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The effect of direct‐acting antiviral (DAA) therapy on extracellular matrix (ECM) turnover, a prominent feature of chronic hepatitis C (CHC), is unknown. ECM protein degradation and formation generate fragments reflecting the tissue turnover balance when quantified in the blood. PRO‐C3 and PRO‐C4 reflect type III and IV collagen formation; C3M and C4M are degradation markers of type III and IV. We aimed to assess the markers' dynamics with DAA therapy in CHC patients. Plasma PRO‐C3, PRO‐C4, C3M and C4M were assessed before, during and up till one year after 12‐24 weeks of DAA therapy in 77 CHC patients with advanced fibrosis (n = 14) or cirrhosis (n = 63). Liver stiffness was evaluated using transient elastography. PRO‐C3, C3M and C4M levels decreased significantly (P <.00001) while PRO‐C4 was unchanged (P =.20) during the study period. There was a steep decrease in the PRO‐C3/C3M ratio during DAA therapy and follow‐up (P <.02). The PRO‐C4/C4M ratio was unchanged (P >.27). The dynamics of the collagen markers behaved similarly between patients with advanced fibrosis and cirrhosis. However, the cirrhosis patients had >20% higher levels of C3M, PRO‐C4 and C4M at all time points (P <.05). The collagen markers correlated with liver stiffness at baseline and follow‐up.Markers of type III and IV collagen formation and degradation decreased during and after successful DAA therapy in CHC patients with advanced liver disease, and associated with disease severity. These results indicate an altered balance between collagen formation and degradation after viral clearance suggesting favourable effects on liver fibrosis. [ABSTRACT FROM AUTHOR]

Sofosbuvir‐based direct‐acting antiviral (DAA) therapy generally cures chronic hepatitis C (CHC) infections, however, the effects on the underlying liver disease and the potential rate of recovery are unclear. We aimed to investigate the effects of DAA therapy on liver inflammation, fibrosis, metabolic function and cognitive function and the time course in CHC patients with advanced liver disease. Seventy‐one CHC patients with advanced liver disease were studied before, during and one year after successful sofosbuvir‐based DAA therapy. Liver inflammation was assessed by plasma sCD163 and sMR levels (ELISA), fibrosis by liver stiffness (transient elastography), function by galactose elimination capacity (GEC) and cognitive performance by continuous reaction time (CRT). During DAA therapy, we observed a rapid sCD163 decline from baseline to end of treatment (6.9 vs 3.8 mg/L, P <.0001), whereas the change in sMR was more subtle (0.37 vs 0.30 mg/L, P <.0001). Liver stiffness decreased by 20% at end of treatment (17.8 vs 14.3 kPa, P <.0001), together suggesting rapid resolution of liver inflammation. One year after treatment, liver stiffness decreased by an additional 15% (P <.0001), suggestive of fibrosis regression. The GEC improved at follow‐up (all: 1.74 vs 1.98 mmol/min), mainly at 12 weeks post‐treatment, both in patients with cirrhosis (n = 56) and those with advanced liver fibrosis (n = 15) (P <.001). The CRT improved at one‐year follow‐up (1.86 vs 2.09, P =.04). In conclusion, successful DAA therapy of CHC proves beneficial in advanced liver disease, with an initial rapid resolution of liver inflammation and a subsequent gradual but steady improvement in liver fibrosis, metabolic liver function and reaction time. [ABSTRACT FROM AUTHOR]

Bank S, Nielsen HM, Hoyer Mathiasen B, Christiansen Leth D, Hagelskjær Kristensen L, Prag J. Fusobacterium necrophorum- detection and identification on a selective agar. APMIS 2010; 118: 994-9. Within the last decade, Fusobacterium necrophorum subsp. funduliforme has been considered a clinically important pathogen causing pharyngitis especially in adolescents and young adults. F. necrophorum pharyngitis can progress into Lemierre's syndrome, which is a severe and life-threatening infection. However, throat swabs are not cultured anaerobically in the routine and even if cultured anaerobically, it can be difficult to identify F. necrophorum from the normal flora of the throat. F. necrophorum is therefore often overlooked as the cause of pharyngitis. In our laboratory, a F. necrophorum selective agar has been developed containing vancomycin and nalidixin, which inhibit the growth of most Gram-positive and many Gram-negative bacteria, respectively. β-haemolysis of horse blood can be detected, which further facilitates the detection and identification of F. necrophorum. The F. necrophorum selective agar was evaluated against a quantitative real-time polymerase chain reaction assay and shown to have a significantly higher sensitivity for detecting F. necrophorum than the anaerobic agar commonly used in Denmark. Furthermore, the F. necrophorum selective agar does not require experienced laboratory technicians, require fewer subcultures, is probably less expensive and is faster to perform than other culture methods. [ABSTRACT FROM AUTHOR]

In Denmark, most cases of nephropathia epidemica (NE) occur on the island of Funen and are caused by the transmission of Puumala hantavirus to humans from the bank vole. This is a case report comprising four cases of NE occurring in close vicinity to Silkeborg, Jutland, where the disease is not usually seen. NE is characterised by increased vascular permeability, and patients present with flu-like symptoms progressing to acute kidney injury. When NE occurs in areas where it has not traditionally been endemic, awareness of the disease is important to ensure proper diagnosis.

Laursen TL, Sandahl TD, Kazankov K, Eriksen PL, Kristensen LH, Holmboe CH, Laursen AL, Vilstrup H, Grønbæk H. Early normalization of reduced urea synthesis capacity after direct-acting antiviral therapy in hepatitis C cirrhosis. Am J Physiol Gastrointest Liver Physiol 319: G151-G156, 2020. First published June 29, 2020; doi:10.1152/ajpgi.00128.2020.-Effects of direct-acting antiviral (DAA) treatment of chronic hepatitis C (CHC) cirrhosis on metabolic liver function are unknown but important for prognosis. Ureagenesis is an essential metabolic liver function involved in whole body nitrogen homeostasis. We aimed to investigate the ureagenesis capacity before and immediately after DAA therapy and relate the findings to hepatic inflammation and structural changes. In an observational before-and-after intervention study, the ureagenesis capacity was quantified by functional hepatic nitrogen clearance (FHNC) in 9 CHC patients with cirrhosis and 10 healthy volunteers. Hepatic inflammation was evaluated by alanine aminotransferase (ALT) and the macrophage activation markers sCD163 and sMR. Structural changes were estimated as liver stiffness and by portal hypertension as the hepatic venous pressure gradient (HVPG). Before treatment, the FHNC in the patients was half of the controls [16.4 L/h (8.2-24.5) vs. 33.4 (29.2-37.6), P = 0.0004]; after successful DAA treatment, it normalized [28.4 (15.9-40.9), P = 0.008 vs. baseline]. DAA treatment normalized ALT ( P < 0.0001) and decreased the elevated sCD163 from 5.6 mg/L (3.5-7.7) to 3.4 (2-0-4.8) ( P < 0.001) and sMR from 0.35 mg/L (0.21-0.49) to 0.31 (0.17-0.45) ( P < 0.01). Liver stiffness fell by 30% ( P < 0.05) but remained over the cirrhosis threshold. HVPG was not affected ( P = 0.59). DAA treatment restored the severely reduced ureagenesis capacity, along with amelioration of hepatic inflammation but without normalization of other cirrhosis characteristics. Our findings indicate that the anti-inflammatory effect of virus eradication independent of hepatic structural effects rapidly improves metabolic dysfunction. We suggest this effect to be an important early onset part of the expected clinical DAA treatment benefit. NEW & NOTEWORTHY Antiviral treatment of chronic hepatitis C restores the liver's reduced capacity to produce urea along with an improvement in liver inflammation without immediate effects on structural liver changes. The effect is suggested to be an important early onset part of the expected clinical treatment benefit.

Erysipelas is a common skin infection involving the lymphatic vessels, which induces an oedema. This has a tendency of persisting after infection is treated. The lymphatic system plays an important role in the immune system, and the impaired lymph drainage leads to a state of local immune deficiency. This is essential to the pathogenesis of recurrent erysipelas, as each episode of erysipelas further damages the lymphatic system and increases the risk of a new infection. This vicious circle makes it important to treat both erysipelas and oedema appropriately to reduce recurrence and morbidity.

Objective: In Denmark, pregnant women have been screened for hepatitis B virus (HBV) since 2005, and children born to HBV-infected mothers offered hepatitis B immunoglobulin at birth, vaccination against HBV at birth and after 1, 2 and 12 months. The purpose of this study was to determine the risk of vertical HBV transmission in children born to mothers with chronic HBV infection, to investigate the antibody response in the children and to investigate possible maternal predictive risk factors for HBV transmission., Materials and Methods: Through the Danish Database for Hepatitis B and C, we identified 589 HBV-infected women who had given birth to 686 children, of whom 370 children were born to 322 women referred to hospital. 132 (36%) children, born to 109 mothers, were included in the study; 128 children had blood samples tested for HBsAg, anti-HBc (total), anti-HBs and HBV-DNA and four children had saliva samples tested for anti-HBc., Results: We found vertical HBV transmission in Denmark to be 2.3% [95% CI: 0.5, 6.5], a high proportion of HBsAg-negative children with low levels of anti-HBs (18.4%) and a high proportion (15.2%) with resolved HBV infection. No maternal risk factor was statistically significantly associated with HBV vertical transmission., Conclusion: In a HBV low prevalence setting as Denmark, despite a national vaccination program, vertical HBV transmission occurred in 2.3% of children born to HBV-infected mothers. In addition, a high proportion of the children had insufficient anti-HBs levels and a high proportion had serological signs of resolved HBV infection.

Introduction: Rotavirus infection is the most common aetiology of acute gastroenteritis (AGE) among young children. In adults, diagnostics focus mainly on bacterial causes, though recent studies suggest that rotavirus is a frequent agent. The aim of this study was to examine the proportion of rotavirus in adults hospitalised with AGE and to identify possible predictors., Methods: During a 24-month period from 1 May 2010 adults (> 15 years) with AGE admitted to one of four hospitals in the Central Denmark Region were examined for rotavirus with VIKIA Rota-Adeno rapid test in addition to routine culture for bacterial pathogens., Results: A total of 265 adult patients were included. 9.4% tested positive for rotavirus. Enteropathogenic bacteria were found in 24.5% of the cases. In the majority of cases (62.3%), no pathogen was found. Overall, rotavirus was the second-most frequent pathogen, exceeded only by Campylobacter spp. Immunosuppression and a C-reactive protein (CRP) below 50 mg/l (0-8 mg/l) were associated with rotavirus. The seasonality of rotavirus differed markedly from that of bacterial gastroenteritis., Conclusion: Rotavirus is the second-most frequently identified pathogen in adults hospitalised with AGE. Close contact to children or travel activity does not predict rotavirus gastroenteritis, but immunosuppression and a CRP below 50 mg/l do. The seasonality of rotavirus differs from that of bacterial gastroenteritis, making rotavirus the most frequently identified cause of AGE in adults admitted to hospital in the colder months., Funding: The trial was funded by an unrestricted grant from Sanofi Pasteur MSD., Trial Registration: not relevant.

Intervertebral discitis is a rare disorder which is easily missed. It presents with non-specific symptoms such as irritability, abdominal pain, decreased appetite and limping. The infection parameters can be normal, and blood cultures are often negative. The pathogenesis is not established but infectious, and inflammatory aetiologies have been suggested. Diagnostic golden standard is magnetic resonance imaging. The treatment is immobilization, anti-inflammatory drugs and often antibiotics. Early treatment is important to reduce the risk of complications such as nerve damage and spine fusion.

Pseudo-Meigs syndrome is a rare condition where a benign and non-ovarian pelvic tumour, pleural effusion and ascites are coexisting, and where removal of the tumour cures the patient. We present a patient with pseudo-Meigs syndrome originating from a leiomyoma of the uterus associated with elevated cancer antigen 125 and inflammatory parameters. Our patient also had pericardial effusion, which has only been reported once before in the literature. All her symptoms disappeared when the uterine fibroma was removed. Pseudo-Meig's syndrome has to be kept in mind in these patients.

Six cases of Lemierre's syndrome were reported from 2004 to 2007 at Viborg Hospital, corresponding to 33 cases per year in Denmark. All six patients were healthy younger persons presenting with a suspected bacterial tonsillitis which had been found strep A antigen negative. Fusobacterium necrophorum was found in throat swabs by anaerobic culture on selective media and/or by real-time PCR. We recommend that all patients 10 to 40 years of age with strep A antigentest negative bacterial tonsillitis have throat swabs anaerobically cultured on selective media. We believe early identification and therapy may prevent progression to Lemierre's syndrome.

Fusobacterium necrophorum plays a role in non-GAS-tonsillitis in adolescents and probably also in small children with recurrent otitis media. Anaerobic culture on selective anaerobic media is recommended to detect F. necrophorum and treat such patients. Denmark sees at least 20 annual cases of Lemierre's syndrome with a mortality reaching 9%. Early suspicion of Lemierre's syndrome in adolescents with non-GAS-tonsillitis, who develop septicaemia, pulmonary symptoms and unilateral swelling on the neck, is mandatory to lower morbidity and mortality.

The treatment of ulcerative colitis has improved since the appearance of Tumor Necrosis Factor (TNF)-alpha inhibitors. However, the use of TNF-alpha inhibitors increases the risk of opportunistic infections. We describe two cases of Pneumocystis jiroveci pneumonia during infliximab therapy for active ulcerative colitis. They were successfully treated with sulfametoxazole/trimetroprim. High awareness of P. jiroveci pneumonia in patients who develop pulmonary symptoms with hypoxia during TNF-alpha modulator therapy is recommended.