Sykdomsforløp blant pasienter innlagt på Bærum sykehus med delta- og omikronvariantene av SARS-CoV-2-viruset.

BACKGROUND: Waves of infection have formed the pattern of the COVID-19 pandemic. A wave dominated by the delta variant of the SARS-CoV-2 virus in autumn 2021 was superseded by the omicron variant over the course of a few weeks around Christmas. We describe how this transition affected the population of patients admitted to a Norwegian local hospital with COVID-19. MATERIAL AND METHOD: All patients admitted to Bærum Hospital with confirmed SARS-CoV-2 virus were included in a quality study which aimed to describe patient characteristics and clinical course. We present patients admitted in the periods 28 June 2021-31 December 2021 and 1 January 2022-12 June 2022, described here as the delta wave and the omicron wave. RESULTS: The SARS-CoV-2-virus was confirmed in a total of 144 patients who were admitted during the delta wave, and in 261 patients during the omicron wave, where 14/144 (10 %) and 89/261 (34 %) were admitted for reasons other than COVID-19. Patients with COVID-19 during the delta wave were younger on average (59 vs. 69 years) and had a lower Charlson comorbidity index score (2.6 vs. 4.9) and a lower Clinical Frailty Scale score (2.8 vs. 3.7) than patients in the omicron wave. Among 302/405 patients admitted with COVID-19 as the principal diagnosis, 88/130 (68 %) patients had respiratory failure during the delta wave and 59/172 (34 %) during the omicron wave, with a median number of 8 bed days (interquartile range 5-15) and 5 (interquartile range 3-8). INTERPRETATION: The transition from the wave of infection that was dominated by the delta variant of the SARS-CoV-2 virus to the wave dominated by the omicron variant had a considerable effect on the characteristics and clinical course of patients admitted to hospital with SARS-CoV-2 infection.

Three waves of COVID-19 in a Norwegian local hospital. / Tre bølger med covid-19 på et norsk lokalsykehus.

BACKGROUND: The objective of this article is to summarise the course of illness and treatment for patients with COVID-19 admitted to Bærum Hospital since the start of the pandemic. MATERIAL AND METHOD: We present data from a prospective observational study with the aim of systematising knowledge about patients admitted because of COVID-19. All patients admitted to Bærum Hospital up to and including 28 June 2021 were included. The results are presented for three waves of admissions: 9 March-23 June 2020, 21 September 2020-28 February 2021 and 1 March-28 June 2021. RESULTS: A total of 300 patients, divided into 77, 101 and 122 in the three waves respectively, were admitted because of COVID-19. The number of hospital deaths during the three waves was 14 (18 %), 11 (11 %) and 5 (4 %) respectively. The average age of the patients was 67.6 years in the first wave and 53.3 years in the third wave. Altogether 204 patients (68 %) received medical oxygen or ventilation support, and 31 of these (10 % of all the patients) received invasive ventilation support. Non-invasive ventilation support was used as the highest level of treatment in 4 (8 %), 9 (13 %) and 17 (20 %) patients with respiratory failure in the three waves respectively. In the second and third wave, 125 out of 152 patients with respiratory failure (82 %) were treated with dexamethasone. INTERPRETATION: Differences in patient characteristics and changes to treatment methods, such as the use of dexamethasone and non-invasive ventilation support, may have contributed to the apparent fall in mortality from the first to the third wave. Conditions that are not registered in the study, such as vaccination status, may also have impacted on mortality.

An immunosuppressed woman in her seventies with night sweats and weight loss. / En immunsupprimert kvinne i 70-årene med nattesvette og vekttap.

BACKGROUND: Candidatus Neoehrlichia mikurensis is an emerging tick-borne pathogen with widespread distribution in Ixodes ricinus ticks in Europe and Asia. It has been found to cause chronic infections, particularly in immunosuppressed individuals. Common symptoms include relapsing fever, night sweats and thromboembolic episodes, likely due to endovascular infection. CASE PRESENTATION: A patient in her seventies developed persistent night sweats and moderate weight loss that persisted for four months prior to evaluation. There was no history of fever or organ-specific symptoms. Prior diseases included a ten-year history of rheumatoid arthritis treated with rituximab. Initial workup revealed moderately increased acute phase reactants, but no evidence of malignant disease or endocrine abnormalities. Night sweats persisted, and after eight months moderate splenic enlargement was observed. PCR revealed presence of Candidatus Neoehrlichia mikurensis DNA, and symptoms resolved promptly after initiation of oral doxycycline treatment. INTERPRETATION: Infection with anaplasmataceae such as Candidatus Neoehrlichia mikurensis can present with non-specific constitutive symptoms. In this case, persistent night sweats and moderate weight loss were the only manifestations over an eight-month period. Diagnosis is readily established by PCR analysis of whole blood, but a high degree of suspicion and careful assessment of potential exposure is required for timely diagnosis.

Complications and mortality among patients hospitalised with COVID-19. / Komplikasjoner og dødelighet blant pasienter innlagt med covid-19.

BACKGROUND: The course of disease, complications and hospital mortality among patients with COVID-19 admitted to Norwegian hospitals has not been widely described. The purpose of this study was to survey patients with COVID-19 admitted to a local hospital. MATERIAL AND METHOD: The data were retrieved from a prospective observational study of all patients admitted with COVID-19 to Bærum Hospital since the start of the coronavirus outbreak. RESULTS: A total of 73 patients with COVID-19 admitted in the period 9 March 2020-7 May 2020 were included. The mean age was 67.9 years, and 43 patients (59 %) were men. The average number of days hospitalised was 10.1. Altogether 19 patients (26 %) had a very severe course of disease, and 14 (19 %) died during their stay in hospital. The mean age among the patients who died was 79.5 years. A total of 49 patients (67 %) had hypoxaemia and required oxygen therapy for an average of 10.1 days. Of these, 9 patients were given invasive respiratory support for a median 18 days. Symptoms of delirium occurred in 26 patients (36 %) and was the most frequent non-respiratory complication. INTERPRETATION: The majority of the patients hospitalised with COVID-19 needed prolonged oxygen therapy, and there was a high incidence of severe complications.

COVID-19: Symptoms, course of illness and use of clinical scoring systems for the first 42 patients admitted to a Norwegian local hospital. / Covid-19: Symptomer, forløp og bruk av kliniske skåringsverktøy hos de 42 første pasientene innlagt på et norsk lokalsykehus.

BACKGROUND: The COVID-19 outbreak is presenting the health system with new challenges, and there is a great need for knowledge about symptoms, clinical findings and course of illness in patients admitted to Norwegian hospitals with COVID-19. MATERIAL AND METHOD: In this observational qualitative study, all patients admitted to a Norwegian local hospital (Bærum Hospital) with proven COVID-19 infection were included consecutively from the start of the outbreak. We present here patient characteristics, symptoms, clinical findings, experience of using clinical scoring systems and course of illness based on data in medical records. RESULTS: In the period 9-31 March 2020, 42 patients, of whom 28 (67 %) were men, were admitted to hospital with COVID-19 infection. The median age was 72.5 years (range 30-95). Fever (79 %), reduced general condition (79 %), dyspnoea (69 %) and cough (67 %) were the most common symptoms. A total of nine patients (21 %) had a critical course of illness with treatment in the Intensive Care Department and/or death during their stay in hospital. Patients with a critical course had a higher average score on National Early Warning Score 2 (NEWS2) on admission (7.6 vs 3.3). Only one of the most severely ill patients scored ≥ 2 on the quick Sepsis-related Organ Failure Assessment (qSOFA) on admission. INTERPRETATION: Most patients admitted to our hospital with COVID-19 had a fever and respiratory tract symptoms. A high percentage of patients had a critical course of illness. A NEWS2 score of ≥ 5 on admission may be a useful aid in identifying patients at risk of a critical course of illness, while CRB-65 and qSOFA score ≥ 2 proved to be of little usefulness for this purpose in our material.

Pulmonary embolism in cases of COVID-19. / Lungeembolisme ved covid-19.

BACKGROUND: Emerging reports indicate a high incidence of venous thromboembolism in patients hospitalised for SARS-CoV-2 pneumonia during the spring 2020 pandemic. The pronounced pulmonary and systemic inflammatory responses observed in these patients may contribute to a transient hypercoagulable state. In this setting, pulmonary embolism may cause further respiratory distress and clinical deterioration. CASE PRESENTATION: We describe the clinical course of three patients admitted with SARS-CoV-2 infection and respiratory distress, where pulmonary embolism was detected during the course of the hospitalisation. Two of the cases occurred despite early institution of standard dosage of low molecular weight heparin thromboprophylaxis, and in one case, pulmonary embolism was diagnosed during the convalescent phase of an otherwise benign COVID-19 disease course. INTERPRETATION: These cases highlight the importance of awareness of the potentially increased incidence of venous thromboembolism in COVID-19 disease. Further research is required to establish appropriate clinical management guidelines for prevention of thromboembolic complications in COVID-19.

Tuberculosis outbreak in Eastern Norway.

BACKGROUND: Tuberculosis is a rare disease in Norway, especially among those who are born here. Contact tracing for cases of pulmonary tuberculosis is essential to find others who are ill or infected, and to prevent further infection. This article describes the investigation of an outbreak in which many of those infected or ill were Norwegian adolescents. MATERIAL AND METHOD: Nine persons directly or indirectly associated with the same educational institution were diagnosed with tuberculosis in 2013. Genetic testing of tuberculosis bacteria linked a further 13 cases of the disease reported in Eastern Norway during the period 2009-2013 to the outbreak. Information from the Norwegian Surveillance System for Communicable Diseases (MSIS) was used to investigate the outbreak, and information was also retrieved on exposure and contact networks. RESULTS: The first patient at the educational institution had long-term symptoms before diagnosis. Contact tracing for this case included 319 persons, of whom eight were ill, 49 infected and 37 received preventive therapy. The extent of contract tracing for the remaining 21 cases varied and included a total of 313 persons, of whom two were found to be ill (included in the 21 cases), 30 were infected and 12 received preventive therapy. INTERPRETATION: Delayed diagnosis led to an unusually large tuberculosis outbreak in a Norwegian context. The extent of contact tracing varied with no obvious relation to the infectiousness of the index patient. The outbreak demonstrates the importance of continued vigilance with regard to tuberculosis as a differential diagnosis, also among patients born in Norway.

[Actinomycosis as a complication of intrauterine device use]. / Aktinomykose som komplikasjon til spiralbruk.

BACKGROUND: Infections in the female pelvis can present clinically in various ways and the causing agent can be difficult to trace. In this paper we present updated knowledge about infections caused by the bacterium Actinomycosis in relation to intrauterine device use. MATERIAL AND METHODS: The article is based on own clinical experience and literature identified through a non-systematic search in PubMed. RESULTS: Actinomycosis in the female pelvis is a rare disease and the pathogenesis is still obscure. The incidence in Scandinavia has not been established. The infection can cause tumor-like structures resulting in bowel and urinary obstruction. The bacteria can be difficult to detect. Preferably the agent should be demonstrated in a specimen from the infected area to ensure the correct diagnosis. However, Actinomyces is a normal inhabitant of the gastrointestinal tract and is also present in 5 % of cervical smears from healthy women. The optimal treatment of actinomycosis is long-term treatment with penicillin, alone or in addition to surgery. INTERPRETATION: To avoid unnecessary and potentially difficult surgical procedures, actinomycosis should be a differential diagnosis when women with a longstanding intrauterine device develop signs of infection in addition to a pelvic mass. Intrauterine devices should be replaced every fifth year and should be removed at menopause.

[An outbreak of methicillin-resistant Staphylococcus aureus infection in a maternity ward]. / Meticillinresistent Staphylococcus aureus-infeksjon i en barselavdeling.

BACKGROUND: Staphylococcus aureus is a frequent cause of serious infections. Methicillin-resistant S. aureus (MRSA) are resistant to almost all types of beta-lactam antibiotics and therefore represent a substantial medical problem. MATERIAL AND METHOD: In April 2006, the Department of Obstetrics at the Asker and Baerum hospital had an outbreak of MRSA that affected four newborns. The source for the infection was sought among family members, other patients and employees, and eradication was attempted. RESULTS: An employee was identified as the probable infectious source. Subsequent investigation identified 13 individuals infected by the same MRSA clone, which was Panton-Valentine-leukocidin (PVL) positive and therefore clearly a pathogen. 10 of the patients had MRSA disease, with 21 months between the first and the last identified case. For 5 of 13 patients MRSA was still detectable after the first attempt of eradication. For 2 patients, including one of the newborns, eradication has so far been unsuccessful and a third patient has acquired a new abscess after one year. INTERPRETATION: Issues connected to MRSA-screening of close contacts and eradication are resource-demanding and require careful consideration of strategy, especially for small children and families with chronic MRSA carriers. Updated detailed national guidelines for MRSA management are needed.

Dolosigranulum pigrum causing biomaterial-associated arthritis.

Dolosigranulum pigrum is a gram-positive, catalase-negative bacteria rarely associated with disease. We report a case of biomaterial-associated arthritis in an immunocompetent patient caused by D. pigrum. The organism was isolated from a synovial biopsy specimen and its identity confirmed by 16S rRNA gene sequencing.