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Valeyre D, Bernaudin JF, Brauner M, Nunes H, Jeny F. Infectious Complications of Pulmonary Sarcoidosis. J Clin Med 2024; 13:342. [PMID: 38256476 PMCID: PMC10816300 DOI: 10.3390/jcm13020342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
In this review, the infectious complications observed in sarcoidosis are considered from a practical point of view to help the clinician not to overlook them in a difficult context, as pulmonary sarcoidosis makes the recognition of superinfections more difficult. An increased incidence of community-acquired pneumonia and of opportunistic pneumonia has been reported, especially in immunosuppressed patients. Pulmonary destructive lesions of advanced sarcoidosis increase the incidence of chronic pulmonary aspergillosis and infection by other agents. Screening and treatment of latent tuberculosis infection are crucial to prevent severe tuberculosis. Severity in COVID-19 appears to be increased by comorbidities rather than by sarcoidosis per se. The diagnosis of infectious complications can be challenging and should be considered as a potential differential diagnosis when the exacerbation of sarcoidosis is suspected. These complications not only increase the need for hospitalizations, but also increase the risk of death. This aspect must be carefully considered when assessing the overall health burden associated with sarcoidosis. The impact of immune dysregulation on infectious risk is unclear except in exceptional cases. In the absence of evidence-based studies on immunosuppressants in the specific context of pulmonary sarcoidosis, it is recommended to apply guidelines used in areas outside sarcoidosis. Preventive measures are essential, beginning with an appropriate use of immunosuppressants and the avoidance of unjustified treatments and doses. This approach should take into account the risk of tuberculosis, especially in highly endemic countries. Additionally, parallel emphasis should be placed on vaccinations, especially against COVID-19.
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Affiliation(s)
- Dominique Valeyre
- INSERM-UMR 1272, SMBH Université Sorbonne Paris-Nord, 93009 Bobigny, France; (D.V.); (J.-F.B.); (H.N.)
- Service de Pneumologie, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France
| | - Jean-François Bernaudin
- INSERM-UMR 1272, SMBH Université Sorbonne Paris-Nord, 93009 Bobigny, France; (D.V.); (J.-F.B.); (H.N.)
- Faculty of Medicine, Sorbonne University, 75013 Paris, France
| | - Michel Brauner
- Service de Radiologie, Hôpital Avicenne, 93009 Bobigny, France;
| | - Hilario Nunes
- INSERM-UMR 1272, SMBH Université Sorbonne Paris-Nord, 93009 Bobigny, France; (D.V.); (J.-F.B.); (H.N.)
- Service de Pneumologie, Hôpital Avicenne, 93009 Bobigny, France
| | - Florence Jeny
- INSERM-UMR 1272, SMBH Université Sorbonne Paris-Nord, 93009 Bobigny, France; (D.V.); (J.-F.B.); (H.N.)
- Service de Pneumologie, Hôpital Avicenne, 93009 Bobigny, France
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2
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Gandhi S, Tonelli R, Murray M, Samarelli AV, Spagnolo P. Environmental Causes of Idiopathic Pulmonary Fibrosis. Int J Mol Sci 2023; 24:16481. [PMID: 38003670 PMCID: PMC10671449 DOI: 10.3390/ijms242216481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF), the most common and severe of the idiopathic interstitial pneumonias, is a chronic and relentlessly progressive disease, which occurs mostly in middle-aged and elderly males. Although IPF is by definition "idiopathic", multiple factors have been reported to increase disease risk, aging being the most prominent one. Several occupational and environmental exposures, including metal dust, wood dust and air pollution, as well as various lifestyle variables, including smoking and diet, have also been associated with an increased risk of IPF, probably through interaction with genetic factors. Many of the predisposing factors appear to act also as trigger for acute exacerbations of the disease, which herald a poor prognosis. The more recent literature on inhalation injuries has focused on the first responders in the World Trade Center attacks and military exposure. In this review, we present an overview of the environmental and occupational causes of IPF and its pathogenesis. While our list is not comprehensive, we have selected specific exposures to highlight based on their overall disease burden.
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Affiliation(s)
- Sheiphali Gandhi
- Division of Occupational and Environmental Medicine, University of California San Francisco, San Francisco, CA 94143-0924, USA; (S.G.); (M.M.)
| | - Roberto Tonelli
- Respiratory Disease Unit, University Hospital of Modena, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 42125 Modena, Italy; (R.T.); (A.V.S.)
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 42121 Modena, Italy
| | - Margaret Murray
- Division of Occupational and Environmental Medicine, University of California San Francisco, San Francisco, CA 94143-0924, USA; (S.G.); (M.M.)
| | - Anna Valeria Samarelli
- Respiratory Disease Unit, University Hospital of Modena, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 42125 Modena, Italy; (R.T.); (A.V.S.)
- Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
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3
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Mateus SP, Ribeiro-Alves M, Salles REB, Costa W, da Costa CH, Lopes AJ, Bártholo TP, Mafort TT, Tura BR, Rufino R. Mortality and comorbidities in patients with bronchiectasis over a 3-year follow-up. Medicine (Baltimore) 2022; 101:e32537. [PMID: 36596005 PMCID: PMC9803512 DOI: 10.1097/md.0000000000032537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
To identify the risk factors associated with all-cause mortality in patients with noncystic fibrosis bronchiectasis (NCFB). This prospective cohort study included 120 adult patients with NCFB, who were regularly treated at a specialized outpatient clinic of a university hospital between January 2017 and June 2020. All patients were diagnosed using high-resolution computed tomography. Demographic and clinical data, pulmonary function tests, and the Euro-quality-of-life 5-domain 3-level questionnaire were analyzed. The factors associated with death were determined using the Cox proportional hazards model. The all-cause mortality rate at 41 months was 10.8%. Adjusted multivariate analysis showed that the main contributing predictors for mortality were female sex, smoking, diabetes, chronic obstructive pulmonary disease, emergency visits, use of antibiotics due to exacerbation, secretion color change, exacerbation, predicted forced expiratory volume in 1 second, predicted forced vital capacity, lack of respiratory physiotherapy, absence of vaccination against pneumococci, and mobility domain. Multiple factors contribute to unfavorable outcomes in patients with NCFB, and early recognition of these factors may improve care management.
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Affiliation(s)
- Simone Paulo Mateus
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | | | | | - Walter Costa
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | - Claudia Henrique da Costa
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | - Thiago Prudente Bártholo
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | - Thiago Thomaz Mafort
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | | | - Rogério Rufino
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
- * Correspondence: Rogério Rufino, Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil (e-mail: )
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4
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Kim SK, Hong SJ, Yoo DM, Min C, Choi HG. Association between asthma or chronic obstructive pulmonary disease and chronic otitis media. Sci Rep 2022; 12:4228. [PMID: 35273329 PMCID: PMC8913729 DOI: 10.1038/s41598-022-08287-w] [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] [Received: 07/13/2021] [Accepted: 02/11/2022] [Indexed: 11/09/2022] Open
Abstract
We hypothesized that asthma/chronic obstructive pulmonary disease (COPD) might increase the risk of chronic otitis media (COM), as asthma or COPD affects other diseases. The aim of this research was to investigate whether the incidence of COM is affected by a diagnosis of asthma or COPD in patients compared to matched controls from the national health screening cohort. A COM group (n = 11,587) and a control group that was 1:4 matched for age, sex, income, and residence area (n = 46,348) were selected. The control group included participants who never received treatment for COM from Korean National Health Insurance Service-Health Screening Cohort from 2002 to 2015. The crude and adjusted odds ratios (ORs) of previous asthma/COPD before the index date for COM were analyzed using conditional logistic regression. The analyses were stratified by age, sex, income, and region of residence. The period prevalence of asthma (17.5% vs. 14.3%, p < 0.001) and COPD (6.6% vs. 5.0%, p < 0.001) were significantly higher in the COM group than in the control group. In addition, the odds of asthma and COPD were significantly higher in the COM group than in the control group. Both asthma (adjusted OR 1.23, 95% confidence interval [CI] 1.16-1.31, p < 0.001) and COPD (adjusted OR 1.23, 95% CI 1.13-1.35, p < 0.001) increased the ORs for COM. This positive association between asthma/COPD and COM indicates that asthma/COPD might increase the incidence of COM.
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Affiliation(s)
- Sung Kyun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Dongtan, Korea.,Laboratory of Brain & Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Seok Jin Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Dongtan, Korea
| | - Dae Myoung Yoo
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea
| | - Chanyang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea.,Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Hyo Geun Choi
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea. .,Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170, Anyang, Gyeonggi, 14068, Republic of Korea.
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5
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Narváez PO, Gomez-Duque S, Alarcon JE, Ramirez-Valbuena PC, Serrano-Mayorga CC, Lozada-Arcinegas J, Bastidas A, Gómez S, Vargas H, Feldman C, Reyes LF. Invasive pneumococcal disease burden in hospitalized adults in Bogota, Colombia. BMC Infect Dis 2021; 21:1059. [PMID: 34641809 PMCID: PMC8507327 DOI: 10.1186/s12879-021-06769-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/21/2021] [Indexed: 02/14/2023] Open
Abstract
Background The incidence of invasive pneumococcal disease (IPD) varies depending on a number of factors, including vaccine uptake, in both children and adults, the geographic location, and local serotype prevalence. There are limited data about the burden of Streptococcus pneumoniae (Spn), serotype distribution, and clinical characteristics of adults hospitalized due to IPD in Colombia. The objectives of this study included assessment of Spn serotype distribution, clinical characteristics, mortality, ICU admission, and the need for mechanical ventilation. Methods This was an observational, retrospective, a citywide study conducted between 2012 and 2019 in Bogotá, Colombia. We analyzed reported positive cases of IPD from 55 hospitals in a governmental pneumococcal surveillance program. Pneumococcal strains were isolated in each hospital and typified in a centralized laboratory. This is a descriptive study stratified by age and subtypes of IPD obtained through the analysis of medical records. Results A total of 310 patients with IPD were included, of whom 45.5% were female. The leading cause of IPD was pneumonia (60%, 186/310), followed by meningitis. The most frequent serotypes isolated were 19A (13.87%, 43/310) and 3 (11.94%, 37/310). The overall hospital mortality rate was 30.3% (94/310). Moreover, 52.6% (163/310 patients) were admitted to the ICU, 45.5% (141/310) required invasive mechanical ventilation and 5.1% (16/310) non-invasive mechanical ventilation. Conclusion Pneumococcal pneumonia is the most prevalent cause of IPD, with serotypes 19A and 3 being the leading cause of IPD in Colombian adults. Mortality due to IPD in adults continues to be very high. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06769-2.
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Affiliation(s)
- Paula O Narváez
- Universidad de la Sabana, Campus Puente del Común, KM 7.5 Autopista Norte de Bogotá, Chía, Colombia
| | - Salome Gomez-Duque
- Universidad de la Sabana, Campus Puente del Común, KM 7.5 Autopista Norte de Bogotá, Chía, Colombia
| | - Juan E Alarcon
- Universidad de la Sabana, Campus Puente del Común, KM 7.5 Autopista Norte de Bogotá, Chía, Colombia
| | - Paula C Ramirez-Valbuena
- Universidad de la Sabana, Campus Puente del Común, KM 7.5 Autopista Norte de Bogotá, Chía, Colombia
| | | | - Julian Lozada-Arcinegas
- Universidad de la Sabana, Campus Puente del Común, KM 7.5 Autopista Norte de Bogotá, Chía, Colombia
| | - Alirio Bastidas
- Universidad de la Sabana, Campus Puente del Común, KM 7.5 Autopista Norte de Bogotá, Chía, Colombia
| | - Sandra Gómez
- Grupo Laboratorio de Salud Pública de Bogotá, Secretaría de Salud de Bogotá, Bogotá, Colombia
| | - Hernan Vargas
- Grupo Laboratorio de Salud Pública de Bogotá, Secretaría de Salud de Bogotá, Bogotá, Colombia
| | - Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Luis Felipe Reyes
- Universidad de la Sabana, Campus Puente del Común, KM 7.5 Autopista Norte de Bogotá, Chía, Colombia. .,Clínica Universidad de la Sabana, Chía, Colombia.
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6
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Karimi A, Hoseini-Alfatemi SM, Tabatabaei SR. A Systematic Review and Meta-Analysis of Serotype Distribution of Streptococcus Pneumoniae in Iran: Practical Evidence to Optimizing Local Vaccination Protocols. Infect Disord Drug Targets 2021; 21:304-310. [PMID: 32310053 DOI: 10.2174/1871526519666191002142953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/27/2020] [Accepted: 03/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Little is known regarding the burden of predominant circulating serotypes of Streptococcus pneumoniae in Iran. Therefore, this study aimed to investigate the serotype distribution of pneumococcal diseases in Iran by using a comprehensive systematic review of available articles. ; Methods: A systematic literature search was carried out to identify papers published by Iranian authors in the Web of Science, PubMed, Scopus, Embase and Google Scholar electronic databases from January 2000 to December 2018. Then, eight publications that met our inclusion criteria were selected for data extraction and analysis by Comprehensive Meta-Analysis software. ; Results: In total, three studies reported the distribution of S. pneumoniae serotypes among patients, two studies among healthy individuals, and three studies among both groups. Of those studies, serotype 19A/F (17.9%; 95% CI: 13.6-23.0) was the most circulating serotype followed by 23A/F (12.3%; 95% CI: 7.7-19.2), 6A/B (11.0%; 95% CI: 8.0-14.9), and 14 (8.8%; 95% CI: 5.8-13.2). In contrast, the lowest circulating serotype was 60 (0.02%; 95% CI: 0.0-1.2), 29 (0.07%; 95% CI: 0.01-5.0), and 36 (0.09%; 95% CI: 0.04-2.1). Meta-regression results showed that prevalence of serotype 23A/F significantly increased each year about 0.2% (95% CI: 0.1-0.3, P <0.001, tau2 <0.001). ; Conclusion: In the present study, it was found that over the last decade, the most prevalent serotypes in Iran were 19, 23, 6, and 14, respectively. These findings provide practical evidence to select effective pneumococcal vaccine candidates for the prevention of invasive diseases in Iranian patients and also to compare our situation with others.
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Affiliation(s)
- Abdollah Karimi
- Pediatric Infections Research Center, Research Institute for Children̍s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Mahsan Hoseini-Alfatemi
- Pediatric Infections Research Center, Research Institute for Children̍s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sedigheh Rafiei Tabatabaei
- Pediatric Infections Research Center, Research Institute for Children̍s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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7
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Tabeling C, Wienhold SM, Birnhuber A, Brack MC, Nouailles G, Kershaw O, Firsching TC, Gruber AD, Lienau J, Marsh LM, Olschewski A, Kwapiszewska G, Witzenrath M. Pulmonary fibrosis in Fra-2 transgenic mice is associated with decreased numbers of alveolar macrophages and increased susceptibility to pneumococcal pneumonia. Am J Physiol Lung Cell Mol Physiol 2021; 320:L916-L925. [PMID: 33655757 DOI: 10.1152/ajplung.00505.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a deadly condition characterized by progressive respiratory dysfunction. Exacerbations due to airway infections are believed to promote disease progression, and presence of Streptococcus in the lung microbiome has been associated with the progression of IPF and mortality. The aim of this study was to analyze the effect of lung fibrosis on susceptibility to pneumococcal pneumonia and bacteremia. The effects of subclinical (low dose) infection with Streptococcus pneumoniae were studied in a well characterized fos-related antigen-2 (Fra-2) transgenic (TG) mouse model of spontaneous, progressive pulmonary fibrosis. Forty-eight hours after transnasal infection with S. pneumoniae, bacterial load was assessed in lung tissue, bronchoalveolar lavage (BAL), blood, and spleen. Leukocyte subsets and cytokine levels were analyzed in BAL and blood. Lung compliance and arterial blood gases were assessed. In contrast to wildtype mice, low dose lung infection with S. pneumoniae in Fra-2 TG mice resulted in substantial pneumonia including weight loss, increased lung bacterial load, and bacteremia. BAL alveolar macrophages were reduced in Fra-2 TG mice compared to the corresponding WT mice. Proinflammatory cytokines and chemokines (IL-1β, IL-6, TNF-α, and CXCL1) were elevated upon infection in BAL supernatant and plasma of Fra-2 TG mice. Lung compliance was decreased in Fra-2 TG mice following low dose infection with S. pneumoniae. Pulmonary fibrosis increases susceptibility to pneumococcal pneumonia and bacteremia possibly via impaired alveolar bacterial clearance.
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Affiliation(s)
- Christoph Tabeling
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra-Maria Wienhold
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anna Birnhuber
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Markus C Brack
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Geraldine Nouailles
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Olivia Kershaw
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Theresa C Firsching
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Achim D Gruber
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Jasmin Lienau
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Leigh M Marsh
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Martin Witzenrath
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,German Center for Lung Research (DZL), Partner Site Charité, Berlin, Germany
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8
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Mehrotra R, Bhagwati M. Pulmonary artery hypertension: A bedside review. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.4103/jpcs.jpcs_110_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Gerke AK. Treatment of Sarcoidosis: A Multidisciplinary Approach. Front Immunol 2020; 11:545413. [PMID: 33329511 PMCID: PMC7732561 DOI: 10.3389/fimmu.2020.545413] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022] Open
Abstract
Sarcoidosis is a systemic disease of unknown etiology defined by the presence of noncaseating granulomatous inflammation that can cause organ damage and diminished quality of life. Treatment is indicated to protect organ function and decrease symptomatic burden. Current treatment options focus on interruption of granuloma formation and propagation. Clinical trials guiding evidence for treatment are lacking due to the rarity of disease, heterogeneous clinical course, and lack of prognostic biomarkers, all of which contribute to difficulty in clinical trial design and implementation. In this review, a multidisciplinary treatment approach is summarized, addressing immunuosuppressive drugs, managing complications of chronic granulomatous inflammation, and assessing treatment toxicity. Discovery of new therapies will depend on research into pathogenesis of antigen presentation and granulomatous inflammation. Future treatment approaches may also include personalized decisions based on pharmacogenomics and sarcoidosis phenotype, as well as patient-centered approaches to manage immunosuppression, symptom control, and treatment of comorbid conditions.
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Affiliation(s)
- Alicia K Gerke
- Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Iowa, Iowa City, IA, United States
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10
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Bonnave C, Mertens D, Peetermans W, Cobbaert K, Ghesquiere B, Deschodt M, Flamaing J. Adult vaccination for pneumococcal disease: a comparison of the national guidelines in Europe. Eur J Clin Microbiol Infect Dis 2019; 38:785-791. [PMID: 30778705 DOI: 10.1007/s10096-019-03485-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
Abstract
Pneumococcal disease constitutes a major global health problem. Adults aged over 50 years and younger adults with specific chronic health conditions are at risk for invasive pneumococcal disease, associated with substantial morbidity and mortality. In Europe, two vaccine types are used in adults for pneumococcal immunization: pneumococcal polysaccharide vaccine (PPV23) and pneumococcal conjugate vaccine (PCV13). To provide an overview and to compare the national guidelines for pneumococcal immunization for adults in Europe. In November 2016, national guidelines on pneumococcal vaccination for adults of 31 European countries were obtained by Google search, the website of European Centre for Disease Prevention and Control, and contacting public health officials. In our analysis, we distinguished between age-based and risk-based guidelines. In October 2017, we used the same method to retrieve guideline updates. We observed great variability regarding age, risk groups, vaccine type, and use of boosters. In age-based guidelines, vaccination is mostly recommended in adults aged over 65 years using PPV23. Boosters are generally not recommended. An upper age limit for vaccination is reported in three countries. In the immunocompromised population, vaccination with both vaccines and administration of a booster is mostly recommended. In the population with chronic health conditions, there is more heterogeneity according vaccine type, sequence, and administration of boosters. Asplenia is the only comorbidity for which all countries recommend vaccination. The great variability in European pneumococcal vaccination guidelines warrants European unification of the guidelines for better control of pneumococcal disease.
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Affiliation(s)
- C Bonnave
- Department of Geriatrics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - D Mertens
- Department of Geriatrics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - W Peetermans
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - K Cobbaert
- Department of Geriatrics, AZ Delta Roeselare, Roeselare, Belgium
| | - B Ghesquiere
- Department of Geriatrics, AZ Delta Roeselare, Roeselare, Belgium
| | - M Deschodt
- Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
- Department of Public Health, University of Basel, Basel, Switzerland
| | - J Flamaing
- Department of Geriatrics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium.
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11
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O'Grady KAF, Cripps AW, Grimwood K. Paediatric and adult bronchiectasis: Vaccination in prevention and management. Respirology 2018; 24:107-114. [PMID: 30477047 DOI: 10.1111/resp.13446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/05/2018] [Indexed: 12/27/2022]
Abstract
Bronchiectasis has received increased attention recently, including an emphasis on preventing infective exacerbations that are associated with disease progression and lung function decline. While there are several bacteria and viruses associated with bronchiectasis, licensed vaccines are only currently available for Streptococcus pneumoniae, Haemophilus influenzae (H. influenzae protein D as a conjugate in a pneumococcal vaccine), Mycobacterium tuberculosis, Bordetella pertussis and influenza virus. The evidence for the efficacy and effectiveness of these vaccines in both preventing and managing bronchiectasis in children and adults is limited with the focus of most research being on other chronic lung disorders, such as chronic obstructive pulmonary diseases, asthma and cystic fibrosis. We review the existing evidence for these vaccines in bronchiectasis and highlight the existing gaps in knowledge. High-quality experimental and non-experimental studies using current state-of-the-art microbiological methods and validated, standardised case definitions are needed across the depth and breadth of the vaccine development pathway.
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Affiliation(s)
- Kerry-Ann F O'Grady
- Queensland University of Technology, Institute of Health and Biomedical Innovation @ Centre for Children's Health Research, Brisbane, QLD, Australia
| | - Allan W Cripps
- School of Medicine, Griffith University, Gold Coast, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Keith Grimwood
- School of Medicine, Griffith University, Gold Coast, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Department of Infectious Diseases, Gold Coast Health, Gold Coast, QLD, Australia.,Department of Paediatrics, Gold Coast Health, Gold Coast, QLD, Australia
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12
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Sohail I, Ghosh S, Mukundan S, Zelewski S, Khan MN. Role of Inflammatory Risk Factors in the Pathogenesis of Streptococcus pneumoniae. Front Immunol 2018; 9:2275. [PMID: 30333833 PMCID: PMC6176091 DOI: 10.3389/fimmu.2018.02275] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 09/12/2018] [Indexed: 12/23/2022] Open
Abstract
Streptococcus pneumoniae (Spn) is a colonizer of the human nasopharynx (NP), causing a variety of infections in humans including otitis media, pneumonia, sepsis, and meningitis. The NP is an immune permissive site which allows for the persistence of commensal bacteria. Acute or chronic respiratory airway inflammation constitutes a significant risk factor for the manifestation of Spn infections. The inflammatory conditions caused by an upper respiratory viral infection or respiratory conditions such as allergic asthma and chronic obstructive pulmonary disorders (COPDs) are implicated in the dysregulation of airway inflammation and tissue damage, which compromise the respiratory barrier integrity. These immune events promote bacterial outgrowth leading to Spn dissemination and invasion into the bloodstream. Therefore, suppression of inflammation and restoration of respiratory barrier integrity could contain Spn infections manifesting in the backdrop of an inflammatory disease condition. The gained knowledge could be harnessed in the design of novel therapeutic interventions to circumvent Spn bacterial infections.
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Affiliation(s)
- Ifrah Sohail
- Biomedical Sciences, University of North Dakota, Grand Forks, ND, United States
| | - Sumit Ghosh
- Biomedical Sciences, University of North Dakota, Grand Forks, ND, United States
| | - Santhosh Mukundan
- Biomedical Sciences, University of North Dakota, Grand Forks, ND, United States
| | - Susan Zelewski
- Biomedical Sciences, University of North Dakota, Grand Forks, ND, United States
| | - M Nadeem Khan
- Biomedical Sciences, University of North Dakota, Grand Forks, ND, United States
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13
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Prescribing Immunoglobulin Replacement Therapy for Patients with Non-classical and Secondary Antibody Deficiency: an Analysis of the Practice of Clinical Immunologists in the UK and Republic of Ireland. J Clin Immunol 2018; 38:204-213. [PMID: 29423883 PMCID: PMC5840253 DOI: 10.1007/s10875-017-0469-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/11/2017] [Indexed: 12/19/2022]
Abstract
Background Immunologists are increasingly being asked to assess patients with non-classical and secondary antibody deficiency to determine their potential need for immunoglobulin replacement therapy (IGRT). Immunoglobulin is a limited, expensive resource and no clear guidance exists for this broad patient group. The purpose of this survey is to establish what factors influence the decision to commence IGRT in adult patients, when diagnostic criteria for primary antibody deficiency are not fulfilled. Methods Under the auspices of the United Kingdom Primary Immunodeficiency Network (UKPIN), a study group was established which circulated an online questionnaire to the consultant body across the UK and Ireland. Results provided a snapshot of the current clinical practice of 71% of consultant immunologists, from 30 centers. Results In order of importance, factors which influence the decision to commence IGRT include number of hospital admissions with infection, serum IgG level, bronchiectasis, radiologically proven pneumonia, number of positive sputum cultures, number of antibiotic courses, and results of immunization studies. The commonest test vaccine used was Pneumovax 23 with measurement of serotype-specific responses at 4 weeks, with a threshold of 0.35 μg/ml in 2/3 of serotypes measured. Eighty-six percent of patients are treated with a trial of prophylactic antibiotics prior to consideration of IGRT. Efficacy of IGRT trial is assessed at between 6 and 12 months. Conclusions There was consistency in clinical practice using a combination of clinical history, evidence of infections, and vaccination testing for diagnosis. However, there was some variation in the implementation of this practice, particularly in vaccine choice and assessment of response to vaccination.
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14
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Chen CH, Wu MS, Wu IC. Vaccination coverage and associated factors for receipt of the 23-valent pneumococcal polysaccharide vaccine in Taiwan: A nation-wide community-based study. Medicine (Baltimore) 2018; 97:e9773. [PMID: 29384869 PMCID: PMC5805441 DOI: 10.1097/md.0000000000009773] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Older adults, particularly those with chronic obstructive pulmonary disease, are advised to receive 23-valent pneumococcal polysaccharide vaccine (PPV23). However, the PPV23 vaccination rate in Taiwan and the determinants of receipt remain unclear.We analyzed the data of 1475 community-dwelling older adults aged ≥75 years who participated in the Healthy Aging Longitudinal Study in Taiwan. Each participant received assessments of PPV23 status, sociodemographic factors (age, sex, education level, marital status, living alone, and occupation), and health-related factors (chronic diseases, smoking status, alcohol intake, physical activities, cognitive status, and physical performance). PPV23 rate was defined as the number of participants who reported receiving free PPV23 divided by the total number of candidates for free PPV23. Multinomial logistic regression analysis was applied to investigate the sociodemographic and health-related determinants of PPV23 status.A PPV23 vaccination rate of 20.7% (305/1475) was observed. Participants who were female, current smokers, and had a low peak expiratory flow were associated with PPV23 nonreceipt (all P <.05). Of the participants who had a low peak expiratory flow, low education status, and physical inactivity were associated with PPV23 nonreceipt (all P <.05).The PPV23 vaccination rate among adults aged ≥75 years was low. Older adults who were women, current smokers, or who had a low PEF were less likely to receive the PPV23. These findings support continual efforts to improve the PPV23 coverage rate in vulnerable populations.
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Affiliation(s)
- Chang-Hua Chen
- Division of Infectious Diseases, Department of Internal Medicine
- Center for Aging and Health, Changhua Christian Hospital, Changhua City
| | - Ming-Shiang Wu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - I-Chien Wu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
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15
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Dodd KE, Mazurek JM. Pneumococcal Vaccination Among Adults With Work-related Asthma. Am J Prev Med 2017; 53:799-809. [PMID: 28964578 PMCID: PMC5912154 DOI: 10.1016/j.amepre.2017.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/09/2017] [Accepted: 07/24/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pneumococcal vaccination is recommended for all adults with asthma and a Healthy People 2020 goal aims to achieve 60% coverage among high-risk adults, including those with asthma. Adults with work-related asthma have more severe asthma symptoms than those with non-work-related asthma and are particularly vulnerable to pneumococcal pneumonia. METHODS To assess pneumococcal vaccination coverage by work-related asthma status among ever-employed adults aged 18-64 years with current asthma, data from the 2012-2013 Behavioral Risk Factor Surveillance System Asthma Call-back Survey for ever-employed adults (18-64 years) with current asthma from 29 states were examined in 2016. Adults with work-related asthma had ever been told by a physician their asthma was work-related. Pneumococcal vaccine recipients self-reported having ever received a pneumococcal vaccine. Multivariate logistic regression was used to calculate adjusted prevalence ratios and associated 95% CIs. RESULTS Among an estimated 12 million ever-employed adults with current asthma in 29 states, 42.0% received a pneumococcal vaccine. Adults with work-related asthma were more likely to have received a pneumococcal vaccine than adults with non-work-related asthma (53.7% versus 35.0%, respectively, prevalence ratio=1.24, 95% CI=1.06, 1.45). Among adults with work-related asthma, pneumococcal vaccine coverage was lowest among Hispanics (36.2%) and those without health insurance (38.5%). CONCLUSIONS Pneumococcal vaccination coverage among adults with work-related asthma and non-work-related asthma is below the Healthy People 2020 target level. Healthcare providers should verify pneumococcal vaccination status in their patients with asthma and offer the vaccine to those not vaccinated.
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Affiliation(s)
- Katelynn E Dodd
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia.
| | - Jacek M Mazurek
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
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16
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Menéndez R, Méndez R, Polverino E, Rosales-Mayor E, Amara-Elori I, Reyes S, Posadas T, Fernández-Barat L, Torres A. Factors associated with hospitalization in bronchiectasis exacerbations: a one-year follow-up study. Respir Res 2017; 18:176. [PMID: 28964260 PMCID: PMC5622554 DOI: 10.1186/s12931-017-0659-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/21/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Bronchiectasis (BE) is a chronic structural lung disease with frequent exacerbations, some of which require hospital admission though no clear associated factors have been identified. We aimed to evaluate factors associated with hospitalization due to exacerbations during a 1-year follow-up period. METHODS A prospective observational study was performed in patients recruited from specialized BE clinics. We considered all exacerbations diagnosed and treated with antibiotics during a follow-up period of 1 year. The protocol recorded baseline variables, usual treatments, Bronchiectasis Severity Index (BSI) and FACED scores, comorbid conditions and prior hospitalizations. RESULTS Two hundred and 65 patients were recruited, of whom 162 required hospital admission during the follow-up period. Independent risk factors for hospital admission were age, previous hospitalization due to BE, use of proton pump inhibitors, heart failure, FACED and BSI, whereas pneumococcal vaccination was a protective factor. The area under the receiver operator characteristic curve (AUC) was 0.799 for BSI model was 0.799, and 0.813 for FACED model. CONCLUSIONS Previous hospitalization, use of proton pump inhibitors, heart failure along with BSI or FACED scores is associated factors for developing exacerbations that require hospitalization. Pneumococcal vaccination was protective. This information may be useful for the design of preventive strategies and more intensive follow-up plans.
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Affiliation(s)
- Rosario Menéndez
- Pneumology Department, Hospital Universitario y Politécnico La Fe / Instituto de Investigación Sanitaria (IIS) La Fe. University of Valencia, Valencia, Spain.
- Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CIBERES, CB06/06/0028), Madrid, Spain.
| | - Raúl Méndez
- Pneumology Department, Hospital Universitario y Politécnico La Fe / Instituto de Investigación Sanitaria (IIS) La Fe. University of Valencia, Valencia, Spain
| | - Eva Polverino
- Institut D' Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CIBERES, CB06/06/0028), Madrid, Spain
| | - Edmundo Rosales-Mayor
- Institut D' Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Isabel Amara-Elori
- Pneumology Department, Hospital Universitario y Politécnico La Fe / Instituto de Investigación Sanitaria (IIS) La Fe. University of Valencia, Valencia, Spain
| | - Soledad Reyes
- Pneumology Department, Hospital Universitario y Politécnico La Fe / Instituto de Investigación Sanitaria (IIS) La Fe. University of Valencia, Valencia, Spain
| | - Tomás Posadas
- Pneumology Department, Hospital Universitario y Politécnico La Fe / Instituto de Investigación Sanitaria (IIS) La Fe. University of Valencia, Valencia, Spain
| | - Laia Fernández-Barat
- Pneumology Department, Hospital Clínic / Institut D' Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CIBERES, CB06/06/0028), Madrid, Spain
| | - Antoni Torres
- Pneumology Department, Hospital Clínic / Institut D' Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CIBERES, CB06/06/0028), Madrid, Spain
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17
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Mantero M, Aliberti S, Azzari C, Moriondo M, Nieddu F, Blasi F, Di Pasquale M. Role of Streptococcus pneumoniae infection in chronic obstructive pulmonary disease patients in Italy. Ther Adv Respir Dis 2017; 11:403-407. [PMID: 28854845 PMCID: PMC5933666 DOI: 10.1177/1753465817728479] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The aim of this study was to determine the incidence of exacerbations due to
Streptococcus pneumoniae in chronic obstructive
pulmonary disease (COPD) patients during stable state. Methods: We conducted a prospective, observational, cohort study including stable COPD
patients, who were evaluated at least every 4 months over a 24-month period
at the Respiratory Unit of the IRCCS Policlinico Hospital in Milan, Italy,
from 2012 to 2015. Sputum samples were collected at enrollment during stable
state to evaluate the frequency of S. pneumoniae
colonization and in case of an acute exacerbation to evaluate the incidence
of pneumococcal infection. Results: A total of 79 stable patients with moderate to very severe COPD were
enrolled. A total of 217 samples were collected, and 27% (n
= 59) of those were positive for S. pneumoniae. A total of
four exacerbations due to S. pneumoniae occurred during
follow up (0.31 per 100 person/month). Among positive samples of S.
pneumoniae, 109 serotypes were identified. The most frequent
serotypes in moderate-to-severe COPD patients during both stable state and
exacerbation were 19F (12%), 18 (10%), 19A and 9V (9%) and 35 F (7%). Only
32% of COPD patients were effectively vaccinated for S.
pneumoniae with PPV23 vaccine. Conclusion: The most frequent S. pneumoniae serotypes in COPD patients
are 19F, 18, 19A, 9V and 35 F, and that almost 50% of S.
pneumoniae strains could be covered by PCV13 in adult COPD
patients.
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Affiliation(s)
- Marco Mantero
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Aliberti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Azzari
- Pediatric Section, Department of Health Sciences, University of Florence and Anna Meyer Children's University Hospital, Florence, Italy
| | - Maria Moriondo
- Pediatric Section, Department of Health Sciences, University of Florence and Anna Meyer Children's University Hospital, Florence, Italy
| | - Francesco Nieddu
- Pediatric Section, Department of Health Sciences, University of Florence and Anna Meyer Children's University Hospital, Florence, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, via Francesco Sofrza 35, Milan, Italy
| | - Marta Di Pasquale
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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McCarthy H, Jackson M, Corcoran M, McElligott M, MacHale E, Sulaiman I, Cushen B, Costello RW, Humpreys H. Colonisation of Irish patients with chronic obstructive pulmonary disease by Streptococcus pneumoniae and analysis of the pneumococcal vaccine coverage: a non-interventional, observational, prospective cohort study. BMJ Open 2017; 7:e013944. [PMID: 28694340 PMCID: PMC5541633 DOI: 10.1136/bmjopen-2016-013944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To characterise the pattern of colonisation and serotypes of Streptococcus pneumoniae among patients with chronic obstructive pulmonary disease (COPD) who currently receive the 23-valent pneumococcal polysaccharide vaccine (PPV-23) according to vaccination status, use of antibiotics and steroids. To investigate the prevalence of PPV-23 and 13-valent pneumococcal conjugate vaccine (PCV-13) serotypes within the study cohort. DESIGN A non-interventional, observational, prospective cohort study with a 12 -month follow-up period inclusive of quarterly study visits. SETTING Beaumont Hospital and The Royal College of Surgeons in Ireland Clinical Research Centre, Dublin, Ireland. PARTICIPANTS Patients with an established diagnosis of COPD attending a tertiary medical centre. PRIMARY OUTCOME MEASURE Colonisation rate of S. pneumoniae in patients with COPD and characterisation of serotypes of S. pneumoniae with correlation to currently available pneumococcal vaccines. Sputum and oropharyngeal swab samples were collected for the isolation of S. pneumoniae. SECONDARY OUTCOME MEASURE Seasonality of colonisation of S. pneumoniae and its relationship with the incidence of exacerbations of COPD. RESULTS S. pneumoniae was detected in 16 of 417 samples, a colonisation incident rate of 3.8% and in 11 of 133 (8%) patients at least once during the study. The majority of S. pneumoniae isolates were identified in spring and were non-vaccine serotypes for either the PPV-23 or PCV-13 (63%). The colonisation incident rate of S. pneumoniae fluctuated over the four seasons with a peak of 6.6% in spring and the lowest rate of 2.2% occurring during winter. Antibiotic use was highest during periods of low colonisation. CONCLUSIONS There is seasonal variation in S. pneumoniae colonisation among patients with COPD which may reflect antibiotic use in autumn and winter. The predominance of non-vaccine types suggests that PCV-13 may have limited impact among patients with COPD in Ireland who currently receive PPV-23. TRIAL REGISTRATION NUMBER NCT02535546; post-results.
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Affiliation(s)
- Hannah McCarthy
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Beaumont, Dublin, Republic of Ireland
| | - Mandy Jackson
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Beaumont, Dublin, Republic of Ireland
| | - Mary Corcoran
- Irish Pneumococcal Reference Laboratory, Epidemiology and Molecular Biology Unit Laboratory, Temple Street Children’s University Hospital, Dublin, Republic of Ireland
| | - Martha McElligott
- Irish Pneumococcal Reference Laboratory, Epidemiology and Molecular Biology Unit Laboratory, Temple Street Children’s University Hospital, Dublin, Republic of Ireland
| | - Elaine MacHale
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Beaumont, Dublin, Republic of Ireland
| | - Imran Sulaiman
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Beaumont, Dublin, Republic of Ireland
| | - Breda Cushen
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Beaumont, Dublin, Republic of Ireland
| | - Richard W Costello
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Beaumont, Dublin, Republic of Ireland
| | - Hilary Humpreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Beaumont, Dublin, Republic of Ireland
- Department of Microbiology, Beaumont Hospital, Beaumont, Dublin, Republic of Ireland
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20
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Ray JC, Snipelisky DF, Shapiro BP. 40-Year-Old Woman With Breathlessness and Fatigue. Mayo Clin Proc 2016; 91:e49-53. [PMID: 26936321 DOI: 10.1016/j.mayocp.2015.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/10/2015] [Accepted: 09/22/2015] [Indexed: 11/22/2022]
Affiliation(s)
- Jordan C Ray
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Jacksonville, FL
| | | | - Brian P Shapiro
- Advisor to resident and fellow and Consultant in Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL.
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21
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McKinnon JE, Maksimowicz-McKinnon K. Autoimmune disease and vaccination: impact on infectious disease prevention and a look at future applications. Transl Res 2016; 167:46-60. [PMID: 26408802 DOI: 10.1016/j.trsl.2015.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 08/27/2015] [Accepted: 08/28/2015] [Indexed: 12/11/2022]
Abstract
Vaccines hold promise both for the prevention of infections and as potential immunologic therapy for patients with autoimmune disease (AD). These patients are at high risk for both common and opportunistic infections, but this risk can be significantly reduced and even obviated with the use of recommended available vaccines. Unfortunately, patients with ADs are not routinely offered or provided indicated vaccinations and have higher rates of complications from vaccine-preventable illnesses than patients without ADs. In addition, vaccine therapy is currently under study for the treatment of autoimmune disorders, with early studies demonstrating immunomodulatory effects that may counter undesired immune activation and alleviate disease activity.
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Affiliation(s)
- John E McKinnon
- Department of Medicine, Division of Infectious Diseases, Henry Ford Hospital System, Detroit, Mich.
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22
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Pennant KN, Costa JJ, Fuhlbrigge AL, Sax PE, Szent-Gyorgyi LE, Coblyn J, Desai SP. Improving Influenza and Pneumococcal Vaccination Rates in Ambulatory Specialty Practices. Open Forum Infect Dis 2015; 2:ofv119. [PMID: 26430697 PMCID: PMC4589825 DOI: 10.1093/ofid/ofv119] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 08/05/2015] [Indexed: 01/08/2023] Open
Abstract
Background. Influenza and pneumococcal vaccinations are recommended for elderly and high-risk patients; however, rates of adherence are low. We sought to implement influenza and pneumococcal vaccine initiatives in 4 different ambulatory specialty practices, using 3 unique approaches. Methods. Four specialties with high-risk patient populations were selected for intervention: allergy (asthma), infectious disease (ID) (human immunodeficiency virus), pulmonary (chronic lung disease), and rheumatology (immunocompromised). Allergy and ID focused on influenza vaccination, and pulmonary and rheumatology focused on pneumococcal vaccination. We used 3 strategies for quality improvement: physician reminders, patient letters, and a nurse-driven model. Physicians were provided their performance data on a monthly basis and presented trended data on a quarterly basis at staff meetings. Results. All 4 specialties developed processes for improving vaccination rates with all showing some increase. Higher rates were achieved with pneumococcal vaccine than influenza. Pneumococcal vaccine rates showed steady improvement from year to year while influenza vaccine rates remained relatively constant. Allergy's influenza rate was 59% in 2011 and 64% in the 2014 flu season. Infectious disease influenza rates moved from 74% in the 2011 flu season to 86% for the 2014 season. Pneumococcal vaccine in pulmonary patients' rate was 52% at the start of intervention in February 2009 and 79% as of January 2015. Rheumatology rates rose from 50% in February 2009 to 87% in January 2015. Conclusions. Integrated routine workflow and performance data sharing can effectively engage specialists and staff in vaccine adherence improvement. Influenza vaccination may require other approaches to achieve the rates seen with pneumococcal vaccine.
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Affiliation(s)
| | - John J Costa
- Divisions of Rheumatology, Immunology and Allergy
| | | | - Paul E Sax
- Infectious Diseases , Brigham and Women's Hospital , Boston
| | - Lara E Szent-Gyorgyi
- Children's Hospital, Standardized Clinical Assessment and Management Plans (SCAMPs) Program , Boston, Massachusetts
| | - Jonathan Coblyn
- Department of Medicine Quality Program ; Divisions of Rheumatology, Immunology and Allergy
| | - Sonali P Desai
- Department of Medicine Quality Program ; Divisions of Rheumatology, Immunology and Allergy
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23
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Use and clinical interpretation of pneumococcal antibody measurements in the evaluation of humoral immune function. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 22:148-52. [PMID: 25520149 DOI: 10.1128/cvi.00735-14] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pneumococcal vaccination is a commonly used technique for assessing the humoral immune status of a patient suspected of having immunodeficiency. Interpretation of what constitutes an adequate response, however, can be challenging. This is due to the complexity of the data generated from serotype-specific assays, historical variations in the assays used to measure pneumococcal antibodies, and varying recommendations on the relevant cut points that define response. In this review, we summarize the historical evolution of assays used for this purpose and discuss the analytical considerations that have influenced published data. We also examine current clinical recommendations for defining an adequate response to vaccination, with a particular focus on the interpretation of serotype-specific data generated by multiplex assays.
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