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Jakobsson, Tell
Publications (10 of 14) Show all publications
Jakobsson, T. & Forsum, U. (2008). Changes in the predominant human Lactobacillus flora during in vitro fertilisation. Annals of Clinical Microbiology and Antimicrobials, 7, Article ID 14.
Open this publication in new window or tab >>Changes in the predominant human Lactobacillus flora during in vitro fertilisation
2008 (English)In: Annals of Clinical Microbiology and Antimicrobials, ISSN 1476-0711, E-ISSN 1476-0711, Vol. 7, article id 14Article in journal (Refereed) Published
Abstract [en]

Background: Signature matching of nucleotide sequences in the V1 and V3 regions 16S rRNA genes using pyrosequencing technology is a powerful tool for typing vaginal Lactobacilli to the species level and has been used for investigating the vaginal microbial niche. Methods: This study has characterized the normal cultivable vaginal Lactobacillus flora at varying estradiol levels in plasma, the study comprised 17 patients undergoing ovarian stimulation for In Vitro Fertilization (IVF) treatment. The vaginal status of each participant was initially assessed as normal according to Amsel and Nugent criteria. Results: L. crispatus, L. gasseri and/or L. jensenii were present in 10of the patients throughout the study period, and little variation among these three species was encountered in individual patients. The flora of three women was dominated by L. delbrüeckii, L. rhamnosus or L. vaginalis. One woman exhibited a dominance of L. iners. The flora of the remaining three women were initially dominated by L. rhamnosus or L. reuteri, but as their estrogen levels rose, their flora composition altered, to become dominated by one of the three species most common in a normal, healthy vagina. Conclusion: Signature matching of nucleotide sequences in the V1 and V3 regions of 16S rRNA genes is a discriminative tool for the study of vaginal Lactobacilli and can be used to track the Lactobacillus flora under a variety of physiological conditions. © 2008 Jakobsson and Forsum, licensee BioMed Central Ltd.

Place, publisher, year, edition, pages
BioMed Central, 2008
Keywords
Bacterial Proteins/genetics Bacterial Typing Techniques Base Sequence DNA, Bacterial/genetics DNA, Ribosomal/genetics Female *Fertilization in Vitro Humans Lactobacillus/genetics/*isolation & purification Molecular Sequence Data Polymerase Chain Reaction
National Category
Other Biological Topics
Identifiers
urn:nbn:se:liu:diva-43432 (URN)10.1186/1476-0711-7-14 (DOI)18590533 (PubMedID)73836 (Local ID)73836 (Archive number)73836 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
Jakobsson, T. (2008). Lactobacillus iners and the normal vaginal flora. (Doctoral dissertation). Linköping University Electronic Press
Open this publication in new window or tab >>Lactobacillus iners and the normal vaginal flora
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [fi]

The ecological niche of the vagina contains a large number of different microbes that are constantly interacting with each other and the host. Culture methods have not been sufficient in order to resolve the complexity of the normal vaginal flora. Further, the methods for delineating normal flora from not normal flora are not easily handled and are traditionally not based on culture but on microscopy of elements of the vaginal fluid. In the work presented in this thesis, an international collaboration was established that pin-pointed some of the difficulties in classifying vaginal floras, including staining, sampling, and discordance when lactobacilli are few in number, and that emphasized the importance of the size of the vision field in microscopes. As lactobacilli are prominent members of the normal vaginal flora they need to be carefully classified if further work towards more robust scoring tools is to be achieved.

Phenotypic methods have not been able to separate the closely related Lactobacillus species of the vagina. Progress in molecular biology has provided possibilities to characterize these lactobacilli, which are mainly from the Lactobacillus acidophilus group. In this work a large number of strains collected by true random sampling were subjected to RAPD-PCR, TTGE and multiplex PCR for species identification. The major species found were L. crispatus, L. gasseri and L. jensenii and the recently described L. iners. The presence of L. iners has not been detected in previous studies due to its special nutrient requirements. Development of pyrosequencing technology also made it possible to match signatures of the two variable regions V1 and V3 of the 16S rRNA gene of the vaginal lactobacilli and identify them to the species level in a high throughput manner. The study confirmed that the dominating flora in women with normal vaginal flora comprises the four species mentioned previously. Repetitive sampling during IVF-treatment with highly varying oestrogen levels demonstrates changes that possibly occur during changes in the natural life cycle. Furthermore, L. iners was found to be the first species to be established after spontaneously resolved or treated Bacterial Vaginosis.

These findings can be of help in developing new strategies for regaining and retaining the normal vaginal flora.

Place, publisher, year, edition, pages
Linköping University Electronic Press, 2008
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1049
Keywords
Vagina, microbes, lactobacilli, phenotypic methods, molecular biology, 16S rRNA, pyrosequencing
National Category
Microbiology in the medical area
Identifiers
urn:nbn:se:liu:diva-11334 (URN)978-91-7393-953-9 (ISBN)
Public defence
2008-04-18, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2008-03-19 Created: 2008-03-19 Last updated: 2018-01-13
Jakobsson, T. & Forsum, U. (2008). The predominant Human vaginal Lactobacillus flora during IVF treatment. Journal of Clinical Microbiology, 7(14), 1-9
Open this publication in new window or tab >>The predominant Human vaginal Lactobacillus flora during IVF treatment
2008 (English)In: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 7, no 14, p. 1-9Article in journal (Refereed) Submitted
Abstract [en]

Background: Signature matching of nucleotide sequences in the V1 and V3 regions 16S rRNA genes using pyrosequencing technology is a powerful tool for typing vaginal Lactobacilli to the species level and has been used for investigating the vaginal microbial niche.

Methods: This study has characterized the normal cultivable vaginal Lactobacillus flora at varying estradiol levels in plasma; the study comprised 17 patients undergoing ovarian stimulation for In Vitro Fertilization (IVF) treatment. The vaginal status of each participant was initially assessed as normal according to Amsel and Nugent criteria.

Results: L. crispatus, L. gasseri and/or L. jensenii were present in 10 of the patients throughout the study period, and little variation among these three species was encountered in individual patients. The flora of three women was dominated by L. delbrüeckii, L. rhamnosus or L. vaginalis. One woman exhibited a dominance of L. iners. The flora of the remaining three women were initially dominated by L. rhamnosus or L. reuteri, but as their estrogen levels rose, their flora composition altered, to become dominated by one of the three species most common in a normal, healthy vagina.

Conclusion: Signature matching of nucleotide sequences in the V1 and V3 regions of 16S rRNA genes is a discriminative tool for the study of vaginal Lactobacilli and can be used to track the Lactobacillus flora under a variety of physiological conditions.

Place, publisher, year, edition, pages
American Society for Microbiology, 2008
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13054 (URN)10.1186/1476-0711-7-14 (DOI)
Available from: 2008-03-19 Created: 2008-03-19 Last updated: 2019-04-02Bibliographically approved
Jakobsson, T. & Forsum, U. (2007). Lactobacillus iners: a marker of changes in the vaginal flora? [Letter to the editor]. Journal of Clinical Microbiology, 45(9), 3145
Open this publication in new window or tab >>Lactobacillus iners: a marker of changes in the vaginal flora?
2007 (English)In: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 45, no 9, p. 3145-Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
American Society for Microbiology, 2007
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13053 (URN)10.1128/JCM.00558-07 (DOI)000249506900072 ()
Available from: 2008-03-19 Created: 2008-03-19 Last updated: 2017-12-13
Larsson, P.-G., Fåhraeus, L., Carlsson, B., Jakobsson, T. & Forsum, U. (2007). Predisposing factors for bacterial vaginosis, treatment efficacy and pregnancy outcome among term deliveries, results from a preterm delivery study. BMC Women's Health, 7
Open this publication in new window or tab >>Predisposing factors for bacterial vaginosis, treatment efficacy and pregnancy outcome among term deliveries, results from a preterm delivery study
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2007 (English)In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 7Article in journal (Refereed) Published
Abstract [en]

Background: Bacterial vaginosis (BV) during pregnancy is associated with an increased risk of preterm delivery but little is known about factors that could predict BV. We have analyzed if it is possible to identify a category of pregnant women that should be screened for BV, and if BV would alter the pregnancy outcome at term, we have also studied the treatment efficacy of clindamycin. Methods: Prospective BV screening and treatment study of 9025 women in a geographically defined region in southeast Sweden. BV was defined as a modified Nugent score of 6 and above. Data was collected from the Swedish Medical Birth Register. Women allocated to treatment were supplied with vaginal clindamycin cream. The main outcome goals were to identify factors that could predict BV. Results: Vaginal smears were consistent with BV criteria in 9.3%. Logistic regression indicates a significant correlation between smoking and BV (p < 0.001) and a greater prevalence of BV in the lower age groups (p < 0.001). We found no correlation between BV and history of preterm deliveries, previous miscarriages, extra-uterine pregnancies, infertility problems or reported history of urinary tract infections-factors that earlier have been associated with BV. Treatment with clindamycin cream showed a cure rate of 77%. Less than 1% of women with a normal vaginal smear in early pregnancy will develop BV during the pregnancy. There was no association between BV and the obstetric outcome among women who delivered at term. Women with BV, both treated patients and nontreated, had the same obstetric outcome at term as women with normal vaginal flora. Conclusion: BV is more than twice as common among smokers, and there is a higher prevalence in the younger age group. However these two markers for BV do not suffice as a tool for screening, and considering the lack of other risk factors associated with BV, screening of all pregnant women might be a strategy to follow in a program intended to reduce the number of preterm births. © 2007 Larsson et al, licensee BioMed Central Ltd.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-41813 (URN)10.1186/1472-6874-7-20 (DOI)59137 (Local ID)59137 (Archive number)59137 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Larsson, P.-G., Fåhraeus, L., Carlsson, B., Jakobsson, T. & Forsum, U. (2006). Late miscarriage and preterm birth after treatment with clindamycin: A randomised consent design study according to Zelen. British Journal of Obstetrics and Gynecology, 113(6), 629-637
Open this publication in new window or tab >>Late miscarriage and preterm birth after treatment with clindamycin: A randomised consent design study according to Zelen
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2006 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 113, no 6, p. 629-637Article in journal (Refereed) Published
Abstract [en]

Objective: To screen for bacterial vaginosis (BV) and to investigate the effect of treatment with vaginal clindamycin in order to observe the effect on late miscarriage and delivery prior to 37 completed weeks (primary outcome). Design: Randomised consent design for clinical trials according to Zelen. Setting: Southeast region of Sweden. Population: A total of 9025 women were screened in early pregnancy. Methods: A total of 819 women with a Nugent score of 6 and above were considered to have BV and treated according to Zelen allocation. The incidence of late miscarriage and spontaneous (noniatrogenic) preterm birth was assessed. Main outcome measures: Late miscarriage and spontaneous preterm delivery before 37 weeks. Results: Therapy with vaginal clindamycin had no significant impact on the incidence of spontaneous preterm delivery prior to 37 completed weeks, OR 0.90, 95% CI 0.40-2.02 (primary outcome variable). However, only 1 of 11 women in the treatment group versus 5 of 12 in the control group delivered prior to 33 completed weeks, OR 0.14, 95% CI 0.02-0.95. Treatment was associated with 32 days longer gestation for the 23 participants who had late miscarriage or spontaneous preterm birth (P= 0.024, Mann-Whitney U test) and significantly fewer infants had a birthweight below 2500 g (secondary outcome). A follow up of infants born preterm 4 years postnatally indicated that extending gestational age did not increase the number of sequelae. Conclusions: Clindamycin vaginal cream therapy was associated with significantly prolonged gestation and reduced cost of neonatal care in women with BV. Early screening for BV and treatment with clindamycin saved approximately €27 per woman. © RCOG 2006 BJOG An International Journal of Obstetrics and Gynaecology.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-35129 (URN)10.1111/j.1471-0528.2006.00946.x (DOI)24946 (Local ID)24946 (Archive number)24946 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Forsum, U., Holst, E., Larsson, P.-G., Vasquesz, A., Jakobsson, T. & Mattsby-Baltzer, I. (2005). Bacterial vaginosis - A microbiological and immunological enigma. Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), 113(2), 81-90
Open this publication in new window or tab >>Bacterial vaginosis - A microbiological and immunological enigma
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2005 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 113, no 2, p. 81-90Article in journal (Refereed) Published
Abstract [en]

The development of bacterial vaginosis (BV) among women of childbearing age and the resulting quantitative and qualitative shift from normally occurring lactobacilli in the vagina to a mixture of mainly anaerobic bacteria is a microbiological and immunological enigma that so far has precluded the formulation of a unifying generally accepted theory on the aetiology and clinical course of BV. This critical review highlights some of the more important aspects of BV research that could help in formulating new basic ideas respecting the biology of BV, not least the importance of the interleukin mediators of local inflammatory responses and the bacterial shift from the normally occurring lactobacilli species: L. crispatus, L. gasseri, L. jensenii, and L. iners to a mixed flora dominated by anaerobic bacteria. Copyright © APMIS 2005.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-30070 (URN)10.1111/j.1600-0463.2005.apm1130201.x (DOI)15531 (Local ID)15531 (Archive number)15531 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
Suhonen, S., Haukkamaa, M., Jakobsson, T. & Rauramo, I. (2004). Clinical performance of a levonorgestrel-releasing intrauterine system and oral contraceptives in young nulliparous women: A comparative study. Contraception, 69(5), 407-412
Open this publication in new window or tab >>Clinical performance of a levonorgestrel-releasing intrauterine system and oral contraceptives in young nulliparous women: A comparative study
2004 (English)In: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 69, no 5, p. 407-412Article in journal (Refereed) Published
Abstract [en]

This 1-year randomized study was carried out at family-planning clinics of two university hospitals to compare the safety and acceptability of a levonorgestrel-releasing intrauterine system (LNG IUS) and oral contraceptives (OCs) in young nulliparous women. The study population consisted of 200 women aged 18-25 years seeking contraception. Ninety-four women entered the LNG IUS group and 99 entered the OC group. Continuation rates, reasons leading to discontinuation, adverse events, menstrual questionnaires, subjective well-being and sexual behavior were evaluated. Nineteen women (20%) in the LNG IUS group discontinued the study during the 1-year observation period, and 27 discontinued (27%) in the OC group. The most common reason (31%) for discontinuation in the IUS group was pain. In the OC group, hormonal side effects were the predominant medical reason for study termination. The safety and acceptability of the LNG IUS for contraception was observed to be as good as with OCs, with a high continuation rate.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24572 (URN)10.1016/j.contraception.2003.11.008 (DOI)6745 (Local ID)6745 (Archive number)6745 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
Larsson, P.-G., Carlsson, B., Fåhraeus, L., Jakobsson, T. & Forsum, U. (2004). Diagnosis of bacterial vaginosis: need for validation of microscopic image area used for scoring bacterial morphotypes. Sexually Transmitted Infections, 80(1), 63-67
Open this publication in new window or tab >>Diagnosis of bacterial vaginosis: need for validation of microscopic image area used for scoring bacterial morphotypes
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2004 (English)In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 80, no 1, p. 63-67Article in journal (Refereed) Published
Abstract [en]

Background: The diagnosis of bacterial vaginosis (BV) is often made according to Nugent's classification, a scoring system based on bacterial counting of Gram stained slides of vaginal secretion. However as the image area of the microscope field will influence the number of morphotypes seen there is a need to standardise the area. Methods: A graph intended for recalculation of number of bacterial morphotypes seen by the observer using 1000 x magnification from various microscope set-ups was constructed and applied to data sets typical for scoring BV. The graph was used in recalculation of Nugent scores, which were also compared with the Ison/Hay scores to evaluate the consequences for the diagnosis of BV. Results: The observed image area differed by 300% among the investigated microscope set-ups. In two different data sets, one treatment study and one screening study, a considerable change in the number of women classified as intermediate was seen when the graph was used to standardise the image area. The recalculated numbers were also compared to the Ison/Hay classification. Weighted kappa indexes between the different methods were 0.84, 0.88, and 0.90, indicating that the methods are comparable. Conclusion: Because of the considerable differences among image areas covered by different microscope set-ups used in Nugent and Ison/Hay scoring, there is a need to standardise the area in order to reach comparable scores reflecting the diagnosis of BV in different laboratories. The differences in the intermediate group will have a considerable effect on the results from both treatment and prevalence studies, even though the kappa indexes indicate very good agreement between the methods used.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-46290 (URN)10.1136/sti.2003.006106 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13
Jakobsson, T. & Forsum, U. (2004). Vaginala laktobaciller som normalflora. In: Larsson, P-G,Bergström, Mats och Forsum, Urban (Ed.), Bakteriell Vaginos: (pp. 31-35). Växjö: Grafiska Punkten
Open this publication in new window or tab >>Vaginala laktobaciller som normalflora
2004 (Swedish)In: Bakteriell Vaginos / [ed] Larsson, P-G,Bergström, Mats och Forsum, Urban, Växjö: Grafiska Punkten , 2004, p. 31-35Chapter in book (Other academic)
Place, publisher, year, edition, pages
Växjö: Grafiska Punkten, 2004
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-22052 (URN)1117 (Local ID)91-631-4800-5 (ISBN)1117 (Archive number)1117 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2013-10-24Bibliographically approved
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