251
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Ushijima B, Meyer JL, Thompson S, Pitts K, Marusich MF, Tittl J, Weatherup E, Reu J, Wetzell R, Aeby GS, Häse CC, Paul VJ. Disease Diagnostics and Potential Coinfections by Vibrio coralliilyticus During an Ongoing Coral Disease Outbreak in Florida. Front Microbiol 2020; 11:569354. [PMID: 33193161 PMCID: PMC7649382 DOI: 10.3389/fmicb.2020.569354] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/06/2020] [Indexed: 01/24/2023] Open
Abstract
A deadly coral disease outbreak has been devastating the Florida Reef Tract since 2014. This disease, stony coral tissue loss disease (SCTLD), affects at least 22 coral species causing the progressive destruction of tissue. The etiological agents responsible for SCTLD are unidentified, but pathogenic bacteria are suspected. Virulence screens of 400 isolates identified four potentially pathogenic strains of Vibrio spp. subsequently identified as V. coralliilyticus. Strains of this species are known coral pathogens; however, cultures were unable to consistently elicit tissue loss, suggesting an opportunistic role. Using an improved immunoassay, the VcpA RapidTest, a toxic zinc-metalloprotease produced by V. coralliilyticus was detected on 22.3% of diseased Montastraea cavernosa (n = 67) and 23.5% of diseased Orbicella faveolata (n = 24). VcpA+ corals had significantly higher mortality rates and faster disease progression. For VcpA- fragments, 21.6% and 33.3% of M. cavernosa and O. faveolata, respectively, died within 21 d of observation, while 100% of similarly sized VcpA+ fragments of both species died during the same period. Further physiological and genomic analysis found no apparent differences between the Atlantic V. coralliilyticus strains cultured here and pathogens from the Indo-Pacific but highlighted the diversity among strains and their immense genetic potential. In all, V. coralliilyticus may be causing coinfections that exacerbate existing SCTLD lesions, which could contribute to the intraspecific differences observed between colonies. This study describes potential coinfections contributing to SCTLD virulence as well as diagnostic tools capable of tracking the pathogen involved, which are important contributions to the management and understanding of SCTLD.
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Affiliation(s)
- Blake Ushijima
- Smithsonian Marine Station, Fort Pierce, FL, United States
| | - Julie L Meyer
- Soil and Water Sciences Department, University of Florida, Gainesville, FL, United States
| | | | - Kelly Pitts
- Smithsonian Marine Station, Fort Pierce, FL, United States
| | | | - Jessica Tittl
- Soil and Water Sciences Department, University of Florida, Gainesville, FL, United States
| | | | - Jacqueline Reu
- Smithsonian Marine Station, Fort Pierce, FL, United States
| | - Raquel Wetzell
- Smithsonian Marine Station, Fort Pierce, FL, United States
| | - Greta S Aeby
- Smithsonian Marine Station, Fort Pierce, FL, United States
| | - Claudia C Häse
- Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, United States
| | - Valerie J Paul
- Smithsonian Marine Station, Fort Pierce, FL, United States
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252
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Changes in antimicrobial utilization during the coronavirus disease 2019 (COVID-19) pandemic after implementation of a multispecialty clinical guidance team. Infect Control Hosp Epidemiol 2020; 42:810-816. [PMID: 33100250 PMCID: PMC7683821 DOI: 10.1017/ice.2020.1291] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: Evaluate changes in antimicrobial use during COVID-19 and after implementation of a multispecialty COVID-19 clinical guidance team compared to pre–COVID-19 antimicrobial use. Design: Retrospective observational study. Setting: Tertiary-care academic medical center. Participants: Internal medicine and medical intensive care unit (MICU) provider teams and hospitalized COVID-19 patients. Methods: Difference-in-differences analyses of antibiotic days of therapy per 1,000 patient days present (DOT) for internal medicine and MICU teams treating COVID-19 patients versus teams that did not were performed for 3 periods: before COVID-19, initial COVID-19 period, and after implementation of a multispecialty COVID-19 clinical guidance team which included daily, patient-specific antimicrobial stewardship recommendations. Patient characteristics associated with antibiotic DOT were evaluated using multivariable Poisson regression. Results: In the initial COVID-19 period, compared to the pre–COVID-19 period, internal medicine and MICU teams increased weekly antimicrobial use by 145.3 DOT (95% CI, 35.1–255.5) and 204.0 DOT (95% CI, −16.9 to 424.8), respectively, compared to non–COVID-19 teams. In the intervention period, internal medicine and MICU COVID-19 teams both had significant weekly decreases of 362.3 DOT (95% CI, −443.3 to −281.2) and 226.3 DOT (95% CI, −381.2 to –71.3). Of 131 patients hospitalized with COVID-19, 86 (65.6%) received antibiotics; no specific patient factors were significantly associated with an expected change in antibiotic days. Conclusions: Antimicrobial use initially increased for COVID-19 patient care teams compared to pre–COVID-19 levels but significantly decreased after implementation of a multispecialty clinical guidance team, which may be an effective strategy to reduce unnecessary antimicrobial use.
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253
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Macias AE, McElhaney JE, Chaves SS, Nealon J, Nunes MC, Samson SI, Seet BT, Weinke T, Yu H. The disease burden of influenza beyond respiratory illness. Vaccine 2020; 39 Suppl 1:A6-A14. [PMID: 33041103 PMCID: PMC7545338 DOI: 10.1016/j.vaccine.2020.09.048] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/10/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023]
Abstract
Although influenza is primarily considered a respiratory infection and causes significant respiratory mortality, evidence suggests that influenza has an additional burden due to broader consequences of the illness. Some of these broader consequences include cardiovascular events, exacerbations of chronic underlying conditions, increased susceptibility to secondary bacterial infections, functional decline, and poor pregnancy outcomes, all of which may lead to an increased risk for hospitalization and death. Although it is methodologically difficult to measure these impacts, epidemiological and interventional study designs have evolved over recent decades to better take them into account. Recognizing these broader consequences of influenza virus infection is essential to determine the full burden of influenza among different subpopulations and the value of preventive approaches. In this review, we outline the main influenza complications and societal impacts beyond the classical respiratory symptoms of the disease.
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Affiliation(s)
- Alejandro E Macias
- Department of Medicine and Nutrition, University of Guanajuato, Guanajuato, Mexico.
| | | | | | | | - Marta C Nunes
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | | | - Bruce T Seet
- Sanofi Pasteur, Toronto, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada.
| | | | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
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254
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Ramadan HKA, Mahmoud MA, Aburahma MZ, Elkhawaga AA, El-Mokhtar MA, Sayed IM, Hosni A, Hassany SM, Medhat MA. Predictors of Severity and Co-Infection Resistance Profile in COVID-19 Patients: First Report from Upper Egypt. Infect Drug Resist 2020; 13:3409-3422. [PMID: 33116660 PMCID: PMC7547142 DOI: 10.2147/idr.s272605] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in a worldwide devastating effect with a diagnostic challenge. Identifying risk factors of severity aids in assessment for the need of early hospitalization. We aimed to demonstrate, for the first time, the clinical, laboratory and radiological characteristics of coronavirus disease 2019 (COVID-19) patients, to identify the predictors of severity and to describe the antimicrobial resistance profile in patients from Upper Egypt. MATERIALS AND METHODS Demographic characters, clinical presentations, laboratory, and radiological data were recorded and analyzed. Presence of other respiratory microorganisms and their sensitivity patterns were identified using the VITEK2 system. Resistance-associated genes were tested by PCR. RESULTS The study included 260 COVID-19 patients. The majority were males (55.4%) aged between 51 and 70 years. Hypertension, diabetes, and ischemic heart disease were common comorbidities. Main clinical manifestations were fever (63.8%), cough (57.7%), dyspnea (40%) and fatigue (30%). According to severity, 51.5% were moderate, 25.4% mild and 23% severe/critical. Lymphopenia, elevated CRP, ferritin, and D-dimer occurred in all patients with significantly higher value in the severe group. Age >53 years and elevated ferritin ≥484 ng/mL were significant risk factors for severity. About 10.7% of the COVID-19 patients showed bacterial and/or fungal infections. Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus were the predominant isolated bacteria while Candida albicans and Candida glabrata were the predominant isolated fungi. All Staphylococci were methicillin-resistant and carried the mecA gene. Gram-negative isolates were multidrug-resistant and carried different resistance-associated genes, including NDM-1, KPC, TEM, CTX-M, and SHV. CONCLUSION Older age and elevated serum ferritin were significant risk factors for severe COVID-19. Bacterial co-infection and multidrug resistance among patients with COVID-19 in Upper Egypt is common. Testing for presence of other co-infecting agents should be considered, and prompt treatment should be carried out according to the antimicrobial sensitivity reports.
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Affiliation(s)
- Haidi Karam-Allah Ramadan
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Manal A Mahmoud
- Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Zakaria Aburahma
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amal A Elkhawaga
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed A El-Mokhtar
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ibrahim M Sayed
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
- Department of Pathology, School of Medicine, University of California, San Diego, CA, USA
| | - Amal Hosni
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sahar M Hassany
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohammed A Medhat
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
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255
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Kuek LE, Lee RJ. First contact: the role of respiratory cilia in host-pathogen interactions in the airways. Am J Physiol Lung Cell Mol Physiol 2020; 319:L603-L619. [PMID: 32783615 PMCID: PMC7516383 DOI: 10.1152/ajplung.00283.2020] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
Respiratory cilia are the driving force of the mucociliary escalator, working in conjunction with secreted airway mucus to clear inhaled debris and pathogens from the conducting airways. Respiratory cilia are also one of the first contact points between host and inhaled pathogens. Impaired ciliary function is a common pathological feature in patients with chronic airway diseases, increasing susceptibility to respiratory infections. Common respiratory pathogens, including viruses, bacteria, and fungi, have been shown to target cilia and/or ciliated airway epithelial cells, resulting in a disruption of mucociliary clearance that may facilitate host infection. Despite being an integral component of airway innate immunity, the role of respiratory cilia and their clinical significance during airway infections are still poorly understood. This review examines the expression, structure, and function of respiratory cilia during pathogenic infection of the airways. This review also discusses specific known points of interaction of bacteria, fungi, and viruses with respiratory cilia function. The emerging biological functions of motile cilia relating to intracellular signaling and their potential immunoregulatory roles during infection will also be discussed.
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Affiliation(s)
- Li Eon Kuek
- Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Robert J Lee
- Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Department of Physiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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256
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Molecular pathogenesis of secondary bacterial infection associated to viral infections including SARS-CoV-2. J Infect Public Health 2020; 13:1397-1404. [PMID: 32712106 PMCID: PMC7359806 DOI: 10.1016/j.jiph.2020.07.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/11/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022] Open
Abstract
Secondary bacterial infections are commonly associated with prior or concomitant respiratory viral infections. Viral infections damage respiratory airways and simultaneously defects both innate and acquired immune response that provides a favorable environment for bacterial growth, adherence, and facilitates invasion into healthy sites of the respiratory tract. Understanding the molecular mechanism of viral-induced secondary bacterial infections will provide us a chance to develop novel and effective therapeutic approaches for disease prevention. The present study describes details about the secondary bacterial infection during viral infections and their immunological changes.The outcome of discussion avails an opportunity to understand possible secondary bacterial infections associated with novel SARS-CoV-2, presently causing pandemic outbreak COVID-19.
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257
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Wang Z, Fang Y, Dong W, Lau M, Mo PKH. Illness representations on pneumonia and pneumococcal vaccination uptake among community-living Chinese people with high-risk conditions aged ≥65 years --- a population-based study. Hum Vaccin Immunother 2020; 17:1455-1462. [PMID: 32991245 DOI: 10.1080/21645515.2020.1814653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This study investigated the associations between illness representations of pneumonia and pneumococcal vaccination (PV) uptake among a group of community-living aging adults having at least one high-risk condition for severe invasive pneumococcal diseases (IPD). A total of 750 community-living Chinese-speaking individuals aged ≥65 y completed a random telephone survey. This study was based on 483 participants having at least one high-risk condition for severe IPD. The Illness Representation Questionnaire-Revised (IPQ-R) measured four dimensions of illness representations. These dimensions included timeline (whether pneumonia is believed to be acute/chronic), consequences (severity of pneumonia), treatment control (whether pneumonia is under volitional control), and emotional response (anger, guilty, or shame). Using PV uptake (among all participants) and behavioral intention to take up PV (among unvaccinated participants) as the dependent variables, logistic regression models were fitted. Among all participants (n = 483), 17.8% reported PV uptake; 18.6% of unvaccinated participants (n = 397) intended to take up two doses of free PV in the next year. After adjustment for significant background variables, participants who perceived more severe consequences of pneumonia (adjusted odds ratios, AOR: 1.18, 95%CI: 1.01, 1.40) and belief that treatment can control pneumonia (AOR: 1.41, 95%CI: 1.25, 1.58) reported higher PV uptake. Perceived pneumonia to be chronic (AOR: 1.44, 95%CI: 1.16, 1.78), belief that treatment can control pneumonia (AOR: 1.25, 95%CI: 1.12, 1.40) and having negative emotions related to pneumonia (AOR: 1.17, 95%CI: 1.09, 1.25) were positively associated with behavioral intention to take up PV. Results confirmed that illness representations were associated with PV-related behaviors.
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Affiliation(s)
- Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China.,Shenzhen Research Institute, the Chinese University of Hong Kong, Shenzhen, China
| | - Yuan Fang
- Department of Early Childhood Education, Faculty of Education and Human Development, The Education University of Hong Kong, Hong Kong SAR, China
| | - Willa Dong
- Department of Health Behavior, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, North Carolina, USA
| | - Mason Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China
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258
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Ferreira EDO, Penna B, Yates EA. Should We Be Worried About Clostridioides difficile During the SARS-CoV2 Pandemic? Front Microbiol 2020; 11:581343. [PMID: 33133048 PMCID: PMC7550402 DOI: 10.3389/fmicb.2020.581343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Eliane de Oliveira Ferreira
- Laboratório de Biologia de Anaeróbios, Departamento de Microbiologia Médica, Instituto de Microbiologia Paulo de Góes- IMPG, Universidade Federal Do Rio de Janeiro- UFRJ, Rio de Janeiro, Brazil
| | - Bruno Penna
- Laboratório de Cocos Gram Positivos, Departamento Do Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Niteroi, Brazil
| | - Edwin A. Yates
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
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259
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Goncalves Mendes Neto A, Lo KB, Wattoo A, Salacup G, Pelayo J, DeJoy R, Bhargav R, Gul F, Peterson E, Albano J, Patarroyo-Aponte G, Rangaswami J, Azmaiparashvili Z. Bacterial infections and patterns of antibiotic use in patients with COVID-19. J Med Virol 2020; 93:1489-1495. [PMID: 32808695 PMCID: PMC7461450 DOI: 10.1002/jmv.26441] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 07/31/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023]
Abstract
Bacterial coinfection is associated with poor outcomes in patients with viral pneumonia, but data on its role in the mortality of patients with coronavirus disease 2019 (COVID-19) is limited. This is a single-center retrospective analysis of 242 patients with confirmed COVID-19 admitted to both intensive care and non-intensive care settings. Bacterial coinfection was determined by the presence of characteristic clinical features and positive culture results. Multivariable logistic regression was used to analyze the association of concomitant bacterial infection with inpatient death after adjusting for demographic factors and comorbidities. Antibiotic use pattern was also determined. Bacterial coinfection was detected in 46 (19%) patients. Genitourinary source was the most frequent, representing 57% of all coinfections. The overall mortality rate was 21%. Concomitant bacterial infections were independently associated with increased inpatient mortality (OR, 5.838; 95% CI, 2.647-12.876). Patients with bacterial coinfection were relatively older (71.35 ± 11.20 vs 64.78 ± 15.23; P = .006). A total of 67% of patients received antibiotic therapy, yet 72% did not have an obvious source of bacterial infection. There was a significantly higher rate of inpatient mortality in patients who received antibiotics compared to those who did not (30% vs 5%; P < .0001). Bacterial coinfection in COVID-19 is associated with increased mortality.
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Affiliation(s)
| | - Kevin Bryan Lo
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Ammaar Wattoo
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Grace Salacup
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Jerald Pelayo
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Robert DeJoy
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Ruchika Bhargav
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Fahad Gul
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Eric Peterson
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Jeri Albano
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Gabriel Patarroyo-Aponte
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania.,Sidney Kimmel College of Thomas Jefferson University, Philadelphia, Pennsylvania.,Division of Pulmonary and Critical Care and Sleep Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
| | - Janani Rangaswami
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania.,Sidney Kimmel College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Zurab Azmaiparashvili
- Department of Medicine, Albert Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania
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260
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Egyir B, Obeng-Nkrumah N, Kyei GB. COVID-19 pandemic and antimicrobial resistance: Another call to strengthen laboratory diagnostic capacity in Africa. Afr J Lab Med 2020; 9:1302. [PMID: 33102171 PMCID: PMC7567179 DOI: 10.4102/ajlm.v9i1.1302] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/07/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Beverly Egyir
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Noah Obeng-Nkrumah
- Department of Medical Laboratory Sciences, University of Ghana, Accra, Ghana
| | - George B Kyei
- Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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261
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Arokiaraj MC. Considering Interim Interventions to Control COVID-19 Associated Morbidity and Mortality-Perspectives. Front Public Health 2020; 8:444. [PMID: 33072682 PMCID: PMC7537040 DOI: 10.3389/fpubh.2020.00444] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/20/2020] [Indexed: 12/22/2022] Open
Abstract
Aims and objectives: The pandemic of COVID-19 is evolving worldwide, and it is associated with high mortality and morbidity. There is a growing need to discuss the elements of a coordinated strategy to control the spread and mitigate the severity of COVID-19. H1N1 and Streptococcus pneumonia vaccines are available. The current analysis was performed to analyze the severity of COVID-19 and influenza (H1N1) vaccination in adults ≥ 65. Also, to correlate the lower respiratory tract infections (LRIs), and influenza attributable to the lower respiratory tract infections' incidence with Covid-19 mortality. Evolutionarily influenza is close in resemblance to SARS-CoV-2 viruses and shares some common epitopes and mechanisms. Methods: Recent influenza vaccination data of 34 countries from OECD and other publications were correlated with COVID-19 mortality from worldometer data. LRIs attributable to influenza and streptococcus pneumonia were correlated with COVID-19 mortality. Specifically, influenza-attributable LRI incidence data of various countries (n = 182) was correlated with COVID-19 death by linear regression and receiver operating characteristic (ROC) curve analyzes. In a logistic regression model, population density and influenza LRI incidence were correlated with COVID-19 mortality. Results: There is a correlation between COVID-19-related mortality, morbidity, and case incidence and the status of influenza vaccination, which appears protective. The tendency of correlation is increasingly highlighted as the pandemic is evolving. In countries where influenza immunization is less common, there is a correlation between LRIs and influenza attributable to LRI incidence and COVID-19 severity, which is beneficial. ROC curve showed an area under the curve of 0.86 (CI 0.78 to 0.944, P < 0.0001) to predict COVID-19 mortality >150/million and a decreasing trend of influenza LRI episodes. To predict COVID-19 mortality of >200/million population, the odds ratio for influenza incidence/100,000 was −1.86 (CI −2.75 to −0.96, P < 0.0001). To predict the parameter Covid-19 mortality/influenza LRI episodes*1000>1000, the influenza parameter had an odd's ratio of −3.83 (CI −5.98 to −1.67), and an AUC of 0.94. Conclusion: Influenza (H1N1) vaccination can be used as an interim measure to mitigate the severity of COVID-19 in the general population. In appropriate high-risk circumstances, Streptococcus pneumonia vaccination would also be an adjunct strategy, especially in countries with a lower incidence of LRIs.
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262
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Penkert RR, Smith AP, Hrincius ER, McCullers JA, Vogel P, Smith AM, Hurwitz JL. Effect of Vitamin A Deficiency in Dysregulating Immune Responses to Influenza Virus and Increasing Mortality Rates After Bacterial Coinfections. J Infect Dis 2020; 223:1806-1816. [PMID: 32959872 DOI: 10.1093/infdis/jiaa597] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Secondary bacterial coinfections are ranked as a leading cause of hospitalization and morbid conditions associated with influenza. Because vitamin A deficiency (VAD) and insufficiency are frequent in both developed and developing countries, we asked how VAD influences coinfection severity. METHODS VAD and control mice were infected with influenza virus for evaluation of inflammatory cytokines, cellular immune responses, and viral clearance. Influenza-infected mice were coinfected with Streptococcus pneumoniae to study weight loss and survival. RESULTS Naive VAD mouse lungs exhibited dysregulated immune function. Neutrophils were enhanced in frequency and there was a significant reduction in RANTES (regulated on activation of normal T cells expressed and secreted), a chemokine instrumental in T-cell homing and recruitment. After influenza virus infection, VAD mice experienced failures in CD4+ T-cell recruitment and B-cell organization into lymphoid structures in the lung. VAD mice exhibited higher viral titers than controls and slow viral clearance. There were elevated levels of inflammatory cytokines and innate cell subsets in the lungs. However, arginase, a marker of alternatively activated M2 macrophages, was rare. When influenza-infected VAD animals were exposed to bacteria, they experienced a 100% mortality rate. CONCLUSION Data showed that VAD dysregulated the immune response. Consequently, secondary bacterial infections were 100% lethal in influenza-infected VAD mice.
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Affiliation(s)
- Rhiannon R Penkert
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Amanda P Smith
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Eike R Hrincius
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jonathan A McCullers
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Peter Vogel
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Amber M Smith
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, Tennessee, USA.,Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Julia L Hurwitz
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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263
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Kirenga B, Muttamba W, Kayongo A, Nsereko C, Siddharthan T, Lusiba J, Mugenyi L, Byanyima RK, Worodria W, Nakwagala F, Nantanda R, Kimuli I, Katagira W, Bagaya BS, Nasinghe E, Aanyu-Tukamuhebwa H, Amuge B, Sekibira R, Buregyeya E, Kiwanuka N, Muwanga M, Kalungi S, Joloba ML, Kateete DP, Byarugaba B, Kamya MR, Mwebesa H, Bazeyo W. Characteristics and outcomes of admitted patients infected with SARS-CoV-2 in Uganda. BMJ Open Respir Res 2020; 7:7/1/e000646. [PMID: 32900781 PMCID: PMC7477797 DOI: 10.1136/bmjresp-2020-000646] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 01/08/2023] Open
Abstract
Rationale Detailed data on the characteristics and outcomes of patients with COVID-19 in sub-Saharan Africa are limited. Objective We determined the clinical characteristics and treatment outcomes of patients diagnosed with COVID-19 in Uganda. Measurements As of the 16 May 2020, a total of 203 cases had been confirmed. We report on the first 56 patients; 29 received hydroxychloroquine (HCQ) and 27 did not. Endpoints included admission to intensive care, mechanical ventilation or death during hospitalisation. Main results The median age was 34.2 years; 67.9% were male; and 14.6% were <18 years. Up 57.1% of the patients were asymptomatic. The most common symptoms were fever (21.4%), cough (19.6%), rhinorrhea (16.1%), headache (12.5%), muscle ache (7.1%) and fatigue (7.1%). Rates of comorbidities were 10.7% (pre-existing hypertension), 10.7% (diabetes) and 7.1% (HIV), Body Mass Index (BMI) of ≥30 36.6%. 37.0% had a blood pressure (BP) of >130/90 mm Hg, and 27.8% had BP of >140/90 mm Hg. Laboratory derangements were leucopenia (10.6%), lymphopenia (11.1%) and thrombocytopenia (26.3%). Abnormal chest X-ray was observed in 14.3%. No patients reached the primary endpoint. Time to clinical recovery was shorter among patients who received HCQ, but this difference did not reach statistical significance. Conclusion Most of the patients with COVID-19 presented with mild disease and exhibited a clinical trajectory not similar to other countries. Outcomes did not differ by HCQ treatment status in line with other concluded studies on the benefit of using HCQ in the treatment of COVID-19.
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Affiliation(s)
- Bruce Kirenga
- Lung Institute, Makerere University, Kampala, Uganda
| | | | - Alex Kayongo
- Lung Institute, Makerere University, Kampala, Uganda
| | | | - Trishul Siddharthan
- Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, USA
| | - John Lusiba
- Uganda Peoples Defense Forces, Uganda Heart Institute Ltd, Kampala, Uganda
| | | | - Rosemary K Byanyima
- Department of Radiology, Mulago National Specialised Hospital, Kampala, Uganda
| | | | - Fred Nakwagala
- Department of Medicine, Mulago National Specialised Hospital, Kampala, Uganda
| | | | - Ivan Kimuli
- Lung Institute, Makerere University, Kampala, Uganda
| | | | - Bernard Sentalo Bagaya
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Emmanuel Nasinghe
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Beatrice Amuge
- Department of Nursing, Mulago National Specialised Hospital, Kampala, Uganda
| | | | - Esther Buregyeya
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Noah Kiwanuka
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Muwanga
- Department of Medicine, Entebbe Regional Referral Hospital, Entebbe, Uganda
| | - Samuel Kalungi
- Pathology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Lutaakome Joloba
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Patrick Kateete
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Baterana Byarugaba
- Department of Medicine, Mulago National Specialised Hospital, Kampala, Uganda
| | - Moses R Kamya
- Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Henry Mwebesa
- Republic of Uganda Ministry of Health, Kampala, Uganda
| | - William Bazeyo
- Entebbe Regional Refferal Hospital, Makerere University, Kampala, Uganda
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264
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Li J, Wang J, Yang Y, Cai P, Cao J, Cai X, Zhang Y. Etiology and antimicrobial resistance of secondary bacterial infections in patients hospitalized with COVID-19 in Wuhan, China: a retrospective analysis. Antimicrob Resist Infect Control 2020; 9:153. [PMID: 32962731 PMCID: PMC7506844 DOI: 10.1186/s13756-020-00819-1] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/15/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A considerable proportion of patients hospitalized with coronavirus disease 2019 (COVID-19) acquired secondary bacterial infections (SBIs). The etiology and antimicrobial resistance of bacteria were reported and used to provide a theoretical basis for appropriate infection therapy. METHODS This retrospective study reviewed electronic medical records of all the patients hospitalized with COVID-19 in the Wuhan Union Hospital between January 27 and March 17, 2020. According to the inclusion and exclusion criteria, patients who acquired SBIs were enrolled. Demographic, clinical course, etiology, and antimicrobial resistance data of the SBIs were collected. Outcomes were also compared between patients who were classified as severe and critical on admission. RESULTS Among 1495 patients hospitalized with COVID-19, 102 (6.8%) patients had acquired SBIs, and almost half of them (49.0%, 50/102) died during hospitalization. Compared with severe patients, critical patients had a higher chance of SBIs. Among the 159 strains of bacteria isolated from the SBIs, 136 strains (85.5%) were Gram-negative bacteria. The top three bacteria of SBIs were A. baumannii (35.8%, 57/159), K. pneumoniae (30.8%, 49/159), and S. maltophilia (6.3%, 10/159). The isolation rates of carbapenem-resistant A. baumannii and K. pneumoniae were 91.2 and 75.5%, respectively. Meticillin resistance was present in 100% of Staphylococcus aureus and Coagulase negative staphylococci, and vancomycin resistance was not found. CONCLUSIONS SBIs may occur in patients hospitalized with COVID-19 and lead to high mortality. The incidence of SBIs was associated with the severity of illness on admission. Gram-negative bacteria, especially A. baumannii and K. pneumoniae, were the main bacteria, and the resistance rates of the major isolated bacteria were generally high. This was a single-center study; thus, our results should be externally examined when applied in other institutions.
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Affiliation(s)
- Jie Li
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Junwei Wang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yi Yang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Peishan Cai
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jingchao Cao
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xuefeng Cai
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Yu Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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265
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Klomp M, Ghosh S, Mohammed S, Nadeem Khan M. From virus to inflammation, how influenza promotes lung damage. J Leukoc Biol 2020; 110:115-122. [PMID: 32895987 DOI: 10.1002/jlb.4ru0820-232r] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/03/2020] [Accepted: 08/22/2020] [Indexed: 12/13/2022] Open
Abstract
Despite seasonal vaccines, influenza-related hospitalization and death rates have remained unchanged over the past 5 years. Influenza pathogenesis has 2 crucial clinical components; first, influenza causes acute lung injury that may require hospitalization. Second, acute injury promotes secondary bacterial pneumonia, a leading cause of hospitalization and disease burden in the United States and globally. Therefore, developing an effective therapeutic regimen against influenza requires a comprehensive understanding of the damage-associated immune-mechanisms to identify therapeutic targets for interventions to mitigate inflammation/tissue-damage, improve antiviral immunity, and prevent influenza-associated secondary bacterial diseases. In this review, the pathogenic immune mechanisms implicated in acute lung injury and the possibility of using lung inflammation and barrier crosstalk for developing therapeutics against influenza are highlighted.
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Affiliation(s)
- Mitchell Klomp
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - Sumit Ghosh
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Sohail Mohammed
- Department of Biomedical Sciences, University of North Dakota, USA
| | - M Nadeem Khan
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA
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266
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Cao Z, Luo Y, Li Z, Tan L, Liu X, Li C, Zheng Y, Cui Z, Yeung KWK, Liang Y, Zhu S, Wu S. Antibacterial Hybrid Hydrogels. Macromol Biosci 2020; 21:e2000252. [PMID: 32881309 DOI: 10.1002/mabi.202000252] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/16/2020] [Indexed: 12/11/2022]
Abstract
Bacterial infectious diseases and bacterial-infected environments have been threatening the health of human beings all over the world. In view of the increased bacteria resistance caused by overuse or improper use of antibiotics, antibacterial biomaterials are developed as the substitutes for antibiotics in some cases. Among them, antibacterial hydrogels are attracting more and more attention due to easy preparation process and diversity of structures by changing their chemical cross-linkers via covalent bonds or noncovalent physical interactions, which can endow them with various specific functions such as high toughness and stretchability, injectability, self-healing, tissue adhesiveness and rapid hemostasis, easy loading and controlled drug release, superior biocompatibility and antioxidation as well as good conductivity. In this review, the recent progress of antibacterial hydrogel including the fabrication methodologies, interior structures, performances, antibacterial mechanisms, and applications of various antibacterial hydrogels is summarized. According to the bacteria-killing modes of hydrogels, several representative hydrogels such as silver nanoparticles-based hydrogel, photoresponsive hydrogel including photothermal and photocatalytic, self-bacteria-killing hydrogel such as inherent antibacterial peptides and cationic polymers, and antibiotics-loading hydrogel are focused on. Furthermore, current challenges of antibacterial hydrogels are discussed and future perspectives in this field are also proposed.
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Affiliation(s)
- Zhongming Cao
- Hubei Key Laboratory of Polymer Materials, School of Materials Science and Engineering, Hubei University, Ministry of Education Key Laboratory for the Green Preparation and Application of Functional Materials, Wuhan, 430062, China
| | - Yue Luo
- Hubei Key Laboratory of Polymer Materials, School of Materials Science and Engineering, Hubei University, Ministry of Education Key Laboratory for the Green Preparation and Application of Functional Materials, Wuhan, 430062, China
| | - Zhaoyang Li
- School of Materials Science and Engineering, The Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Tianjin, 300072, China
| | - Lei Tan
- Hubei Key Laboratory of Polymer Materials, School of Materials Science and Engineering, Hubei University, Ministry of Education Key Laboratory for the Green Preparation and Application of Functional Materials, Wuhan, 430062, China
| | - Xiangmei Liu
- Hubei Key Laboratory of Polymer Materials, School of Materials Science and Engineering, Hubei University, Ministry of Education Key Laboratory for the Green Preparation and Application of Functional Materials, Wuhan, 430062, China
| | - Changyi Li
- Stomatological Hospital, Tianjin Medical University, Tianjin, 300070, China
| | - Yufeng Zheng
- College of Engineering, State Key Laboratory for Turbulence and Complex System, Department of Materials Science and Engineering, Peking University, Beijing, 100871, China
| | - Zhenduo Cui
- School of Materials Science and Engineering, The Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Tianjin, 300072, China
| | - Kelvin Wai Kwok Yeung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, 999077, China
| | - Yanqin Liang
- School of Materials Science and Engineering, The Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Tianjin, 300072, China
| | - Shengli Zhu
- School of Materials Science and Engineering, The Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Tianjin, 300072, China
| | - Shuilin Wu
- School of Materials Science and Engineering, The Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Tianjin, 300072, China
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267
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The impact of candidate influenza virus and egg-based manufacture on vaccine effectiveness: Literature review and expert consensus. Vaccine 2020; 38:6047-6056. [PMID: 32600916 DOI: 10.1016/j.vaccine.2020.06.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/01/2020] [Accepted: 06/07/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Influenza is associated with significant morbidity and mortality worldwide. Whilst vaccination is key for the prevention of influenza infection, there are many factors which may contribute to reduced vaccine effectiveness, including antigenic evolution via both antigenic drift and egg-adaptations. Due to the currently dissociated and indirect evidence supporting both the occurrence of these two phenomena in the egg-based manufacturing process and their effects on vaccine effectiveness, this topic remains a subject of debate. OBJECTIVE To review the evidence and level of agreement in expert opinion supporting a mechanistic basis for reduced vaccine effectiveness due to egg-based manufacturing, using an expert consensus-based methodology and literature reviews. METHODS Ten European influenza specialists were recruited to the expert panel. The overall research question was deconstructed into four component principles, which were examined in series using a novel, online, two-stage assessment of proportional group awareness and consensus. The first stage independently generated a list of supporting references for each component principle via literature searches and expert assessments. In the second stage, a summary of each reference was circulated amongst the experts, who rated their agreement that each reference supported the component principle on a 5-point Likert scale. Finally, the panel were asked if they agreed that, as a whole, the evidence supported a mechanistic basis for reduced vaccine effectiveness due to egg-based manufacturing. RESULTS All component principles were reported to have a majority of strong or very strong supporting evidence (70-90%). CONCLUSIONS On reviewing the evidence for all component principles, experts unanimously agreed that there is a mechanistic basis for reduced vaccine effectiveness resulting from candidate influenza virus variation due to egg-based manufacturing, particularly in the influenza A/H3N2 strain. Experts pointed to surveillance, candidate vaccine virus selection and manufacturing stages involving eggs as the most likely to impact vaccine effectiveness.
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268
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Mirzaei R, Goodarzi P, Asadi M, Soltani A, Aljanabi HAA, Jeda AS, Dashtbin S, Jalalifar S, Mohammadzadeh R, Teimoori A, Tari K, Salari M, Ghiasvand S, Kazemi S, Yousefimashouf R, Keyvani H, Karampoor S. Bacterial co-infections with SARS-CoV-2. IUBMB Life 2020; 72:2097-2111. [PMID: 32770825 PMCID: PMC7436231 DOI: 10.1002/iub.2356] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/11/2020] [Accepted: 07/12/2020] [Indexed: 12/13/2022]
Abstract
The pandemic coronavirus disease 2019 (COVID‐19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2), has affected millions of people worldwide. To date, there are no proven effective therapies for this virus. Efforts made to develop antiviral strategies for the treatment of COVID‐19 are underway. Respiratory viral infections, such as influenza, predispose patients to co‐infections and these lead to increased disease severity and mortality. Numerous types of antibiotics such as azithromycin have been employed for the prevention and treatment of bacterial co‐infection and secondary bacterial infections in patients with a viral respiratory infection (e.g., SARS‐CoV‐2). Although antibiotics do not directly affect SARS‐CoV‐2, viral respiratory infections often result in bacterial pneumonia. It is possible that some patients die from bacterial co‐infection rather than virus itself. To date, a considerable number of bacterial strains have been resistant to various antibiotics such as azithromycin, and the overuse could render those or other antibiotics even less effective. Therefore, bacterial co‐infection and secondary bacterial infection are considered critical risk factors for the severity and mortality rates of COVID‐19. Also, the antibiotic‐resistant as a result of overusing must be considered. In this review, we will summarize the bacterial co‐infection and secondary bacterial infection in some featured respiratory viral infections, especially COVID‐19.
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Affiliation(s)
- Rasoul Mirzaei
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.,Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Pedram Goodarzi
- Faculty of Pharmacy, Iran University of Medical Sciences, Tehran, Iran
| | - Muhammad Asadi
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ayda Soltani
- School of Basic Sciences, Ale-Taha Institute of Higher Education, Tehran, Iran
| | - Hussain Ali Abraham Aljanabi
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Alnahrain University College of Medicine, Iraq
| | - Ali Salimi Jeda
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Dashtbin
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saba Jalalifar
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Rokhsareh Mohammadzadeh
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Teimoori
- Department of Virology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Kamran Tari
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran.,Department of Environmental Health Engineering, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehdi Salari
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran.,Department of Environmental Health Engineering, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sima Ghiasvand
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sima Kazemi
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rasoul Yousefimashouf
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hossein Keyvani
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sajad Karampoor
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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269
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Traditional Herbal Remedies with a Multifunctional Therapeutic Approach as an Implication in COVID-19 Associated Co-Infections. COATINGS 2020. [DOI: 10.3390/coatings10080761] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Co-infection in patients with viral infection as a predisposing factor is less focused on during epidemic outbreaks, resulting in increased morbidity and mortality. Recent studies showed that patients with coronavirus disease 2019 (COVID-19) often have both bacterial and fungal co-infections. In this study, sputum samples of 120 OPD (outdoor patients) suffering from respiratory tract infection (RTI) but negative for tuberculosis infection were collected with informed consent. Morphological, biochemical, and resistance criteria were used to classify isolates and to distinguish multidrug resistant (MDR) isolates, which were further classified on a molecular basis. We found that the isolates, including MDR strains, showed remarkable sensitivity against acetone and methanol extracts of Moringa oleifera, Adhatoda vasica, and Cassia fistula. The results strongly confirmed that multifactorial infections can produce MDR characteristics against antimicrobial drugs, which gave insight into the use of herbal drugs with their age-old traditional importance as having antiviral, antibacterial, antifungal, anti-inflammatory, and immunomodulatory effects. We conclude that apart from this, the anti-infective potential of these plants can be used in the future in the form of products such as cosmetics, pharmaceutical coatings, surface coatings, drug delivery vehicle coatings, and other bioengineered coatings for public use. Future studies are required to assess therapeutics for co-infective resistant strains and nosocomial infections with immune-enhancing effects, thereby promoting their function in holistic treatment and therapy of COVID-19 patients.
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270
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Manohar P, Loh B, Nachimuthu R, Hua X, Welburn SC, Leptihn S. Secondary Bacterial Infections in Patients With Viral Pneumonia. Front Med (Lausanne) 2020; 7:420. [PMID: 32850912 PMCID: PMC7419580 DOI: 10.3389/fmed.2020.00420] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/30/2020] [Indexed: 01/08/2023] Open
Abstract
Pulmonary diseases of viral origin are often followed by the manifestation of secondary infections, leading to further clinical complications and negative disease outcomes. Thus, research on secondary infections is essential. Here, we review clinical data of secondary bacterial infections developed after the onset of pulmonary viral infections. We review the most recent clinical data and current knowledge of secondary bacterial infections and their treatment in SARS-CoV-2 positive patients; case reports from SARS-CoV, MERS-CoV, SARS-CoV2 and the best-studied respiratory virus, influenza, are described. We outline treatments used or prophylactic measures employed for secondary bacterial infections. This evaluation includes recent clinical reports of pulmonary viral infections, including those by COVID-19, that reference secondary infections. Where data was provided for COVID-19 patients, a mortality rate of 15.2% due to secondary bacterial infections was observed for patients with pneumonia (41 of 268). Most clinicians treated patients with SARS-CoV-2 infections with prophylactic antibiotics (63.7%, n = 1,901), compared to 73.5% (n = 3,072) in all clinical reports of viral pneumonia included in this review. For all cases of viral pneumonia, a mortality rate of 10.9% due to secondary infections was observed (53 of 482). Most commonly, quinolones, cephalosporins and macrolides were administered, but also the glycopeptide vancomycin. Several bacterial pathogens appear to be prevalent as causative agents of secondary infections, including antibiotic-resistant strains of Staphylococcus aureus and Klebsiella pneumoniae.
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Affiliation(s)
- Prasanth Manohar
- Zhejiang University-University of Edinburgh (ZJU-UoE) Institute, Zhejiang University, Haining, China.,School of Medicine, The Second Affiliated Hospital Zhejiang University (SAHZU), Hangzhou, China
| | - Belinda Loh
- Zhejiang University-University of Edinburgh (ZJU-UoE) Institute, Zhejiang University, Haining, China
| | - Ramesh Nachimuthu
- Antibiotic Resistance and Phage Therapy Laboratory, School of Bio Sciences and Technology, Vellore Institute of Technology (VIT), Vellore, India
| | - Xiaoting Hua
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
| | - Susan C Welburn
- Zhejiang University-University of Edinburgh (ZJU-UoE) Institute, Zhejiang University, Haining, China.,Infection Medicine, Biomedical Sciences, Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom
| | - Sebastian Leptihn
- Zhejiang University-University of Edinburgh (ZJU-UoE) Institute, Zhejiang University, Haining, China.,Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Infection Medicine, Biomedical Sciences, Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom
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271
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Johnson KEE, Ghedin E. Quantifying between-Host Transmission in Influenza Virus Infections. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a038422. [PMID: 31871239 DOI: 10.1101/cshperspect.a038422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The error-prone replication and life cycle of influenza virus generate a diverse set of genetic variants. Transmission between hosts strictly limits both the number of virus particles and the genetic diversity of virus variants that reach a new host and establish an infection. This sharp reduction in the virus population at transmission--the transmission bottleneck--is significant to the evolution of influenza virus and to its epidemic and pandemic potential. This review describes transmission bottlenecks and their effect on the diversity and evolution of influenza virus. It also reviews the methods for calculating and predicting bottleneck sizes and highlights the host and viral determinants of influenza transmissibility.
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Affiliation(s)
- Katherine E E Johnson
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, New York 10003, USA
| | - Elodie Ghedin
- Center for Genomics and Systems Biology, Department of Biology, and Department of Epidemiology, College of Global Public Health, New York University, New York, New York 10003, USA
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272
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Baloxavir Marboxil Single-dose Treatment in Influenza-infected Children: A Randomized, Double-blind, Active Controlled Phase 3 Safety and Efficacy Trial (miniSTONE-2). Pediatr Infect Dis J 2020; 39:700-705. [PMID: 32516282 PMCID: PMC7360097 DOI: 10.1097/inf.0000000000002747] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Baloxavir marboxil (baloxavir) is a novel, cap-dependent endonuclease inhibitor that has previously demonstrated efficacy in the treatment of influenza in adults and adolescents. We assessed the safety and efficacy of baloxavir in otherwise healthy children with acute influenza. METHODS MiniSTONE-2 (Clinicaltrials.gov: NCT03629184) was a double-blind, randomized, active controlled trial enrolling children 1-<12 years old with a clinical diagnosis of influenza. Children were randomized 2:1 to receive either a single dose of oral baloxavir or oral oseltamivir twice daily for 5 days. The primary endpoint was incidence, severity and timing of adverse events (AEs); efficacy was a secondary endpoint. RESULTS In total, 173 children were randomized and dosed, 115 to the baloxavir group and 58 to the oseltamivir group. Characteristics of participants were similar between treatment groups. Overall, 122 AEs were reported in 84 (48.6%) children. Incidence of AEs was similar between baloxavir and oseltamivir groups (46.1% vs. 53.4%, respectively). The most common AEs were gastrointestinal (vomiting/diarrhea) in both groups [baloxavir: 12 children (10.4%); oseltamivir: 10 children (17.2%)]. No deaths, serious AEs or hospitalizations were reported. Median time (95% confidence interval) to alleviation of signs and symptoms of influenza was similar between groups: 138.1 (116.6-163.2) hours with baloxavir versus 150.0 (115.0-165.7) hours with oseltamivir. CONCLUSIONS Oral baloxavir is well tolerated and effective at alleviating symptoms in otherwise healthy children with acute influenza. Baloxavir provides a new therapeutic option with a simple oral dosing regimen.
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273
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Rossi D, Shadman M, Condoluci A, Brown JR, Byrd JC, Gaidano G, Hallek M, Hillmen P, Mato A, Montserrat E, Ghia P. How We Manage Patients With Chronic Lymphocytic Leukemia During the SARS-CoV-2 Pandemic. Hemasphere 2020; 4:e432. [PMID: 32803132 PMCID: PMC7410019 DOI: 10.1097/hs9.0000000000000432] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/02/2020] [Indexed: 12/15/2022] Open
Abstract
Infections are a major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL). These can be exacerbated by anti-leukemic treatments. In addition, the typical patients with CLL already have fragilities and background risk factors that apply to the general population for severe COVID-19. On these bases, patients with CLL may experience COVID-19 morbidity and mortality. Recurrent seasonal epidemics of SARS-CoV-2 are expected, and doctors taking care of patients with CLL must be prepared for the possibility of substantial resurgences of infection and adapt their approach to CLL management accordingly. In this Guideline Article, we aim at providing clinicians with a literature-informed expert opinion on the management of patients with CLL during SARS-CoV-2 epidemic.
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Affiliation(s)
- Davide Rossi
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Laboratory of Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Mazyar Shadman
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Adalgisa Condoluci
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Jennifer R. Brown
- Chronic Lymphocytic Leukemia Center, Division of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - John C. Byrd
- The Ohio State University Comprehensive Cancer Center and Division of Hematology, Columbus, Ohio, USA
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Michael Hallek
- Center of Integrated Oncology Cologne Bonn and German CLL Study Group, University of Cologne, Cologne, Germany
| | - Peter Hillmen
- Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, United Kingdom
- Section of Experimental Haematology, University of Leeds, Leeds, United Kingdom
| | - Anthony Mato
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Emili Montserrat
- Hospital Clinic, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Paolo Ghia
- Division of Experimental Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
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274
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Thindwa D, Garcia Quesada M, Liu Y, Bennett J, Cohen C, Knoll MD, von Gottberg A, Hayford K, Flasche S. Use of seasonal influenza and pneumococcal polysaccharide vaccines in older adults to reduce COVID-19 mortality. Vaccine 2020; 38:5398-5401. [PMID: 32600911 PMCID: PMC7303659 DOI: 10.1016/j.vaccine.2020.06.047] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Deus Thindwa
- Centre for Mathematical Modelling of Infectious Disease, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Maria Garcia Quesada
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yang Liu
- Centre for Mathematical Modelling of Infectious Disease, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Julia Bennett
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Maria Deloria Knoll
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Kyla Hayford
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stefan Flasche
- Centre for Mathematical Modelling of Infectious Disease, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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275
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Goursaud S, Mombrun M, du Cheyron D. COVID-19 necrotising pneumonia and extracorporeal membrane oxygenation: a challenge for anticoagulation. ERJ Open Res 2020; 6:00182-2020. [PMID: 32665949 PMCID: PMC7335839 DOI: 10.1183/23120541.00182-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/26/2020] [Indexed: 01/08/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) support is proposed as rescue therapy for severe acute respiratory distress syndrome (ARDS) related to coronavirus disease 2019 (COVID-19) [1]. Severe bleeding events were described in severe ARDS patients requiring ECMO in large cohorts [2]. Few studies reported their experiences in COVID-19 critically ill patients receiving ECMO [3]. However, Yanget al. [4] highlighted in their retrospective cohort a high mortality rate in these patients. We report a severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) necrotising pneumonia-induced fatal haemorrhagic complication with ECMO. ECMO and curative anticoagulation may be associated with severe bleeding events in #COVID19 pneumonia. ECMO and high levels of anticoagulation must be considered with caution in the most severe patients with #SARS-CoV-2 necrotising pneumonia.https://bit.ly/3clhu31
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Affiliation(s)
- Suzanne Goursaud
- Dept of Medical Intensive Care, Caen University Hospital, Caen, France.,Normandie Univ., UNICAEN, INSERM, U1237, PhIND "Physiopathology and imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
| | - Martin Mombrun
- Dept of Medical Intensive Care, Caen University Hospital, Caen, France
| | - Damien du Cheyron
- Dept of Medical Intensive Care, Caen University Hospital, Caen, France
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276
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Wang Z, Fang Y, Ip M, Lau M, Lau JTF. Facilitators and barriers to completing recommended doses of pneumococcal vaccination among community-living individuals aged ≥65 years in Hong Kong - a population-based study. Hum Vaccin Immunother 2020; 17:527-536. [PMID: 32614636 DOI: 10.1080/21645515.2020.1776545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Individuals aged ≥65 y are recommended to receive pneumococcal vaccination (PV). PV completion is defined as receiving two doses of PV among those with at least one high-risk condition for severe invasive pneumococcal diseases (IPD) or receiving one dose of PV among those without any high-risk conditions. This study investigated factors associated with PV completion among a random sample of community-living older adults in Hong Kong, China. In addition, factors associated with receiving a single dose of PV among older adults with at least one high-risk condition were also investigated. A total of 750 community-living Chinese-speaking individuals aged ≥65 y in Hong Kong (response rate: 63.4%) completed a random telephone survey from May to July 2019. PV completion was 10% among all participants. Among participants with high-risk condition(s) for severe IPD, 11.4% received a single dose of PV. After adjustment for significant background variables, several Health Belief Model constructs were significantly associated with both dependent variables: (1) perceived risk of contracting pneumococcal diseases, (2) perceived benefits of PV for protecting themselves or others, (3) perceived barriers to PV uptake, (4) being suggested by significant others to take up PV (cue to action), and (5) confidence to take up PV (perceived self-efficacy). In addition, being knowledgeable about pneumococcal diseases and vaccination, and knowing at least one peer of similar age who had taken up PV were also positively associated with both dependent variables. Targeted, theory-based health promotion efforts are needed to increase PV coverage among elderly in Hong Kong.
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Affiliation(s)
- Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong, China.,Shenzhen Research Institute, The Chinese University of Hong Kong , Shenzhen, China
| | - Yuan Fang
- Department of Early Childhood Education, The Education University of Hong Kong , Hong Kong SAR, China
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong SAR, China
| | - Mason Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong, China
| | - Joseph T F Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong, China.,Shenzhen Research Institute, The Chinese University of Hong Kong , Shenzhen, China
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277
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BR B, Damle H, Ganju S, Damle L. In silico screening of known small molecules to bind ACE2 specific RBD on Spike glycoprotein of SARS-CoV-2 for repurposing against COVID-19. F1000Res 2020; 9:663. [PMID: 32765844 PMCID: PMC7385708 DOI: 10.12688/f1000research.24143.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Human coronavirus (SARS-CoV-2) is causing a pandemic with significant morbidity and mortality. As no effective novel drugs are available currently, drug repurposing is an alternative intervention strategy. Here we present an in silico drug repurposing study that implements successful concepts of computer-aided drug design (CADD) technology for repurposing known drugs to interfere with viral cellular entry via the spike glycoprotein (SARS-CoV-2-S), which mediates host cell entry via the hACE2 receptor. Methods: A total of 4015 known and approved small molecules were screened for interaction with SARS-CoV-2-S through docking studies and 15 lead molecules were shortlisted. Additionally, streptomycin, ciprofloxacin, and glycyrrhizic acid (GA) were selected based on their reported anti-viral activity, safety, availability and affordability. The 18 molecules were subjected to molecular dynamics (MD) simulation. Results: The MD simulation results indicate that GA of plant origin may be repurposed for SARS-CoV-2 intervention, pending further studies. Conclusions: Repurposing is a beneficial strategy for treating COVID-19 with existing drugs. It is aimed at using docking studies to screen molecules for clinical application and investigating their efficacy in inhibiting SARS-CoV-2-S. SARS-CoV-2-S is a key pathogenic protein that mediates pathogen-host interaction. Hence, the molecules screened for inhibitory properties against SARS-CoV-2-S can be clinically used to treat COVID-19 since the safety profile is already known.
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Affiliation(s)
- Bharath BR
- Computational Biology, Atrimed Biotech LLP, Banglore, 560100, India
| | | | - Shiban Ganju
- Atrimed Pharmaceuticals Pvt. Ltd, Banglore, 560001, India
| | - Latha Damle
- Computational Biology, Atrimed Biotech LLP, Banglore, 560100, India
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278
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Hughes S, Troise O, Donaldson H, Mughal N, Moore LSP. Bacterial and fungal coinfection among hospitalized patients with COVID-19: a retrospective cohort study in a UK secondary-care setting. Clin Microbiol Infect 2020; 26:1395-1399. [PMID: 32603803 PMCID: PMC7320692 DOI: 10.1016/j.cmi.2020.06.025] [Citation(s) in RCA: 409] [Impact Index Per Article: 102.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/15/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022]
Abstract
Objectives To investigate the incidence of bacterial and fungal coinfection of hospitalized patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in this retrospective observational study across two London hospitals during the first UK wave of coronavirus disease 2019 (COVID-19). Methods A retrospective case series of hospitalized patients with confirmed SARS-CoV-2 by PCR was analysed across two acute NHS hospitals (20 February–20 April 2020; each isolate reviewed independently in parallel). This was contrasted to a control group of influenza-positive patients admitted during the 2019–2020 flu season. Patient demographics, microbiology and clinical outcomes were analysed. Results A total of 836 patients with confirmed SARS-CoV-2 were included; 27 (3.2%) of 836 had early confirmed bacterial isolates identified (0–5 days after admission), rising to 51 (6.1%) of 836 throughout admission. Blood cultures, respiratory samples, pneumococcal or Legionella urinary antigens and respiratory viral PCR panels were obtained from 643 (77%), 110 (13%), 249 (30%), 246 (29%) and 250 (30%) COVID-19 patients, respectively. A positive blood culture was identified in 60 patients (7.1%), of which 39 were classified as contaminants. Bacteraemia resulting from respiratory infection was confirmed in two cases (one each community-acquired Klebsiella pneumoniae and ventilator-associated Enterobacter cloacae). Line-related bacteraemia was identified in six patients (three Candida, two Enterococcus spp. and one Pseudomonas aeruginosa). All other community-acquired bacteraemias (n = 16) were attributed to nonrespiratory infection. Zero concomitant pneumococcal, Legionella or influenza infection was detected. A low yield of positive respiratory cultures was identified; Staphylococcus aureus was the most common respiratory pathogen isolated in community-acquired coinfection (4/24; 16.7%), with pseudomonas and yeast identified in late-onset infection. Invasive fungal infections (n = 3) were attributed to line-related infections. Comparable rates of positive coinfection were identified in the control group of confirmed influenza infection; clinically relevant bacteraemias (2/141; 1.4%), respiratory cultures (10/38; 26.3%) and pneumococcal-positive antigens (1/19; 5.3%) were low. Conclusions We found a low frequency of bacterial coinfection in early COVID-19 hospital presentation, and no evidence of concomitant fungal infection, at least in the early phase of COVID-19.
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Affiliation(s)
- S Hughes
- Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK.
| | - O Troise
- Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK
| | - H Donaldson
- Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK; North West London Pathology, Imperial College Healthcare NHS Trust, Hammersmith Campus, London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
| | - N Mughal
- Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK; North West London Pathology, Imperial College Healthcare NHS Trust, Hammersmith Campus, London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
| | - L S P Moore
- Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK; North West London Pathology, Imperial College Healthcare NHS Trust, Hammersmith Campus, London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
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279
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Manohar P, Loh B, Athira S, Nachimuthu R, Hua X, Welburn SC, Leptihn S. Secondary Bacterial Infections During Pulmonary Viral Disease: Phage Therapeutics as Alternatives to Antibiotics? Front Microbiol 2020; 11:1434. [PMID: 32733404 PMCID: PMC7358648 DOI: 10.3389/fmicb.2020.01434] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/03/2020] [Indexed: 12/25/2022] Open
Abstract
Secondary bacterial infections manifest during or after a viral infection(s) and can lead to negative outcomes and sometimes fatal clinical complications. Research and development of clinical interventions is largely focused on the primary pathogen, with research on any secondary infection(s) being neglected. Here we highlight the impact of secondary bacterial infections and in particular those caused by antibiotic-resistant strains, on disease outcomes. We describe possible non-antibiotic treatment options, when small molecule drugs have no effect on the bacterial pathogen and explore the potential of phage therapy and phage-derived therapeutic proteins and strategies in treating secondary bacterial infections, including their application in combination with chemical antibiotics.
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Affiliation(s)
- Prasanth Manohar
- Zhejiang University-University of Edinburgh Institute, Zhejiang University, Haining, China.,The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Belinda Loh
- Zhejiang University-University of Edinburgh Institute, Zhejiang University, Haining, China
| | - Sudarsanan Athira
- Antibiotic Resistance and Phage Therapy Laboratory, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India
| | - Ramesh Nachimuthu
- Antibiotic Resistance and Phage Therapy Laboratory, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India
| | - Xiaoting Hua
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
| | - Susan C Welburn
- Zhejiang University-University of Edinburgh Institute, Zhejiang University, Haining, China.,Infection Medicine, Biomedical Sciences, Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom
| | - Sebastian Leptihn
- Zhejiang University-University of Edinburgh Institute, Zhejiang University, Haining, China.,Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Infection Medicine, Biomedical Sciences, Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom
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280
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Atere M, Arulthasan V, Nfonoyim JM. A Case of Atraumatic, Streptococcal Pneumocephalus: A Rare Complication of Influenza B Infection. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923029. [PMID: 32576808 PMCID: PMC7334837 DOI: 10.12659/ajcr.923029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Female, 51-year-old Final Diagnosis: Pneumocephalus • Pneumococcal meningitis Symptoms: Worsening of mental status Medication:— Clinical Procedure: — Specialty: Critical Care Medicine • Infectious Diseases • General and Internal Medicine
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Affiliation(s)
- Muhammed Atere
- Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | | | - Jay M Nfonoyim
- Department of Critical Care/Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA
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281
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Bengoechea JA, Bamford CG. SARS-CoV-2, bacterial co-infections, and AMR: the deadly trio in COVID-19? EMBO Mol Med 2020; 12:e12560. [PMID: 32453917 PMCID: PMC7283846 DOI: 10.15252/emmm.202012560] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Jose A Bengoechea
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Connor Gg Bamford
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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282
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Tian Q, Ye J, Yuan W, Zhang S, Shi L, Zhong J, Ning G. Highly effective antibacterial activity of lithium-doped magnesium oxide particles synthesized by the microwave-assisted hydrothermal route. POWDER TECHNOL 2020. [DOI: 10.1016/j.powtec.2020.05.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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283
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Microbiome disturbance and resilience dynamics of the upper respiratory tract during influenza A virus infection. Nat Commun 2020; 11:2537. [PMID: 32439901 PMCID: PMC7242466 DOI: 10.1038/s41467-020-16429-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 04/28/2020] [Indexed: 01/10/2023] Open
Abstract
Infection with influenza can be aggravated by bacterial co-infections, which often results in disease exacerbation. The effects of influenza infection on the upper respiratory tract (URT) microbiome are largely unknown. Here, we report a longitudinal study to assess the temporal dynamics of the URT microbiomes of uninfected and influenza virus-infected humans and ferrets. Uninfected human patients and ferret URT microbiomes have stable healthy ecostate communities both within and between individuals. In contrast, infected patients and ferrets exhibit large changes in bacterial community composition over time and between individuals. The unhealthy ecostates of infected individuals progress towards the healthy ecostate, coinciding with viral clearance and recovery. Pseudomonadales associate statistically with the disturbed microbiomes of infected individuals. The dynamic and resilient microbiome during influenza virus infection in multiple hosts provides a compelling rationale for the maintenance of the microbiome homeostasis as a potential therapeutic target to prevent IAV associated bacterial co-infections. Influenza A virus (IAV) infection can be exacerbated by bacterial co-infections but the effect of IAV on the upper respiratory tract (URT) microbiome remains unclear. Here, the authors compare the dynamics of the UTR microbiome in IAV-infected ferrets and humans, finding similar trends at the ecosystem and individual taxon level in both hosts.
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284
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Meilleur CE, Memarnejadian A, Shivji AN, Benoit JM, Tuffs SW, Mele TS, Singh B, Dikeakos JD, Topham DJ, Mu HH, Bennink JR, McCormick JK, Haeryfar SMM. Discordant rearrangement of primary and anamnestic CD8+ T cell responses to influenza A viral epitopes upon exposure to bacterial superantigens: Implications for prophylactic vaccination, heterosubtypic immunity and superinfections. PLoS Pathog 2020; 16:e1008393. [PMID: 32433711 PMCID: PMC7239382 DOI: 10.1371/journal.ppat.1008393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 02/10/2020] [Indexed: 12/21/2022] Open
Abstract
Infection with (SAg)-producing bacteria may precede or follow infection with or vaccination against influenza A viruses (IAVs). However, how SAgs alter the breadth of IAV-specific CD8+ T cell (TCD8) responses is unknown. Moreover, whether recall responses mediating heterosubtypic immunity to IAVs are manipulated by SAgs remains unexplored. We employed wild-type (WT) and mutant bacterial SAgs, SAg-sufficient/deficient Staphylococcus aureus strains, and WT, mouse-adapted and reassortant IAV strains in multiple in vivo settings to address the above questions. Contrary to the popular view that SAgs delete or anergize T cells, systemic administration of staphylococcal enterotoxin B (SEB) or Mycoplasma arthritidis mitogen before intraperitoneal IAV immunization enlarged the clonal size of ‘select’ IAV-specific TCD8 and reshuffled the hierarchical pattern of primary TCD8 responses. This was mechanistically linked to the TCR Vβ makeup of the impacted clones rather than their immunodominance status. Importantly, SAg-expanded TCD8 retained their IFN-γ production and cognate cytolytic capacities. The enhancing effect of SEB on immunodominant TCD8 was also evident in primary responses to vaccination with heat-inactivated and live attenuated IAV strains administered intramuscularly and intranasally, respectively. Interestingly, in prime-boost immunization settings, the outcome of SEB administration depended strictly upon the time point at which this SAg was introduced. Accordingly, SEB injection before priming raised CD127highKLRG1low memory precursor frequencies and augmented the anamnestic responses of SEB-binding TCD8. By comparison, introducing SEB before boosting diminished recall responses to IAV-derived epitopes drastically and indiscriminately. This was accompanied by lower Ki67 and higher Fas, LAG-3 and PD-1 levels consistent with a pro-apoptotic and/or exhausted phenotype. Therefore, SAgs can have contrasting impacts on anti-IAV immunity depending on the naïve/memory status and the TCR composition of exposed TCD8. Finally, local administration of SEB or infection with SEB-producing S. aureus enhanced pulmonary TCD8 responses to IAV. Our findings have clear implications for superinfections and prophylactic vaccination. Exposure to bacterial superantigens (SAgs) is often a consequence of infection with common Gram-positive bacteria causing septic and toxic shock or food poisoning. How SAgs affect the magnitude, breadth and quality of infection/vaccine-elicited CD8+ T cell (TCD8) responses to respiratory viral pathogens, including influenza A viruses (IAVs), is far from clear. Also importantly, superinfections with IAVs and SAg-producing bacteria are serious clinical occurrences during seasonal and pandemic flu and require urgent attention. We demonstrate that two structurally distinct SAgs, including staphylococcal enterotoxin B (SEB), unexpectedly enhance primary TCD8 responses to ‘select’ IAV-derived epitopes depending on the TCR makeup of the responding clones. Intriguingly, the timing of exposure to SEB dictates the outcome of prime-boost immunization. Seeing a SAg before priming raises memory precursor frequencies and augments anamnestic TCD8 responses. Conversely, a SAg encounter before boosting renders TCD8 prone to death or exhaustion and impedes recall responses, thus likely compromising heterosubtypic immunity to IAVs. Finally, local exposure to SEB increases the pulmonary response of immunodominant IAV-specific TCD8. These findings shed new light on how bacterial infections and SAgs influence the effectiveness of anti-IAV TCD8 responses, and have, as such, wide-ranging implications for preventative vaccination and infection control.
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Affiliation(s)
- Courtney E. Meilleur
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Arash Memarnejadian
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Adil N. Shivji
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Jenna M. Benoit
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Stephen W. Tuffs
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Tina S. Mele
- Division of General Surgery, Department of Surgery, Western University, London, Ontario, Canada
- Division of Critical Care Medicine, Department of Medicine, Western University, London, Ontario, Canada
| | - Bhagirath Singh
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Centre for Human Immunology, Western University, London, Ontario, Canada
| | - Jimmy D. Dikeakos
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - David J. Topham
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Hong-Hua Mu
- Division of Rheumatology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Jack R. Bennink
- Viral Immunology Section, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - John K. McCormick
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Centre for Human Immunology, Western University, London, Ontario, Canada
| | - S. M. Mansour Haeryfar
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
- Division of General Surgery, Department of Surgery, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Centre for Human Immunology, Western University, London, Ontario, Canada
- Division of Clinical Immunology & Allergy, Department of Medicine, Western University, London, Ontario, Canada
- * E-mail:
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285
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Influenza A virus PB1‐F2 protein: An ambivalent innate immune modulator and virulence factor. J Leukoc Biol 2020; 107:763-771. [DOI: 10.1002/jlb.4mr0320-206r] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/14/2022] Open
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286
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Bajpai V, Gupta E, Mitra LG, Kumar H, Maiwall R, Soni KD, Gupta A. Spectrum of respiratory viral infections in liver disease patients with cirrhosis admitted in critical care unit. J Lab Physicians 2020; 11:356-360. [PMID: 31929704 PMCID: PMC6943874 DOI: 10.4103/jlp.jlp_6_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND: Clinical significance of respiratory viruses (RVs) as an etiology of pneumonia in liver disease patients with cirrhosis is usually underestimated. Therefore, the aim of this study was to evaluate the spectrum of RVs in cirrhotic patients with pneumonia admitted in critical care units (CCUs) and its impact on the clinical outcome of cirrhotic patients. MATERIAL AND METHOD: A prospective study was conducted in a tertiary care CCU, and consecutive cirrhotic patients with pneumonia were included. Bronchoalveolar lavage or throat swab/nasal swab was collected in viral transport medium for analysis of RVs by multiplex real-time polymerase chain reaction. A total of 135 cirrhotic patients were included, viral and bacterial etiology of pneumonia was identified, and analysis was done with the clinical outcome. RESULTS: Overall, RVs were detected in 30 (22.2%) cirrhotic patients and viral–bacterial coinfection in 16 (11.8%) cirrhotic patients. The most common virus detected was rhinovirus in 9 (30%) patients. Mortality in cirrhotic patients with RV infection was significantly higher in comparison to cirrhotic patients with no RV infection (25 [83.3%] and 11 [12.3%], respectively, P < 0.001). CONCLUSION: Respiratory viruses in cirrhotic patients with pneumonia are associated with poor clinical outcome.
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Affiliation(s)
- Vijeta Bajpai
- Departments of Clinical Virology, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Ekta Gupta
- Departments of Clinical Virology, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Lalita Gauri Mitra
- Critical Care and Anaesthesia, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Hemant Kumar
- Pulmonary Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Rakhi Maiwall
- Hepatology, Institute of Liver and Biliary Sciences, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Department of Trauma and Critical Intensive Care Unit, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Gupta
- Department of Surgery, JPNATC, All India Institute of Medical Sciences, New Delhi, India
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287
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Kanyiri CW, Luboobi L, Kimathi M. Application of Optimal Control to Influenza Pneumonia Coinfection with Antiviral Resistance. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2020; 2020:5984095. [PMID: 32256682 PMCID: PMC7091548 DOI: 10.1155/2020/5984095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/01/2020] [Accepted: 02/13/2020] [Indexed: 12/30/2022]
Abstract
Influenza and pneumonia independently lead to high morbidity and mortality annually among the human population globally; however, a glaring fact is that influenza pneumonia coinfection is more vicious and it is a threat to public health. Emergence of antiviral resistance is a major impediment in the control of the coinfection. In this paper, a deterministic mathematical model illustrating the transmission dynamics of influenza pneumonia coinfection is formulated having incorporated antiviral resistance. Optimal control theory is then applied to investigate optimal strategies for controlling the coinfection using prevalence reduction and treatment as the system control variables. Pontryagin's maximum principle is used to characterize the optimal control. The derived optimality system is solved numerically using the Runge-Kutta-based forward-backward sweep method. Simulation results reveal that implementation of prevention measures is sufficient to eradicate influenza pneumonia coinfection from a given population. The prevention measures could be social distancing, vaccination, curbing mutation and reassortment, and curbing interspecies movement of the influenza virus.
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Affiliation(s)
- Caroline W. Kanyiri
- Department of Mathematics, Pan African University Institute of Basic Sciences, Technology and Innovation, P.O. Box 62000-00200, Nairobi, Kenya
| | - Livingstone Luboobi
- Institute of Mathematical Sciences, Strathmore University, P.O. Box 59857-00200, Nairobi, Kenya
| | - Mark Kimathi
- Department of Mathematics, Machakos University, P.O. Box 139-90100, Machakos, Kenya
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288
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Bednarz J, Mok D, Zieren J, Ferguson T, Gomez-Garcia J, Glass J, McCown M, Smith K, Yonish B, Bodoe AC. Personal Opinions Seem to be the Major Contributor to the Influenza Vaccination Disparity in Sneedville, TN. Cureus 2020; 12:e7015. [PMID: 32211251 PMCID: PMC7082785 DOI: 10.7759/cureus.7015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Relevance Although the seasonal flu vaccine remains the most effective way to prevent the spread of influenza and reduce its associated mortalities, the proportion of individuals receiving the vaccine continues to be an issue in various communities across the United States. The attitudes of residents who live in Sneedville, a small town in a rural northeastern Tennessee, were surveyed. Objective(s) To determine the barriers to influenza vaccination in Sneedville, Tennessee and contribute to the literature on why some rural communities across the United States show low influenza vaccination rates. Materials and Methods Door-to-door convenience sampling was conducted in Sneedville, TN. Participants were asked to complete a survey consisting of three yes or no demographic questions (one with an option to further elaborate) and nine opinion questions based on a five-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = undecided, 4 = agree, 5 = strongly agree). Participants were not provided any additional details pertaining to the Likert scale questions and were given the option to skip the Likert scale questions. These questions were chosen to gauge the potential structural, socioeconomic, belief, and provider-related barriers to vaccination. Two-tailed independent t-tests were used to compare the Likert scale means for each of the nine opinion questions in those that received the influenza vaccine and those who did not. Univariate analysis was conducted to assess difference in the distribution of Likert responses in vaccinators compared to non-vaccinators. Results This project surveyed 172 residents of which 60.5% (104/172) indicated that they did not receive the influenza vaccine for the 2017-2018 flu season. Compared to individuals who vaccinate against the flu, individuals who do not vaccinate against the flu believe the flu shot is not worthwhile and believe the flu shot has a greater chance to make them sick. Conclusions This study finds that structural, socioeconomic, and provider-related barriers are not the underlying cause of the low influenza vaccination rates in this rural area. Instead, public opinion on influenza vaccination seems to be the reason for the disparity.
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Affiliation(s)
- Jacek Bednarz
- Family Medicine, Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, USA
| | - Daniel Mok
- Family Medicine, Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, USA
| | - Jan Zieren
- Family Medicine, Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, USA
| | - Theresa Ferguson
- Family Medicine, Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, USA
| | - Jose Gomez-Garcia
- Osteopathic Medicine, Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, USA
| | - Jordan Glass
- Family Medicine, Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, USA
| | - Melanie McCown
- Osteopathic Medicine, Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, USA
| | - Kelcie Smith
- Family Medicine, Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, USA
| | - Brian Yonish
- Family Medicine, Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, USA
| | - Aveesha C Bodoe
- Wellness Services, Healthy Campus Team, Mount Royal University, Calgary, CAN
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289
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Aguilera ER, Lenz LL. Inflammation as a Modulator of Host Susceptibility to Pulmonary Influenza, Pneumococcal, and Co-Infections. Front Immunol 2020; 11:105. [PMID: 32117259 PMCID: PMC7026256 DOI: 10.3389/fimmu.2020.00105] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/15/2020] [Indexed: 12/24/2022] Open
Abstract
Bacterial and viral pathogens are predominant causes of pulmonary infections and complications. Morbidity and mortality from these infections is increased in populations that include the elderly, infants, and individuals with genetic disorders such as Down syndrome. Immune senescence, concurrent infections, and other immune alterations occur in these susceptible populations, but the underlying mechanisms that dictate increased susceptibility to lung infections are not fully defined. Here, we review unique features of the lung as a mucosal epithelial tissue and aspects of inflammatory and immune responses in model pulmonary infections and co-infections by influenza virus and Streptococcus pneumoniae. In these models, lung inflammatory responses are a double-edged sword: recruitment of immune effectors is essential to eliminate bacteria and virus-infected cells, but inflammatory cytokines drive changes in the lung conducive to increased pathogen replication. Excessive accumulation of inflammatory cells also hinders lung function, possibly causing death of the host. Some animal studies have found that targeting host modulators of lung inflammatory responses has therapeutic or prophylactic effects in these infection and co-infection models. However, conflicting results from other studies suggest microbiota, sequence of colonization, or other unappreciated aspects of lung biology also play important roles in the outcome of infections. Regardless, a predisposition to excessive or aberrant inflammatory responses occurs in susceptible human populations. Hence, in appropriate contexts, modulation of inflammatory responses may prove effective for reducing the frequency or severity of pulmonary infections. However, there remain limitations in our understanding of how this might best be achieved—particularly in diverse human populations.
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Affiliation(s)
- Elizabeth R Aguilera
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Laurel L Lenz
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO, United States
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290
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Abstract
Purpose of Review This investigation aims to understand the role and burden of viral co-infections for acute respiratory illnesses in children. Co-infection can be either viral-viral or viral-bacterial and with new technology there is more information on the role they play on the health of children. Recent Findings With the proliferation of multiplex PCR for rapid diagnosis of multiple viruses as well as innovations on identification of bacterial infections, research has been attempting to discover how these co-infections affect each other and the host. Studies are aiming to discern if the epidemiology of viruses seen at a population level is related to the interaction between different viruses on a host level. Studies are also attempting to discover the burden of morbidity and mortality of these viral-viral co-infections on the pediatric population. It is also becoming important to understand the interplay of certain viruses with specific bacteria and understanding the impact of viral-bacterial co-infections. Summary RSV continues to contribute to a large burden of disease for pediatric patients with acute respiratory illnesses. However, recent literature suggests that viral-viral co-infections do not add to this burden and might, in some cases, be protective of severe disease. Viral-bacterial co-infections, on the other hand, are most likely adding to the burden of morbidity in pediatric patients because of the synergistic way they can infect the nasopharyngeal space. Future research needs to focus on confirming these conclusions as it could affect hospital cohorting, role of molecular testing, and therapeutic interventions.
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Affiliation(s)
- Sarah D Meskill
- Department of Pediatrics, Sections of Emergency Medicine, Baylor College of Medicine, 6621 Fannin St. A2210, Houston, TX, USA.
| | - Shelease C O'Bryant
- Department of Pediatrics, Sections of Emergency Medicine, Baylor College of Medicine, 6621 Fannin St. A2210, Houston, TX, USA
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291
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Koul PA, Swaminathan S, Rajgopal T, Ramsubramanian V, Joseph B, Shanbhag S, Mishra A, Raut SK. Adult Immunization in Occupational Settings: A Consensus of Indian Experts. Indian J Occup Environ Med 2020; 24:3-15. [PMID: 32435109 PMCID: PMC7227733 DOI: 10.4103/ijoem.ijoem_50_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 12/18/2022] Open
Abstract
There is an increasing focus on instituting wellness programs at the workplace among organizations in India. Such programs are aimed at improving employee health, which in turn, helps in reducing absenteeism, as well as in increasing work productivity and improving employee engagement. Of note, adult vaccination plays a significant role in ensuring the well-being of employees, as well as in keeping an organization profitable. The burden of vaccine-preventable diseases (VPDs) in adults is increasing in India, causing significant morbidity and disability. Moreover, adult immunization is an underpublicized concept in India. There is an urgent need to create awareness about adult immunization in India, particularly in occupational health settings-both at the employee and employer levels. In view of this, an expert meeting was held under the aegis of the Indian Association of Occupational Health (IAOH) to discuss key issues pertaining to the burden of VPDs in the working population in India and to formulate guidelines on adult vaccination in occupational health settings. This consensus guideline document may act as a guide for organizations across India to create awareness about adult vaccination and also to design workplace vaccination programs to promote better health among employees.
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Affiliation(s)
- Parvaiz A. Koul
- Professor and Head, Internal and Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Subramanium Swaminathan
- Senior Consultant, Infectious Diseases, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Thirumalai Rajgopal
- Vice President, Global Medical and Occupational Health, Unilever, Mumbai, Maharashtra, India
| | - V. Ramsubramanian
- Senior Consultant, Infectious Diseases and Tropical Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Bobby Joseph
- Professor, Community Health; Head, Occupational Health Services, St. John's Medical College, Bangalore, Karnataka, India
| | - Shrinivas Shanbhag
- Medical Advisor, Chairman's Office, Reliance Industries Limited, Mumbai, Maharashtra, India
| | - Ashish Mishra
- Health Director – Europe, Middle East, Africa and India, Dow Chemical International Pvt. Ltd. and President, Indian Association of Occupational Health, Mumbai Branch, Maharashtra, India
| | - Sidram K. Raut
- Director, Noble Hospital; Head of Blood Bank, Corporate and Overseas Business and Clinical Research, Noble Hospital, Pune, Maharashtra and President, Indian Association of Occupational Health, India
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292
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Fluorescent sialic derivatives for the specific detection of influenza viruses. Bioorg Med Chem Lett 2019; 29:126773. [DOI: 10.1016/j.bmcl.2019.126773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/19/2019] [Accepted: 10/19/2019] [Indexed: 12/20/2022]
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293
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Keilich SR, Bartley JM, Haynes L. Diminished immune responses with aging predispose older adults to common and uncommon influenza complications. Cell Immunol 2019; 345:103992. [PMID: 31627841 PMCID: PMC6939636 DOI: 10.1016/j.cellimm.2019.103992] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 02/06/2023]
Abstract
Influenza (flu) is a serious disease for older adults, with increased severity of infection and greater risk for hospitalization and death. Flu infection is limited to pulmonary epithelial cells, yet there are many systemic symptoms and older adults are more susceptible to flu-related complications. In older adults, flu rarely comes without additional complications and there is a perfect storm for enhanced disease due to multiple factors including existing co-morbidities, plus impaired lung function and dysregulated immune responses that occur with even healthy aging. Commonly, opportunistic secondary bacterial infections prosper in damaged lungs. Intensified systemic inflammation with aging can cause dysfunction in extra-pulmonary organs and tissues such as cardiovascular, musculoskeletal, neuropathologic, hepatic, and renal complications. Often overlooked is the underappreciated connections between many of these conditions, which exacerbate one another when in parallel. This review focuses on flu infection and the numerous complications in older adults associated with diminished immune responses.
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Affiliation(s)
- Spencer R Keilich
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
| | - Jenna M Bartley
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT 06030, USA; Department of Immunology, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
| | - Laura Haynes
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT 06030, USA; Department of Immunology, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
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294
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Skelton RM, Shepardson KM, Hatton A, Wilson PT, Sreenivasan C, Yu J, Wang D, Huber VC, Rynda-Apple A. Contribution of Host Immune Responses Against Influenza D Virus Infection Toward Secondary Bacterial Infection in a Mouse Model. Viruses 2019; 11:E994. [PMID: 31671825 PMCID: PMC6893757 DOI: 10.3390/v11110994] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 12/14/2022] Open
Abstract
Influenza D viruses (IDV) are known to co-circulate with viral and bacterial pathogens in cattle and other ruminants. Currently, there is limited knowledge regarding host responses to IDV infection and whether IDV infection affects host susceptibility to secondary bacterial infections. To begin to address this gap in knowledge, the current study utilized a combination of in vivo and in vitro approaches to evaluate host cellular responses against primary IDV infection and secondary bacterial infection with Staphylococcus aureus (S. aureus). Primary IDV infection in mice did not result in clinical signs of disease and it did not enhance the susceptibility to secondary S. aureus infection. Rather, IDV infection appeared to protect mice from the usual clinical features of secondary bacterial infection, as demonstrated by improved weight loss, survival, and recovery when compared to S. aureus infection alone. We found a notable increase in IFN-β expression following IDV infection while utilizing human alveolar epithelial A549 cells to analyze early anti-viral responses to IDV infection. These results demonstrate for the first time that IDV infection does not increase the susceptibility to secondary bacterial infection with S. aureus, with evidence that anti-viral immune responses during IDV infection might protect the host against these potentially deadly outcomes.
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Affiliation(s)
- Raegan M Skelton
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA.
| | - Kelly M Shepardson
- Department of Microbiology and Immunology, Montana State University, Bozeman, MT 59717, USA.
| | - Alexis Hatton
- Department of Microbiology and Immunology, Montana State University, Bozeman, MT 59717, USA.
| | - Patrick T Wilson
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA.
| | - Chithra Sreenivasan
- Department of Biology and Microbiology, South Dakota State University, Brookings, SD 57007, USA.
| | - Jieshi Yu
- Department of Biology and Microbiology, South Dakota State University, Brookings, SD 57007, USA.
| | - Dan Wang
- Department of Biology and Microbiology, South Dakota State University, Brookings, SD 57007, USA.
| | - Victor C Huber
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA.
| | - Agnieszka Rynda-Apple
- Department of Microbiology and Immunology, Montana State University, Bozeman, MT 59717, USA.
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295
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Marvadi SK, Krishna VS, Sinegubova EO, Volobueva AS, Esaulkova YL, Muryleva AA, Tentler DG, Sriram D, Zarubaev VV, Kantevari S. 5-Chloro-2-thiophenyl-1,2,3-triazolylmethyldihydroquinolines as dual inhibitors of Mycobacterium tuberculosis and influenza virus: Synthesis and evaluation. Bioorg Med Chem Lett 2019; 29:2664-2669. [DOI: 10.1016/j.bmcl.2019.07.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 02/03/2023]
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296
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Abstract
Many important interactions between bacterial pathogens and their hosts are highly specific binding events that involve host or pathogen carbohydrate structures (glycans). Glycan interactions can mediate adhesion, invasion and immune evasion and can act as receptors for toxins. Several bacterial pathogens can also enzymatically alter host glycans to reveal binding targets, degrade the host cell glycans or alter the function of host glycoproteins. In recent years, high-throughput screening technologies, such as lectin, glycan and mucin microarrays, have transformed the field by identifying new bacterial-host glycointeractions, which are crucial for colonization, persistence and disease. In this Review, we discuss interactions involving both host and bacterial glycans that have a role in bacterial pathogenesis. We also highlight recent technological advances that have illuminated the glycoscience of microbial pathogenesis.
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297
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Sharma-Chawla N, Stegemann-Koniszewski S, Christen H, Boehme JD, Kershaw O, Schreiber J, Guzmán CA, Bruder D, Hernandez-Vargas EA. In vivo Neutralization of Pro-inflammatory Cytokines During Secondary Streptococcus pneumoniae Infection Post Influenza A Virus Infection. Front Immunol 2019; 10:1864. [PMID: 31474978 PMCID: PMC6702285 DOI: 10.3389/fimmu.2019.01864] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/23/2019] [Indexed: 11/20/2022] Open
Abstract
An overt pro-inflammatory immune response is a key factor contributing to lethal pneumococcal infection in an influenza pre-infected host and represents a potential target for therapeutic intervention. However, there is a paucity of knowledge about the level of contribution of individual cytokines. Based on the predictions of our previous mathematical modeling approach, the potential benefit of IFN-γ- and/or IL-6-specific antibody-mediated cytokine neutralization was explored in C57BL/6 mice infected with the influenza A/PR/8/34 strain, which were subsequently infected with the Streptococcus pneumoniae strain TIGR4 on day 7 post influenza. While single IL-6 neutralization had no effect on respiratory bacterial clearance, single IFN-γ neutralization enhanced local bacterial clearance in the lungs. Concomitant neutralization of IFN-γ and IL-6 significantly reduced the degree of pneumonia as well as bacteremia compared to the control group, indicating a positive effect for the host during secondary bacterial infection. The results of our model-driven experimental study reveal that the predicted therapeutic value of IFN-γ and IL-6 neutralization in secondary pneumococcal infection following influenza infection is tightly dependent on the experimental protocol while at the same time paving the way toward the development of effective immune therapies.
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Affiliation(s)
- Niharika Sharma-Chawla
- Frankfurt Institute for Advanced Studies, Frankfurt am Main, Germany.,Immune Regulation Group, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany.,Infection Immunology Group, Institute of Medical Microbiology, Infection Prevention and Control, Health Immunology, Infectiology and Inflammation, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Sabine Stegemann-Koniszewski
- Immune Regulation Group, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany.,Infection Immunology Group, Institute of Medical Microbiology, Infection Prevention and Control, Health Immunology, Infectiology and Inflammation, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,Experimental Pneumology, University Hospital of Pneumology, Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Henrike Christen
- Immune Regulation Group, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Julia D Boehme
- Immune Regulation Group, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany.,Infection Immunology Group, Institute of Medical Microbiology, Infection Prevention and Control, Health Immunology, Infectiology and Inflammation, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Olivia Kershaw
- Department of Veterinary Medicine, Institute of Veterinary Pathology, Free University Berlin, Berlin, Germany
| | - Jens Schreiber
- Experimental Pneumology, University Hospital of Pneumology, Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Carlos A Guzmán
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany.,Centre for Individualized Infection Medicine (CiiM), Hanover, Germany
| | - Dunja Bruder
- Immune Regulation Group, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany.,Infection Immunology Group, Institute of Medical Microbiology, Infection Prevention and Control, Health Immunology, Infectiology and Inflammation, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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298
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Barnes CE, MacIntyre CR. Risk modelling the mortality impact of antimicrobial resistance in secondary pneumococcal pneumonia infections during the 2009 influenza pandemic. Int J Infect Dis 2019; 85:1-6. [DOI: 10.1016/j.ijid.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 12/18/2022] Open
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299
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Epidemiology of post-influenza bacterial pneumonia due to Panton-Valentine leucocidin positive Staphylococcus aureus in intensive care units: a retrospective nationwide study. Intensive Care Med 2019; 45:1312-1314. [PMID: 31267196 DOI: 10.1007/s00134-019-05665-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2019] [Indexed: 12/19/2022]
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300
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Dubourg G, Edouard S, Raoult D. Relationship between nasopharyngeal microbiota and patient's susceptibility to viral infection. Expert Rev Anti Infect Ther 2019; 17:437-447. [PMID: 31106653 DOI: 10.1080/14787210.2019.1621168] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: The burden of respiratory viral infections is a global public health concern with significant mortality, morbidity, and economic impact. While Koch's postulate led to considering only the etiological agent, numerous works have demonstrated that commensal microbes could contribute to both the susceptibility and the severity of these infections, in particular those of the nasopharynx. Areas covered: Herein, we first propose to briefly recall the historical background that led to considering microbes inhabiting the nasopharyngeal microbiota as a potential contributor to human viral infections. We describe the evolution of the normal nasopharyngeal microbiota composition over time, especially during the first year of life. We aimed to resume the changes of the nasopharyngeal microbiota during viral respiratory infections. We also develop how nasopharyngeal microbiota could contribute to the acquisition of respiratory viral infections. We finally provide the potential therapeutic perspectives deriving from these findings. Expert opinion: Prospective studies focusing on children have identified that nasopharyngeal microbiota composition is associated with predisposition to acute respiratory illness and bronchiolitis, while data are scarce regarding adults. For the latter, further works are needed, in particular as a part of the multi-OMICS approach that should probably be performed in conjunction with gut microbiota studies.
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Affiliation(s)
- Grégory Dubourg
- a IRD, Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI) , Aix Marseille University , Marseille , France.,b IHU-Méditerranée Infection , Marseille , France
| | - Sophie Edouard
- a IRD, Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI) , Aix Marseille University , Marseille , France.,b IHU-Méditerranée Infection , Marseille , France
| | - Didier Raoult
- a IRD, Assistance Publique Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI) , Aix Marseille University , Marseille , France.,b IHU-Méditerranée Infection , Marseille , France
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