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Huda MN, Lewis Z, Kalanetra KM, Rashid M, Ahmad SM, Raqib R, Qadri F, Underwood MA, Mills DA, Stephensen CB. Stool microbiota and vaccine responses of infants. Pediatrics 2014; 134:e362-72. [PMID: 25002669 PMCID: PMC4187229 DOI: 10.1542/peds.2013-3937] [Citation(s) in RCA: 270] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Oral vaccine efficacy is low in less-developed countries, perhaps due to intestinal dysbiosis. This study determined if stool microbiota composition predicted infant oral and parenteral vaccine responses. METHODS The stool microbiota of 48 Bangladeshi infants was characterized at 6, 11, and 15 weeks of age by amplification and sequencing of the 16S ribosomal RNA gene V4 region and by Bifidobacterium-specific, quantitative polymerase chain reaction. Responses to oral polio virus (OPV), bacille Calmette-Guérin (BCG), tetanus toxoid (TT), and hepatitis B virus vaccines were measured at 15 weeks by using vaccine-specific T-cell proliferation for all vaccines, the delayed-type hypersensitivity skin-test response for BCG, and immunoglobulin G responses using the antibody in lymphocyte supernatant method for OPV, TT, and hepatitis B virus. Thymic index (TI) was measured by ultrasound. RESULTS Actinobacteria (predominantly Bifidobacterium longum subspecies infantis) dominated the stool microbiota, with Proteobacteria and Bacteroidetes increasing by 15 weeks. Actinobacteria abundance was positively associated with T-cell responses to BCG, OPV, and TT; with the delayed-type hypersensitivity response; with immunoglobulin G responses; and with TI. B longum subspecies infantis correlated positively with TI and several vaccine responses. Bacterial diversity and abundance of Enterobacteriales, Pseudomonadales, and Clostridiales were associated with neutrophilia and lower vaccine responses. CONCLUSIONS Bifidobacterium predominance may enhance thymic development and responses to both oral and parenteral vaccines early in infancy, whereas deviation from this pattern, resulting in greater bacterial diversity, may cause systemic inflammation (neutrophilia) and lower vaccine responses. Vaccine responsiveness may be improved by promoting intestinal bifidobacteria and minimizing dysbiosis early in infancy.
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Affiliation(s)
- M. Nazmul Huda
- US Department of Agriculture Western Human Nutrition Research Center, Davis California;,International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh; and
| | | | | | - Mamunur Rashid
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh; and
| | - Shaikh M. Ahmad
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh; and
| | - Rubhana Raqib
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh; and
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh; and
| | | | | | - Charles B. Stephensen
- US Department of Agriculture Western Human Nutrition Research Center, Davis California
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Clinical value of plasma soluble urokinase-type plasminogen activator receptor levels in term neonates with infection or sepsis: a prospective study. Mediators Inflamm 2014; 2014:375702. [PMID: 24882949 PMCID: PMC4026989 DOI: 10.1155/2014/375702] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 04/08/2014] [Indexed: 12/13/2022] Open
Abstract
Background. suPAR, the soluble form of the urokinase-type plasminogen activator receptor, has been identified as a biomarker of infection in adults but its properties in neonatal infection are not known. Methods. Plasma suPAR levels were determined by ELISA in 47 term neonates with infection (19 bacterial and 28 viral) and in 18 healthy neonates as controls. Thirteen out of 47 infected neonates were septic. In all infected neonates, suPAR levels were repeated at 24 hours, 48 hours, 3–5 days, and 7–10 days following admission. Results. Plasma suPAR levels were significantly increased in infected neonates upon admission, whereas they were highest in septic neonates, in comparison with controls (P < 0.001) and correlated positively with serum CRP levels (P = 0.001). At infection subsidence, suPAR concentrations decreased significantly in comparison with baseline (P < 0.001) but remained higher than in controls (P = 0.01). Receiver operating characteristic analysis resulted in significant areas under the curve for detecting either infected or septic neonates, but not for discriminating between bacterial and viral cause of infection. Conclusions. suPAR is a diagnostic biomarker of infection or sepsis in term neonates; however, it cannot discriminate bacterial from viral infections and also its utility for monitoring the response to treatment is questioned.
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Liu CL, Ai HW, Wang WP, Chen L, Hu HB, Ye T, Zhu XH, Wang F, Liao YL, Wang Y, Ou G, Xu L, Sun M, Jian C, Chen ZJ, Li L, Zhang B, Tian L, Wang B, Yan S, Sun ZY. Comparison of 16S rRNA gene PCR and blood culture for diagnosis of neonatal sepsis. Arch Pediatr 2013; 21:162-9. [PMID: 24388336 DOI: 10.1016/j.arcped.2013.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/01/2013] [Accepted: 11/26/2013] [Indexed: 11/29/2022]
Abstract
UNLABELLED Septicemia is a common cause of morbidity and mortality among newborns in the developing world. However, accurate clinical diagnosis of neonatal sepsis is often difficult because symptoms and signs are often nonspecific. Blood culture has been the gold standard for confirmation of the diagnosis. However, the sensitivity is low and results are usually not promptly obtained. Therefore, the diagnosis of sepsis is often based on clinical signs in association with laboratory tests such as platelets count, immature/total neutrophils ratio (I/T), and a rise in C-reactive protein (CRP). Polymerase chain reaction (PCR) methods for the detection of neonatal sepsis represent new diagnostic tools for the early identification of pathogens. METHODS During a 4-month prospective study, 16S rRNA PCR was compared with conventional blood culture for the diagnosis of neonatal bacterial sepsis. In addition, the relationship between known risk factors, clinical signs, laboratory parameters, and the diagnosis of sepsis was considered. RESULTS Sepsis was suspected in 706 infants from the intensive neonatal care unit. They all were included in the study. The number of positive cultures and positive PCR results were 95 (13.5%) and 123 (17.4%), respectively. Compared with blood culture, the diagnosis of bacterial sepsis by PCR revealed a 100.0% sensitivity, 95.4% specificity, 77.2% positive predictive value, and 100.0% negative predictive value. In this study, Apgar scores at 5 min, weight, icterus, irritability, feeding difficulties, gestational age (GA), premature rupture of membrane (PRM), platelets count, I/T, and a marked rise in CRP were important in establishing the diagnosis of sepsis in the newborn. In addition, weight, GA, PRM, irritability, duration of antibiotic usage, mortality rate, and number of purulent meningitis cases were significantly different between early-onset sepsis and late-onset sepsis. CONCLUSION 16S rRNA PCR increased the sensitivity in detecting bacterial DNA in newborns with signs of sepsis, allowed a rapid detection of the pathogens, and led to shorter antibiotic courses. However, uncertainty about the bacterial cause of sepsis was not reduced by this method. 16S rRNA PCR needs to be further developed and improved. Blood culture is currently irreplaceable, since pure isolates are essential for antimicrobial drug susceptibility testing.
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Affiliation(s)
- C L Liu
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China
| | - H W Ai
- Department of clinical laboratory, children's Hospital, 430030 Wuhan, PR China
| | - W P Wang
- Department of clinical laboratory, women and children hospital, 430030 Wuhan, PR China
| | - L Chen
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China
| | - H B Hu
- Department of clinical laboratory, children's Hospital, 430030 Wuhan, PR China
| | - T Ye
- Department of clinical laboratory, women and children hospital, 430030 Wuhan, PR China
| | - X H Zhu
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China
| | - F Wang
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China
| | - Y L Liao
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China
| | - Y Wang
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China
| | - G Ou
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China
| | - L Xu
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China
| | - M Sun
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China
| | - C Jian
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China
| | - Z J Chen
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China
| | - L Li
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China
| | - B Zhang
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China
| | - L Tian
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China
| | - B Wang
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China
| | - S Yan
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China
| | - Z Y Sun
- Department of clinical laboratory, Tongji hospital, Tongji medical college, Huazhong university of science and technology, 430030 Wuhan, PR China.
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Diagnosis value of the serum amyloid A test in neonatal sepsis: a meta-analysis. BIOMED RESEARCH INTERNATIONAL 2013; 2013:520294. [PMID: 23984377 PMCID: PMC3747616 DOI: 10.1155/2013/520294] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/04/2013] [Indexed: 12/28/2022]
Abstract
Neonatal sepsis (NS), a common disorder for humans, is recognized as a leading global public health challenge. This meta-analysis was performed to assess the accuracy of the serum amyloid A (SAA) test for diagnosing NS. The studies that evaluated the SAA test as a diagnostic marker were searched in Pubmed, EMBASE, the Cochrane Library, and Google Network between January 1996 and June 2013. A total of nine studies including 823 neonates were included in our meta-analysis. Quality of each study was evaluated by the quality assessment of diagnostic accuracy studies tool (QUADAS). The SAA test showed moderate accuracy in the diagnosis of NS both at the first suspicion of sepsis and 8-96 h after the sepsis onset, both with Q* = 0.91, which is similar to the PCT and CRP tests for the diagnosis of NS in the same period. Heterogeneity between studies was also explained by cut-off point, SAA assay, and age of included neonates. On the basis of our meta-analysis, therefore, SAA could be promising and meaningful in the diagnosis of NS.
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Fanos V, Fanni C, Ottonello G, Noto A, Dessì A, Mussap M. Metabolomics in adult and pediatric nephrology. Molecules 2013; 18:4844-57. [PMID: 23615531 PMCID: PMC6270081 DOI: 10.3390/molecules18054844] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 03/26/2013] [Accepted: 04/18/2013] [Indexed: 12/22/2022] Open
Abstract
Metabolomics, the latest of the “omics” sciences, has a non-selective approach and can thus lead to the identification of all the metabolites (molecules < 1 kDa) in a biological system. The metabolomic profile can be considered the most predictive phenotype capable of evaluating epigenetic modifications determined by external factors. It is so close to the phenotype as to be considered the phenotype itself in its unique individuality (fingerprinting), both in health (phenome), and disease (diseasome). Urine, compared to other biological liquids, has the advantage of being a complex fluid with many components, including intermediate metabolites. Metabolomics may thus play a role in the study of different kidney diseases and overcome diagnostic difficulties. We shall present the studies that to our knowledge have been published on Nephrology and Pediatric Nephrology. Some are experimental while others are clinical. We have not considered carcinomas and transplantations. Although scarce, the data on adults and the very few ones in pediatrics are quite interesting. Further studies on kidneys are needed to determine the practical clinical impact of metabolomics in kidney renal pathologies. The “multiplatform” “omic” study of urine and namely metabolomics can contribute to improving early diagnosis and the outcome of kidney diseases.
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Affiliation(s)
- Vassilios Fanos
- Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, Cagliari 09131, Italy.
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