadogiannakis; Carina Ritzmo; Britt-Marie Ygge; Björn Nordlund. 2018. "Retrospective study showed that blood sampling errors risked children's well-being and safety in a Swedish paediatric tertiary care." Acta Paediatrica 108, no. 3: 522-528.