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Ferrari A, Schiavetti I, Ogliastro M, Minet C, Sibilio R, Giberti I, Costa E, Massaro E, Lai PL, Mosca S, Bruzzone B, Orsi A, Panatto D, Icardi G. Co-detection of respiratory pathogens among ILI patients: characterization of samples collected during the 2018/19 and 2019/20 pre-pandemic seasons. BMC Infect Dis 2024; 24:881. [PMID: 39210273 PMCID: PMC11361097 DOI: 10.1186/s12879-024-09687-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Influenza-like illness (ILI) patients co-detected with respiratory pathogens exhibit poorer health outcomes than those with single infections. To address the paucity of knowledge concerning the incidence of concurrent respiratory pathogens, their relationships, and the clinical differences between patients detected with single and multiple pathogens, we performed an in-depth characterization of the oropharyngeal samples of primary care patients collected in Genoa (Northwest Italy), during winter seasons 2018/19-2019/20.The apriori algorithm was employed to evaluate the incidence of viral, bacterial, and viral-bacterial pairs during the study period. The grade of correlation between pathogens was investigated using the Phi coefficient. Factors associated with viral, bacterial or viral-bacterial co-detection were assessed using logistic regression.The most frequently identified pathogens included influenza A, rhinovirus, Haemophilus influenzae and Streptococcus pneumoniae. The highest correlations were found between bacterial-bacterial and viral-bacterial pairs, such as Haemophilus influenzae-Streptococcus pneumoniae, adenovirus-Haemophilus influenzae, adenovirus-Streptococcus pneumoniae, RSV-A-Bordetella pertussis, and influenza B Victoria-Bordetella parapertussis. Viruses were detected together at significantly lower rates. Notably, rhinovirus, influenza, and RSV exhibited significant negative correlations with each other. Co-detection was more prevalent in children aged < 4, and cough was shown to be a reliable indicator of viral co-detection.Given the evolving epidemiological landscape following the COVID-19 pandemic, future research utilizing the methodology described here, while considering the circulation of SARS-CoV-2, could further enrich the understanding of concurrent respiratory pathogens.
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Affiliation(s)
- Allegra Ferrari
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
| | - Irene Schiavetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Matilde Ogliastro
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Carola Minet
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Raffaella Sibilio
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Irene Giberti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Elisabetta Costa
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Elvira Massaro
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Piero Luigi Lai
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Interuniversity Research Center On Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Stefano Mosca
- Interuniversity Research Center On Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
| | | | - Andrea Orsi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Interuniversity Research Center On Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Donatella Panatto
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Interuniversity Research Center On Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Interuniversity Research Center On Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Chao Y, Mørch M, Håkansson AP, Shannon O. Biofilm-dispersed pneumococci induce elevated leukocyte and platelet activation. Front Cell Infect Microbiol 2024; 14:1405333. [PMID: 39149421 PMCID: PMC11324597 DOI: 10.3389/fcimb.2024.1405333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/18/2024] [Indexed: 08/17/2024] Open
Abstract
Introduction Streptococcus pneumoniae (the pneumococcus) effectively colonizes the human nasopharynx, but can migrate to other host sites, causing infections such as pneumonia and sepsis. Previous studies indicate that pneumococci grown as biofilms have phenotypes of bacteria associated with colonization whereas bacteria released from biofilms in response to changes in the local environment (i.e., dispersed bacteria) represent populations with phenotypes associated with disease. How these niche-adapted populations interact with immune cells upon reaching the vascular compartment has not previously been studied. Here, we investigated neutrophil, monocyte, and platelet activation using ex vivo stimulation of whole blood and platelet-rich plasma with pneumococcal populations representing distinct stages of the infectious process (biofilm bacteria and dispersed bacteria) as well as conventional broth-grown culture (planktonic bacteria). Methods Flow cytometry and ELISA were used to assess surface and soluble activation markers for neutrophil and monocyte activation, platelet-neutrophil complex and platelet-monocyte complex formation, and platelet activation and responsiveness. Results Overall, we found that biofilm-derived bacteria (biofilm bacteria and dispersed bacteria) induced significant activation of neutrophils, monocytes, and platelets. In contrast, little to no activation was induced by planktonic bacteria. Platelets remained functional after stimulation with bacterial populations and the degree of responsiveness was inversely related to initial activation. Bacterial association with immune cells followed a similar pattern as activation. Discussion Differences in activation of and association with immune cells by biofilm-derived populations could be an important consideration for other pathogens that have a biofilm state. Gaining insight into how these bacterial populations interact with the host immune response may reveal immunomodulatory targets to interfere with disease development.
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Affiliation(s)
- Yashuan Chao
- Division of Infection Medicine, Department of Clinical Sciences, Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Section for Oral Biology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Martina Mørch
- Division of Infection Medicine, Department of Clinical Sciences, Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Section for Oral Biology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Anders P Håkansson
- Division of Experimental Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Oonagh Shannon
- Division of Infection Medicine, Department of Clinical Sciences, Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Section for Oral Biology, Faculty of Odontology, Malmö University, Malmö, Sweden
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Li Y, Mao X, Shi P, Wan Z, Yang D, Ma T, Wang B, Wang J, Wang J, Zhu R. Microbiome-host interactions in the pathogenesis of acute exacerbation of chronic obstructive pulmonary disease. Front Cell Infect Microbiol 2024; 14:1386201. [PMID: 39091676 PMCID: PMC11291260 DOI: 10.3389/fcimb.2024.1386201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/24/2024] [Indexed: 08/04/2024] Open
Abstract
Objective To explore the underlying mechanisms the airway microbiome contributes to Acute Exacerbation of Chronic Obstructive Pulmonary Disease(AECOPD). Methods We enrolled 31 AECOPD patients and 26 stable COPD patients, their sputum samples were collected for metagenomic and RNA sequencing, and then subjected to bioinformatic analyses. The expression of host genes was validated by Quantitative Real-time PCR(qPCR) using the same batch of specimens. Results Our results indicated a higher expression of Rothia mucilaginosa(p=0.015) in the AECOPD group and Haemophilus influenzae(p=0.005) in the COPD group. The Different expressed genes(DEGs) detected were significantly enriched in "type I interferon signaling pathway"(p<0.001, q=0.001) in gene function annotation, and "Cytosolic DNA-sensing pathway"(p=0.002, q=0.024), "Toll-like receptor signaling pathway"(p=0.006, q=0.045), and "TNF signaling pathway"(p=0.006, q=0.045) in KEGG enrichment analysis. qPCR amplification experiment verified that the expression of OASL and IL6 increased significantly in the AECOPD group. Conclusion Pulmonary bacteria dysbiosis may regulate the pathogenesis of AECOPD through innate immune system pathways like type I interferon signaling pathway and Toll-like receptor signaling pathway.
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Affiliation(s)
- Yao Li
- Department of Respiratory and Critical Care Medicine, Huaian Clinical College of Xuzhou Medical University, Huaian, China
| | - Xiaoyan Mao
- Department of Intensive Care Unit, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, China
| | - Pengfei Shi
- Department of Respiratory and Critical Care Medicine, Huaian Clinical College of Xuzhou Medical University, Huaian, China
| | - Zongren Wan
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Dan Yang
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Ting Ma
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Baolan Wang
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Jipeng Wang
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Jingjing Wang
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rong Zhu
- Department of Respiratory and Critical Care Medicine, Huaian Clinical College of Xuzhou Medical University, Huaian, China
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Krammer M, Hoffmann R, Ruf HG, Neumann AU, Traidl-Hoffmann C, Goekkaya M, Gilles S. Ten-year retrospective data analysis reveals frequent respiratory co-infections in hospitalized patients in Augsburg. iScience 2024; 27:110136. [PMID: 38966568 PMCID: PMC11223076 DOI: 10.1016/j.isci.2024.110136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/19/2024] [Accepted: 05/27/2024] [Indexed: 07/06/2024] Open
Abstract
Clinical data on the types of respiratory pathogens which are most frequently engaged in respiratory co-infections of children and adults are lacking. We analyzed 10 years of data on a total of over 15,000 tests for 16 viral and bacterial pathogens detected in clinical samples at the University Hospital of Augsburg, Germany. Co-infection frequencies and their seasonal patterns were examined using a proportional distribution model. Co-infections were detected in 7.3% of samples, with a higher incidence in children and males. The incidence of interbacterial and interviral co-infections was higher than expected, whereas bacterial-viral co-infections were less frequent. H. influenzae, S. pneumoniae, rhinovirus, and respiratory syncytial virus (RSV) were most frequently involved. Most co-infections occurred in winter, but distinct summer peaks were also observed, which occurred even in children, albeit less pronounced than in adults. Seasonality of respiratory (co-)infections decreased with age. Our results suggest to adjust existing testing strategies during high-incidence periods.
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Affiliation(s)
- Martin Krammer
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Reinhard Hoffmann
- Institute for Laboratory Medicine and Microbiology, University Hospital of Augsburg, Augsburg, Germany
| | - Hans-Georg Ruf
- Institute for Laboratory Medicine and Microbiology, University Hospital of Augsburg, Augsburg, Germany
| | - Avidan U. Neumann
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - Claudia Traidl-Hoffmann
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
- Christine-Kühne-Center for Allergy Research & Education (CK-Care), Davos, Switzerland
| | - Mehmet Goekkaya
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - Stefanie Gilles
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
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Zhang J, Qi H, Wu JJ, Mao X, Zhang H, Amin N, Xu F, Dong C, Wang C, Wang P, Zheng L. Disposable Peptidoglycan-Specific Biosensor for Noninvasive Real-Time Detection of Broad-Spectrum Gram-Positive Bacteria in Exhaled Breath Condensates. Anal Chem 2024; 96:9817-9825. [PMID: 38730304 DOI: 10.1021/acs.analchem.4c00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Rapidly identifying and quantifying Gram-positive bacteria are crucial to diagnosing and treating bacterial lower respiratory tract infections (LRTIs). This work presents a field-deployable biosensor for detecting Gram-positive bacteria from exhaled breath condensates (EBCs) based on peptidoglycan recognition using an aptamer. Dielectrophoretic force is employed to enrich the bacteria in 10 s without additional equipment or steps. Concurrently, the measurement of the sensor's interfacial capacitance is coupled to quantify the bacteria during the enrichment process. By incorporation of a semiconductor condenser, the whole detection process, including EBC collection, takes about 3 min. This biosensor has a detection limit of 10 CFU/mL, a linear range of up to 105 CFU/mL and a selectivity of 1479:1. It is cost-effective and disposable due to its low cost. The sensor provides a nonstaining, culture-free and PCR-independent solution for noninvasive and real-time diagnosis of Gram-positive bacterial LRTIs.
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Affiliation(s)
- Jian Zhang
- College of Electrical and Electronic Engineering, Wenzhou University, Wenzhou 325035, China
- School of Food and Biological Engineering, Hefei University of Technology, Hefei 230009, China
- State Key Laboratory of Transducer Technology, Shanghai Institute of Microsystem and Information Technology, Chinese Academy of Sciences, Shanghai 200050, China
| | - Haochen Qi
- College of Electrical and Electronic Engineering, Wenzhou University, Wenzhou 325035, China
- Department of Electrical Engineering and Computer Science, the University of Tennessee, Knoxville, Tennessee 37996, United States
| | - Jie Jayne Wu
- Department of Electrical Engineering and Computer Science, the University of Tennessee, Knoxville, Tennessee 37996, United States
| | - Xuanjiao Mao
- Clinical Laboratory, The People's Hospital of Pingyang, Wenzhou 325400, China
| | - Hailin Zhang
- Department of Children's Respiratory Medicine, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Niloufar Amin
- Department of Electrical Engineering and Computer Science, the University of Tennessee, Knoxville, Tennessee 37996, United States
| | - Feng Xu
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450001, China
| | - Changkun Dong
- College of Electrical and Electronic Engineering, Wenzhou University, Wenzhou 325035, China
| | - Chunchang Wang
- Laboratory of Dielectric Functional Materials, School of Materials Science & Engineering, Anhui University, Hefei 230601, China
| | - Pengjun Wang
- College of Electrical and Electronic Engineering, Wenzhou University, Wenzhou 325035, China
| | - Lei Zheng
- School of Food and Biological Engineering, Hefei University of Technology, Hefei 230009, China
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Morrison JM, Kono N, Rush M, Hahn A, Forster CS, Cogen JD, Thomson J, DeYoung SH, Bashiri S, Mack WJ, Neely MN, Simon TD, Russell CJ. Factors associated with tracheostomy-associated infection treatment: A multicenter observational study. Pediatr Pulmonol 2024. [PMID: 38860585 DOI: 10.1002/ppul.27117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/17/2024] [Accepted: 05/28/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE To characterize factors that influence the decision to treat suspected pediatric bacterial tracheostomy-associated respiratory infections (bTRAINs; e.g., pneumonia, tracheitis). METHODS We conducted a multicenter, prospective cohort study of children with pre-existing tracheostomy hospitalized at six children's hospitals for a suspected bTRAIN (receipt of respiratory culture plus ≥1 doses of an antibiotic within 48 h). The primary predictor was respiratory culture growth categorized as Pseudomonas aeruginosa, P. aeruginosa + ≥1 other bacterium, other bacteria alone, or normal flora/no growth. Our primary outcome was bTRAIN treatment with a complete course of antibiotics as documented by the discharge team. We used logistic regression with generalized estimating equations to identify the association between our primary predictor and outcome and to identify demographic, clinical, and diagnostic testing factors associated with treatment. RESULTS Of the 440 admissions among 289 patients meeting inclusion criteria, 307 (69.8%) had positive respiratory culture growth. Overall, 237 (53.9%) of admissions resulted in bTRAIN treatment. Relative to a negative culture, a culture positive for P. aeruginosa plus ≥1 other organism (adjusted odds ratio [aOR] 2.3; 95% confidence interval [CI] 1.02-5.0)] or ≥1 other organism alone (aOR: 2.8; 95% CI: 1.4-5.6)] was associated with treatment. Several clinical and diagnostic testing (respiratory Gram-stain and chest radiograph) findings were also associated with treatment. Positive respiratory viral testing was associated with reduced odds of treatment (aOR: 0.5; 95% CI: 0.2-0.9). CONCLUSIONS Positive respiratory cultures as well as clinical indicators of acute illness and nonculture test results were associated with bTRAIN treatment. Clinicians may be more comfortable withholding antibiotics when a virus is identified during testing.
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Affiliation(s)
- John M Morrison
- Division of Pediatric Hospital Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Naoko Kono
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Margaret Rush
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washingto, District Columbia, USA
- Division of Hospital Medicine, Children's National Hospital, Washington, District Columbia, USA
| | - Andrea Hahn
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washingto, District Columbia, USA
- Division of Infectious Diseases, Children's National Hospital, Washington, District Columbia, USA
- Center for Genetic Medicine Research, Children's National Research Institute, Washington, District Columbia, USA
| | - Catherine S Forster
- Divisions of Pediatric Hospital Medicine and Pediatric Nephrology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jonathan D Cogen
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Seattle Children's Hospital/University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA
| | - Joanna Thomson
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sarah Hofman DeYoung
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Seattle Children's Hospital/University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA
| | - Sowgand Bashiri
- Divisions of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Wendy J Mack
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael N Neely
- Division of Infectious Disease, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Tamara D Simon
- Divisions of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Christopher J Russell
- Divisions of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
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Kakati B, Singh R, Mittal G, Koul N. Comparative performance of biofire pneumonia panel and standard culture-based methods for diagnosing pneumonia in critically ill patients: Impact on antibiotic stewardship. Indian J Med Microbiol 2024; 49:100564. [PMID: 38649113 DOI: 10.1016/j.ijmmb.2024.100564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Lower respiratory tract infections (LRTIs) are a common cause of morbidity and mortality worldwide. Accurate identification of the pathogens causing LRTIs is crucial for ensuring of diagnostic and antibiotic stewardship. The Biofire Pneumonia Panel (BFPP) is a molecular diagnostic test that allows rapid detection of various bacterial and viral pathogens. In this study, we compared the performance of BFPP with standard culture methods for the detection of pathogens. MATERIALS AND METHODS Respiratory samples from 70 patient with suspected LRTIs were tested using both BFPP and standard culture methods. The distribution of isolated bacterial pathogens was analyzed, and the sensitivity and specificity of BFPP were calculated. Additionally, the performance of BFPP in detecting antimicrobial resistance genes was evaluated. The results were compared with those obtained from VITEK-2 antimicrobial susceptibility testing and culture-based methods. RESULTS Among the suspected LRTI cases, BFPP identified a single pathogen in 32.8% of cases and multiple pathogens in 40% of cases. The standard culture method detected a single pathogen in 47.1% of cases. BFPP showed a sensitivity of 93.9% and a specificity of 45.9% for the total sample. The performance of BFPP in detecting antimicrobial resistance genes varied for different pathogens with overall sensitivity of 40.1% and specificity of 95.9%. CONCLUSION The Biofire Pneumonia Panel (BFPP) demonstrated high sensitivity for several bacterial pathogens, indicating its potential as a rapid diagnostic tool. However, its performance varied for different microorganisms, and it had limitations in detecting certain pathogens and antimicrobial resistance genes for which still required more further studies to explore different resistance gene mechanism that can be incorporated in this panel in future. The BFPP can complement standard culture methods as a rapid tool in the diagnosis of LRTIs.
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Affiliation(s)
- Barnali Kakati
- Dept. of Microbiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jollygrant, Dehradun, Uttarakhand, India.
| | - Rajender Singh
- Dept. of Microbiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jollygrant, Dehradun, Uttarakhand, India.
| | - Garima Mittal
- Dept. of Microbiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jollygrant, Dehradun, Uttarakhand, India.
| | - Nupur Koul
- Dept. of Microbiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jollygrant, Dehradun, Uttarakhand, India.
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Wang JZ, Yuan D, Yang XH, Sun CH, Hou LL, Zhang Y, Xie HX, Gao YX. Epidemiological and etiological characteristics of 1266 patients with severe acute respiratory infection in central China, 2018-2020: a retrospective survey. BMC Infect Dis 2024; 24:426. [PMID: 38649799 PMCID: PMC11034018 DOI: 10.1186/s12879-024-09297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Severe acute respiratory infection (SARI), a significant global health concern, imposes a substantial disease burden. In China, there is inadequate data concerning the monitoring of respiratory pathogens, particularly bacteria, among patients with SARI. Therefore, this study aims to delineate the demographic, epidemiological, and aetiological characteristics of hospitalised SARI patients in Central China between 2018 and 2020. METHODS Eligible patients with SARI admitted to the First Affiliated Hospital of Zhengzhou University between 1 January 2018 and 31 December 2020 were included in this retrospective study. Within the first 24 h of admission, respiratory (including sputum, nasal/throat swabs, bronchoalveolar lavage fluid, thoracocentesis fluid, etc.), urine, and peripheral blood specimens were collected for viral and bacterial testing. A multiplex real-time polymerase chain reaction (PCR) diagnostic approach was used to identify human influenza virus, respiratory syncytial virus, parainfluenza virus, adenovirus, human bocavirus, human coronavirus, human metapneumovirus, and rhinovirus. Bacterial cultures of respiratory specimens were performed with a particular focus on pathogenic microorganisms, including S. pneumoniae, S. aureus, K. pneumoniae, P. aeruginosa, Strep A, H. influenzae, A. baumannii, and E. coli. In cases where bacterial culture results were negative, nucleic acid extraction was performed for PCR to assay for the above-mentioned eight bacteria, as well as L. pneumophila and M. pneumoniae. Additionally, urine specimens were exclusively used to detect Legionella antigens. Furthermore, epidemiological, demographic, and clinical data were obtained from electronic medical records. RESULTS The study encompassed 1266 patients, with a mean age of 54 years, among whom 61.6% (780/1266) were males, 61.4% (778/1266) were farmers, and 88.8% (1124/1266) sought medical treatment in 2020. Moreover, 80.3% (1017/1266) were housed in general wards. The most common respiratory symptoms included fever (86.8%, 1122/1266) and cough (77.8%, 986/1266). Chest imaging anomalies were detected in 62.6% (792/1266) of cases, and 58.1% (736/1266) exhibited at least one respiratory pathogen, with 28.5% (361/1266) having multiple infections. Additionally, 95.7% (1212/1266) of the patients were from Henan Province, with the highest proportion (38.3%, 486/1266) falling in the 61-80 years age bracket, predominantly (79.8%, 1010/1266) seeking medical aid in summer and autumn. Bacterial detection rate (39.0%, 495/1266) was higher than viral detection rate (36.9%, 468/1266), with the primary pathogens being influenza virus (13.8%, 175/1266), K. pneumoniae (10.0%, 127/1266), S. pneumoniae (10.0%, 127/1266), adenovirus (8.2%, 105/1266), P. aeruginosa (8.2%, 105/1266), M. pneumoniae (7.8%, 100/1266), and respiratory syncytial virus (7.7%, 98/1266). During spring and winter, there was a significant prevalence of influenza virus and human coronavirus, contrasting with the dominance of parainfluenza viruses in summer and autumn. Respiratory syncytial virus and rhinovirus exhibited higher prevalence across spring, summer, and winter. P. aeruginosa, K. pneumoniae, and M. pneumoniae were identified at similar rates throughout all seasons without distinct spikes in prevalence. However, S. pneumoniae showed a distinctive pattern with a prevalence that doubled during summer and winter. Moreover, the positive detection rates of various other viruses and bacteria were lower, displaying a comparatively erratic prevalence trend. Among patients admitted to the intensive care unit, the predominant nosocomial bacteria were K. pneumoniae (17.2%, 43/249), A. baumannii (13.6%, 34/249), and P. aeruginosa (12.4%, 31/249). Conversely, in patients from general wards, predominant pathogens included influenza virus (14.8%, 151/1017), S. pneumoniae (10.4%, 106/1017), and adenovirus (9.3%, 95/1017). Additionally, paediatric patients exhibited significantly higher positive detection rates for influenza virus (23.9%, 11/46) and M. pneumoniae (32.6%, 15/46) compared to adults and the elderly. Furthermore, adenovirus (10.0%, 67/669) and rhinovirus (6.4%, 43/669) were the primary pathogens in adults, while K. pneumoniae (11.8%, 65/551) and A. baumannii (7.1%, 39/551) prevailed among the elderly, indicating significant differences among the three age groups. DISCUSSION In Central China, among patients with SARI, the prevailing viruses included influenza virus, adenovirus, and respiratory syncytial virus. Among bacteria, K. pneumoniae, S. pneumoniae, P. aeruginosa, and M. pneumoniae were frequently identified, with multiple infections being very common. Additionally, there were substantial variations in the pathogen spectrum compositions concerning wards and age groups among patients. Consequently, this study holds promise in offering insights to the government for developing strategies aimed at preventing and managing respiratory infectious diseases effectively.
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Affiliation(s)
- Jin-Zhu Wang
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, 310014, Hangzhou, Zhejiang, China
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, 450001, Zhengzhou, Henan, China
| | - Ding Yuan
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, 450001, Zhengzhou, Henan, China
| | - Xiang-Hong Yang
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, 310014, Hangzhou, Zhejiang, China
| | - Chang-Hua Sun
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, 450001, Zhengzhou, Henan, China
| | - Lin-Lin Hou
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, 450001, Zhengzhou, Henan, China
| | - Yan Zhang
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, 450001, Zhengzhou, Henan, China
| | - Hong-Xiang Xie
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 250014, Jinan, Shandong, China.
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, 310014, Hangzhou, Zhejiang, China.
| | - Yan-Xia Gao
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, 450001, Zhengzhou, Henan, China.
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9
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Chen J, Wang Q, Zhong B, Zheng H, Wang D, Huang X, Liu L, Liu T. Activation of the RIG-I/MAVS Signaling Pathway during Human Adenovirus Type 3 Infection Impairs the Pro-Inflammatory Response Induced by Secondary Infection with Staphylococcus aureus. Int J Mol Sci 2024; 25:4178. [PMID: 38673764 PMCID: PMC11049948 DOI: 10.3390/ijms25084178] [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: 12/26/2023] [Revised: 03/25/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024] Open
Abstract
The exacerbation of pneumonia in children with human adenovirus type 3 (HAdV-3E) is secondary to a Staphylococcus aureus (S. aureus) infection. The influence of host-pathogen interactions on disease progression remains unclear. It is important to note that S. aureus infections following an HAdV-3E infection are frequently observed in clinical settings, yet the underlying susceptibility mechanisms are not fully understood. This study utilized an A549 cell model to investigate secondary infection with S. aureus following an HAdV-3E infection. The findings suggest that HAdV-3E exacerbates the S. aureus infection by intensifying lung epithelial cell damage. The results highlight the role of HAdV-3E in enhancing the interferon signaling pathway through RIG-I (DDX58), resulting in the increased expression of interferon-stimulating factors like MX1, RSAD2, and USP18. The increase in interferon-stimulating factors inhibits the NF-κB and MAPK/P38 pro-inflammatory signaling pathways. These findings reveal new mechanisms of action for HAdV-3E and S. aureus in secondary infections, enhancing our comprehension of pathogenesis.
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Affiliation(s)
| | | | | | | | | | | | - Li Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China; (J.C.); (Q.W.); (B.Z.); (H.Z.); (D.W.); (X.H.)
| | - Tiantian Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China; (J.C.); (Q.W.); (B.Z.); (H.Z.); (D.W.); (X.H.)
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10
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Hammarskjöld F, Berg S, Bavelaar H, Henningson AJ, Taxbro K. Pulmonary superinfection diagnosed with bronchoalveolar lavage at intubation in COVID patients: A Swedish single-centre study. Acta Anaesthesiol Scand 2024; 68:512-519. [PMID: 38282310 DOI: 10.1111/aas.14378] [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: 09/06/2023] [Revised: 12/05/2023] [Accepted: 01/11/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patients with severe coronavirus disease 2019 (COVID) pneumonia and acute respiratory distress syndrome (C-ARDS) on invasive mechanical ventilation (IMV) have been found to be prone to having other microbial findings than severe acute respiratory syndrome coronavirus 2 (SARS-2)-CoV-19 in the bronchoalveolar lavage (BAL) fluid at intubation causing a superinfection. These BAL results could guide empirical antibiotic treatment in complex clinical situations. However, there are limited data on the relationship between microbial findings in the initial BAL at intubation and later ventilator-associated pneumonia (VAP) diagnoses. OBJECTIVE To analyse the incidence of, and microorganisms responsible for, superinfections in C-ARDS patients at the time of first intubation through microbial findings in BAL fluid. To correlate these findings to markers of inflammation in plasma and later VAP development. DESIGN Retrospective single-centre study. SETTING One COVID-19 intensive care unit (ICU) at a County Hospital in Sweden during the first year of the pandemic. PATIENTS All patients with C-ARDS who were intubated in the ICU. RESULTS We analysed BAL fluid specimens from 112 patients at intubation, of whom 31 (28%) had superinfections. Blood levels of the C-reactive protein, procalcitonin, neutrophil granulocytes, and lymphocytes were indistinguishable between patients with and without a pulmonary superinfection. Ninety-eight (88%) of the patients were treated with IMV for more than 48 h and of these patients, 37% were diagnosed with VAP. The microorganisms identified in BAL at the time of intubation are normally found at the oral, pharyngeal, and airway sites. Only one patient had an indistinguishable bacterial strain responsible for both superinfection at intubation and in VAP. CONCLUSIONS One fourth of the patients with C-ARDS had a pulmonary superinfection in the lungs that was caused by another microorganism identified at intubation. Routine serum inflammatory markers could not be used to identify this complication. Microorganisms located in BAL at intubation were rarely associated with later VAP development.
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Affiliation(s)
- Fredrik Hammarskjöld
- Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sören Berg
- Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Herjan Bavelaar
- Division of clinical Microbiology, Department of Laboratory Medicine, Region Jönköping County, Jönköping, Sweden
| | - Anna J Henningson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Division of clinical Microbiology, Department of Laboratory Medicine, Region Jönköping County, Jönköping, Sweden
| | - Knut Taxbro
- Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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11
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Jahn K, Karakioulaki M, Schumann DM, Hirsch HH, Leuzinger K, Grize L, Aliberti S, Sotgiu G, Tamm M, Stolz D. Impact of bronchoalveolar lavage on the management of immunocompromised hosts. Eur J Intern Med 2024; 120:52-61. [PMID: 37722932 DOI: 10.1016/j.ejim.2023.09.007] [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] [Received: 08/05/2023] [Revised: 08/25/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Respiratory infections are an important cause of morbidity and mortality in immunocompromised individuals. Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) is an important tool to detect infectious agents in immunocompromised patients with low respiratory tract infections (LRTI). RESEARCH QUESTION BAL changes the management of immunocompromised patients with suspected LRTI. STUDY DESIGN AND METHODS Immunocompromised patients with a suspicion of LRTI underwent diagnostic BAL. The primary composite outcome consisted of pre-defined modifications in the management of the immunocompromised patients following BAL. We quantified the impact of bronchoscopy up to 30 days after the procedure. RESULTS A total of 2666 visits from 1301 patients were included in the study and immunosuppression was classified as haematological (n = 1040; 544 patients), solid organ transplantation (n = 666; 107 patients) and other causes (n = 960; 650 patients). BAL led to a change in management in 52.36% (n = 1396) of all cases. This percentage, as well as the 30-day mortality differed significantly amongst the three groups. Age, C-reactive protein and aetiology of infection determined significantly the risk of 30-day mortality in all patients. In 1.89% (n = 50) of all cases, a combination of 2 respiratory viral agents was identified and 24.23% (n = 646) were diagnosed with a single respiratory viral agent. INTERPRETATION BAL leads to changes in management in the majority of immunosuppressed patients. There is a high prevalence of multimicrobial infections and respiratory viral infections in immunocompromised patients with respiratory symptoms. Individual virus infection is associated with diverse risk of a negative outcome.
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Affiliation(s)
- Kathleen Jahn
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Meropi Karakioulaki
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland; Clinic of Respiratory Medicine, Faculty of Medicine, University of Freiburg, Germany
| | - Desiree M Schumann
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Hans H Hirsch
- Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland University Hospital, Basel, Switzerland; Transplantation & Clinical Virology, Department Biomedicine, University of Basel, Basel Switzerland; Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Karoline Leuzinger
- Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland University Hospital, Basel, Switzerland; Transplantation & Clinical Virology, Department Biomedicine, University of Basel, Basel Switzerland
| | - Leticia Grize
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; IRCCS Humanitas Research Hospital, Respiratory Unit, Rozzano, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Michael Tamm
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland; Clinic of Respiratory Medicine, Faculty of Medicine, University of Freiburg, Germany.
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12
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Jorda A, Gabler C, Blaschke A, Wölfl-Duchek M, Gelbenegger G, Nussbaumer-Pröll A, Radtke C, Zeitlinger M, Bergmann F. Community-acquired and hospital-acquired bacterial co-infections in patients hospitalized with Covid-19 or influenza: a retrospective cohort study. Infection 2024; 52:105-115. [PMID: 37326938 PMCID: PMC10811098 DOI: 10.1007/s15010-023-02063-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Bacterial co-infections are believed to be less frequent in patients with Covid-19 than influenza, but frequencies varied between studies. METHODS This single-center retrospective, propensity score-matched analysis included adult patients with Covid-19 or influenza admitted to normal-care wards between 02/2014 and 12/2021. Covid-19 cases were propensity score matched to influenza cases at a 2:1 ratio. Community-acquired and hospital-acquired bacterial co-infections were defined as positive blood or respiratory cultures ≤ 48 h or > 48 h after hospital admission, respectively. The primary outcome was comparison of community-acquired and hospital-acquired bacterial infections between patients with Covid-19 and influenza in the propensity score-matched cohort. Secondary outcomes included frequency of early and late microbiological testing. RESULTS A total of 1337 patients were included in the overall analysis, of which 360 patients with Covid-19 were matched to 180 patients with influenza. Early (≤ 48 h) microbiological sampling was performed in 138 (38.3%) patients with Covid-19 and 75 (41.7%) patients with influenza. Community-acquired bacterial co-infections were found in 14 (3.9%) of 360 patients with Covid-19 and 7 (3.9%) of 180 patients with influenza (OR 1.0, 95% CI 0.3-2.7). Late (> 48 h) microbiological sampling was performed in 129 (35.8%) patients with Covid-19 and 74 (41.1%) patients with influenza. Hospital-acquired bacterial co-infections were found in 40 (11.1%) of 360 patients with Covid-19 and 20 (11.1%) of 180 patients with influenza (OR 1.0, 95% CI 0.5-1.8). CONCLUSION The rate of community-acquired and hospital-acquired bacterial co-infections was similar in hospitalized Covid-19 and influenza patients. These findings contrast previous literature reporting that bacterial co-infections are less common in Covid-19 than influenza.
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Affiliation(s)
- Anselm Jorda
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Cornelia Gabler
- IT Systems and Communications, Medical University of Vienna, Vienna, Austria
| | - Amelie Blaschke
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Wölfl-Duchek
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Georg Gelbenegger
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Alina Nussbaumer-Pröll
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christine Radtke
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Felix Bergmann
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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13
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Jordan PM, Günther K, Nischang V, Ning Y, Deinhardt-Emmer S, Ehrhardt C, Werz O. Influenza A virus selectively elevates prostaglandin E 2 formation in pro-resolving macrophages. iScience 2024; 27:108775. [PMID: 38261967 PMCID: PMC10797193 DOI: 10.1016/j.isci.2023.108775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/15/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024] Open
Abstract
Respiratory influenza A virus (IAV) infections are major health concerns worldwide, where bacterial superinfections substantially increase morbidity and mortality. The underlying mechanisms of how IAV impairs host defense remain elusive. Macrophages are pivotal for the innate immune response and crucially regulate the entire inflammatory process, occurring as inflammatory M1- or pro-resolving M2-like phenotypes. Lipid mediators (LM), produced from polyunsaturated fatty acids by macrophages, are potent immune regulators and impact all stages of inflammation. Using LM metabololipidomics, we show that human pro-resolving M2-macrophages respond to IAV infections with specific and robust production of prostaglandin (PG)E2 along with upregulation of cyclooxygenase-2 (COX-2), which persists after co-infection with Staphylococcus aureus. In contrast, cytokine/interferon production in macrophages was essentially unaffected by IAV infection, and the functionality of M1-macrophages was not influenced. Conclusively, IAV infection of M2-macrophages selectively elevates PGE2 formation, suggesting inhibition of the COX-2/PGE2 axis as strategy to limit IAV exacerbation.
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Affiliation(s)
- Paul M. Jordan
- Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich Schiller University Jena, Philosophenweg 14, 07743 Jena, Germany
- Jena Center for Soft Matter (JCSM); Friedrich Schiller University Jena, Philosophenweg 7, 07743 Jena, Germany
| | - Kerstin Günther
- Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich Schiller University Jena, Philosophenweg 14, 07743 Jena, Germany
| | - Vivien Nischang
- Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich Schiller University Jena, Philosophenweg 14, 07743 Jena, Germany
| | - Yuping Ning
- Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich Schiller University Jena, Philosophenweg 14, 07743 Jena, Germany
| | | | - Christina Ehrhardt
- Section of Experimental Virology, Institute of Medical Microbiology, Center for Molecular Biomedicine (CMB), Jena University Hospital, Hans-Knoell-Str. 2, 07745 Jena, Germany
| | - Oliver Werz
- Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich Schiller University Jena, Philosophenweg 14, 07743 Jena, Germany
- Jena Center for Soft Matter (JCSM); Friedrich Schiller University Jena, Philosophenweg 7, 07743 Jena, Germany
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14
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Guo M, Zhang J, Wang Q, Tang J, Li Y, Zhou H, Lin H, Ma Z, Fan H. Porcine circovirus type 2 and Glaesserella parasuis serotype 4 co-infection activates Snail1 to disrupt the intercellular junctions and facilitate bacteria translocation across the tracheal epithelium. Vet Microbiol 2024; 288:109954. [PMID: 38104440 DOI: 10.1016/j.vetmic.2023.109954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
Clinically, Porcine circovirus type 2 (PCV2) often causes disease through coinfection with other bacterial pathogens, including Glaesserella parasuis (G. parasuis), which causes high morbidity and mortality. However, the mechanism of PCV2 and G. parasuis serotype 4 (GPS4) co-infection is still not fully understood. In this study, swine tracheal epithelial cells (STEC) were used as a barrier model, and our results showed that PCV2 infection increased the adhesion of GPS4 to STEC, while decreasing the levels of ZO-1, Occludin and increasing tracheal epithelial permeability, and ultimately facilitated GPS4 translocation. Snail1 is a transcriptional repressor, and has been known to induce epithelial-to-mesenchymal transition (EMT) during development or in cancer metastasis. Importantly, we found that Snail1, as a transcriptional repressor, was crucial in destroying the tracheal epithelial barrier induced by PCV2, GPS4, PCV2 and GPS4 coinfection. For the first time, we found that PCV2, GPS4, PCV2 and GPS4 coinfection cross-activates TGF-β and p38/MAPK signaling pathways to upregulate the expression of Snail1, down-regulate the levels of ZO-1 and Occludin, and thus disrupt the integrity of tracheal epithelial barrier then promoting GPS4 translocation. Finally, PCV2 and GPS4 co-infection also can activate TGF-β and p38/MAPK signaling pathways in vivo and upregulate Snail1, ultimately down-regulating the expression of ZO-1 and Occludin. Our study elucidates how PCV2 infection promotes GPS4 to breach the tracheal epithelial barrier and aggravate clinical manifestations.
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Affiliation(s)
- Mengru Guo
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Jianan Zhang
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Qing Wang
- Anhui Province Key Laboratory of Veterinary Pathobiology and Disease Control, College of Animal Science and Technology, Anhui Agricultural University, Hefei, China
| | - Jinsheng Tang
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Yuhui Li
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Hong Zhou
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Huixing Lin
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Zhe Ma
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Hongjie Fan
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China; College of Animal Science, Anhui Science and Technology University, Fengyang, China.
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15
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Kyne S, Ní Shíocháin D, McDonnell C, Byrne A, Sutton-Fitzpatrick U, Crowley N, Nertney L, Myers C, Waldron J, Ahmed A, Wrynne C, Fennell J, Fitzpatrick P, Fitzsimons JJ, Scanlan B, Vaughan D, Gorman KM, Cunney R, Smyth AE, Hourihane JO. Increased rates of invasive bacterial disease in late 2022. Eur J Pediatr 2024; 183:323-334. [PMID: 37882822 DOI: 10.1007/s00431-023-05282-9] [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] [Received: 07/27/2023] [Revised: 09/29/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023]
Abstract
Invasive bacterial disease is associated with significant morbidity and mortality. In winter 2022, there was an apparent increased rate of invasive bacterial disease compared to preceding years. Cross-site retrospective analysis of the three Children's Health Ireland (CHI) hospitals looking at children admitted between 1st October 2022-31st December 2022 (Q4) with community-acquired invasive bacterial disease, defined as an abscess in a normally sterile site in the head, neck and chest or isolation or PCR detection of Streptococcus pneumoniae, Neisseria meningitidis, Streptococcus pyogenes (Group A streptococcus) or Haemophilus influenzae from a normally sterile site. Case numbers were compared to Q4 in each of 2018-2021. Eighty-two children met the case definition in Q4 2022 vs 97 (Q4 2018-2021). In 2022, 42/82 (51%) were female, median age 3.75 years (1.5-8.25 years). Only 2 (2%) were immunosuppressed and 2 others (2%) had underlying neurodisability. Fifty (61%) were admitted on second or subsequent presentation to a healthcare setting. Fifty-six (68%) had an abscess in a sterile site. Bloodstream infection (positive blood culture or PCR: 24 (29%)) was the most common site of infection, followed by neck 22 (27%) and intracranial 12 (15%). Group A streptococcus (GAS) 27 (33%) was the most common organism isolated. Seven cases (9%) died in 2022 compared to 2 patients (2%) from 2018 to 2021 (p < 0.05). More children had Paediatric Overall Performance Category (POPC) scores > 1 in 2022 than 2018-2021 (p = 0.003). Conclusion: Invasive bacterial diseases increased in Q4 2022 with higher morbidity and mortality than in the preceding 4 years. Group A streptococcal infection was the most significant organism in 2022. What is known: • Invasive bacterial disease is the leading cause of childhood mortality globally. • There was an increase in cases of invasive Group A streptococcus infections reported in many countries (including Ireland) during the winter of 2022/23. What is new: • Head, neck and chest abscesses increased in Q4 of 2022 compared to the previous 4 years combined. • Invasive bacterial infections in Q4 of 2022 were associated with higher rates of mortality (9%), paediatric intensive care unit (PICU) admission (24%) and requirement for surgical drainage or intervention (67%) than in the preceding years.
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Affiliation(s)
- Sarah Kyne
- General Paediatrics, Children's Health Ireland, Dublin, Ireland.
| | | | | | - Aisling Byrne
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | | | - Niamh Crowley
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - Leona Nertney
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - Conor Myers
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - John Waldron
- Radiology, Children's Health Ireland, Dublin, Ireland
| | - Aneeq Ahmed
- Radiology, Children's Health Ireland, Dublin, Ireland
| | - Caragh Wrynne
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - Jerome Fennell
- Clinical Microbiology, Children's Health Ireland, Dublin, Ireland
| | - Patrick Fitzpatrick
- Emergency Medicine, Children's Health Ireland, Dublin, Ireland
- Royal College of Surgeons, Dublin, Ireland
| | - John J Fitzsimons
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
- Royal College of Surgeons, Dublin, Ireland
| | - Barry Scanlan
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - David Vaughan
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
| | - Kathleen M Gorman
- Neurology, Children's Health Ireland, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Robert Cunney
- Clinical Microbiology, Children's Health Ireland, Dublin, Ireland
- Royal College of Surgeons, Dublin, Ireland
| | - Anna E Smyth
- Radiology, Children's Health Ireland, Dublin, Ireland
| | - Jonathan O'B Hourihane
- General Paediatrics, Children's Health Ireland, Dublin, Ireland
- Royal College of Surgeons, Dublin, Ireland
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16
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Mochan E, Sego TJ. Mathematical Modeling of the Lethal Synergism of Coinfecting Pathogens in Respiratory Viral Infections: A Review. Microorganisms 2023; 11:2974. [PMID: 38138118 PMCID: PMC10745501 DOI: 10.3390/microorganisms11122974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Influenza A virus (IAV) infections represent a substantial global health challenge and are often accompanied by coinfections involving secondary viruses or bacteria, resulting in increased morbidity and mortality. The clinical impact of coinfections remains poorly understood, with conflicting findings regarding fatality. Isolating the impact of each pathogen and mechanisms of pathogen synergy during coinfections is challenging and further complicated by host and pathogen variability and experimental conditions. Factors such as cytokine dysregulation, immune cell function alterations, mucociliary dysfunction, and changes to the respiratory tract epithelium have been identified as contributors to increased lethality. The relative significance of these factors depends on variables such as pathogen types, infection timing, sequence, and inoculum size. Mathematical biological modeling can play a pivotal role in shedding light on the mechanisms of coinfections. Mathematical modeling enables the quantification of aspects of the intra-host immune response that are difficult to assess experimentally. In this narrative review, we highlight important mechanisms of IAV coinfection with bacterial and viral pathogens and survey mathematical models of coinfection and the insights gained from them. We discuss current challenges and limitations facing coinfection modeling, as well as current trends and future directions toward a complete understanding of coinfection using mathematical modeling and computer simulation.
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Affiliation(s)
- Ericka Mochan
- Department of Computational and Chemical Sciences, Carlow University, Pittsburgh, PA 15213, USA
| | - T. J. Sego
- Department of Medicine, University of Florida, Gainesville, FL 32611, USA;
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17
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Lalbiaktluangi C, Yadav MK, Singh PK, Singh A, Iyer M, Vellingiri B, Zomuansangi R, Zothanpuia, Ram H. A cooperativity between virus and bacteria during respiratory infections. Front Microbiol 2023; 14:1279159. [PMID: 38098657 PMCID: PMC10720647 DOI: 10.3389/fmicb.2023.1279159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/27/2023] [Indexed: 12/17/2023] Open
Abstract
Respiratory tract infections remain the leading cause of morbidity and mortality worldwide. The burden is further increased by polymicrobial infection or viral and bacterial co-infection, often exacerbating the existing condition. Way back in 1918, high morbidity due to secondary pneumonia caused by bacterial infection was known, and a similar phenomenon was observed during the recent COVID-19 pandemic in which secondary bacterial infection worsens the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) condition. It has been observed that viruses paved the way for subsequent bacterial infection; similarly, bacteria have also been found to aid in viral infection. Viruses elevate bacterial infection by impairing the host's immune response, disrupting epithelial barrier integrity, expression of surface receptors and adhesion proteins, direct binding of virus to bacteria, altering nutritional immunity, and effecting the bacterial biofilm. Similarly, the bacteria enhance viral infection by altering the host's immune response, up-regulation of adhesion proteins, and activation of viral proteins. During co-infection, respiratory bacterial and viral pathogens were found to adapt and co-exist in the airways of their survival and to benefit from each other, i.e., there is a cooperative existence between the two. This review comprehensively reviews the mechanisms involved in the synergistic/cooperativity relationship between viruses and bacteria and their interaction in clinically relevant respiratory infections.
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Affiliation(s)
- C. Lalbiaktluangi
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, India
| | - Mukesh Kumar Yadav
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, India
| | - Prashant Kumar Singh
- Department of Biotechnology, Mizoram University (A Central University), Pachhunga University College, Aizawl, Mizoram, India
| | - Amit Singh
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, India
| | - Mahalaxmi Iyer
- Department of Zoology, Central University of Punjab, Bathinda, Punjab, India
| | | | - Ruth Zomuansangi
- Department of Microbiology, Central University of Punjab, Bathinda, Punjab, India
| | - Zothanpuia
- Department of Biotechnology, Mizoram University (A Central University), Pachhunga University College, Aizawl, Mizoram, India
| | - Heera Ram
- Department of Zoology, Jai Narain Vyas University, Jodhpur, India
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18
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Lin R, Xing Z, Liu X, Chai Q, Xin Z, Huang M, Zhu C, Luan C, Gao H, Du Y, Deng X, Zhang H, Ma D. Performance of targeted next-generation sequencing in the detection of respiratory pathogens and antimicrobial resistance genes for children. J Med Microbiol 2023; 72. [PMID: 37910007 DOI: 10.1099/jmm.0.001771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Introduction. Respiratory tract infection, which is associated with high morbidity and mortality, occurs frequently in children. At present, the main diagnostic method is culture. However, the low pathogen detection rate of the culture approach prevents timely and accurate diagnosis. Fortunately, next-generation sequencing (NGS) can compensate for the deficiency of culture, and its application in clinical diagnostics has become increasingly available.Gap Statement. Targeted NGS (tNGS) is a platform that can select and enrich specific regions before data enter the NGS pipeline. However, the performance of tNGS in the detection of respiratory pathogens and antimicrobial resistance genes (ARGs) in infections in children is unclear.Aim and methodology. In this study, we estimated the performance of tNGS in the detection of respiratory pathogens and ARGs in 47 bronchoalveolar lavage fluid (BALF) specimens from children using conventional culture and antimicrobial susceptibility testing (AST) as the gold standard.Results. RPIP (Respiratory Pathogen ID/AMR enrichment) sequencing generated almost 500 000 reads for each specimen. In the detection of pathogens, RPIP sequencing showed targeted superiority in detecting difficult-to-culture bacteria, including Mycoplasma pneumoniae. Compared with the results of culture, the sensitivity and specificity of RPIP were 84.4 % (confidence interval 70.5-93.5 %) and 97.7 % (95.9 -98.8%), respectively. Moreover, RPIP results showed that a single infection was detected in 10 of the 47 BALF specimens, and multiple infections were detected in 34, with the largest number of bacterial/viral coinfections. Nevertheless, there were also three specimens where no pathogen was detected. Furthermore, we analysed the drug resistance genes of specimens containing Streptococcus pneumoniae, which was detected in 25 out of 47 specimens in the study. A total of 58 ARGs associated with tetracycline, macrolide-lincosamide-streptogramin, beta-lactams, sulfonamide and aminoglycosides were identified by RPIP in 19 of 25 patients. Using the results of AST as a standard, the coincidence rates of erythromycin, tetracycline, penicillin and sulfonamides were 89.5, 79.0, 36.8 and 42.1 %, respectively.Conclusion. These results demonstrated the superiority of RPIP in pathogen detection, particularly for multiple and difficult-to-culture pathogens, as well as in predicting resistance to erythromycin and tetracycline, which has significance for the accurate diagnosis of pathogenic infection and in the guidance of clinical treatment.
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Affiliation(s)
- Ruihong Lin
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Zhihao Xing
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Xiaorong Liu
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Qiang Chai
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Zefeng Xin
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Meng Huang
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Chunqing Zhu
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Ce Luan
- Department of Anatomy, College of Basic Medicine, Chongqing Medical University, Chongqing 400042, PR China
| | - Hongdan Gao
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Yao Du
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Xuwen Deng
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Hetong Zhang
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Dongli Ma
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
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19
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Sunder S, Bhandari K, Sounkaria S, Vyas M, Singh BP, Chandra P. Antibiotics and nano-antibiotics in treatment of lung infection: In management of COVID-19. Microb Pathog 2023; 184:106356. [PMID: 37743025 DOI: 10.1016/j.micpath.2023.106356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023]
Abstract
The world has witnessed the cruelty of COVID-19 disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The association of COVID-19 with other secondary and bacterial co-infections has tremendously contributed to lung infections. An increased probability of having a secondary lung infection was observed among the post-COVID patients. The treatment of antibiotics has ameliorated the mortality rate. However, the stewardship of antibiotic treatment was linked to increased organ failure. Therefore, the paper discusses the interactions between the virus and host through the ACE2 receptors that contribute to COVID-19 development. Furthermore, the paper provides an invaluable compendium history of SARS-CoV-2 genomic composition. It revolves around most classes of antibiotics used to treat COVID-19 disease and post-COVID lung infections with the complete mechanism. This binds with the exertion of the antibiotics for bacterial infection associated with COVID-19 patients and how beneficial and effective responses have been recorded for the treatment. The application of nanotechnology and possible approaches of nanomedicines is also discussed to its potential usage.
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Affiliation(s)
- Sushant Sunder
- Department of Biotechnology, Delhi Technological University, New Delhi, 110042, India; Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Kriti Bhandari
- Department of Biotechnology, Delhi Technological University, New Delhi, 110042, India
| | - Shruti Sounkaria
- Department of Biotechnology, Delhi Technological University, New Delhi, 110042, India
| | - Manjari Vyas
- Department of Biotechnology, Delhi Technological University, New Delhi, 110042, India
| | - Bhupendra Pratap Singh
- Department of Environmental Studies, Central University of Haryana, Jant-Pali, Mahendergarh, Haryana, 123031, India
| | - Prakash Chandra
- Department of Biotechnology, Delhi Technological University, New Delhi, 110042, India.
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20
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Baker PJ, Amaral EP, Castro E, Bohrer AC, Torres-Juárez F, Jordan CM, Nelson CE, Barber DL, Johnson RF, Hilligan KL, Mayer-Barber KD. Co-infection of mice with SARS-CoV-2 and Mycobacterium tuberculosis limits early viral replication but does not affect mycobacterial loads. Front Immunol 2023; 14:1240419. [PMID: 37720210 PMCID: PMC10502726 DOI: 10.3389/fimmu.2023.1240419] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Viral co-infections have been implicated in worsening tuberculosis (TB) and during the COVID-19 pandemic, the global rate of TB-related deaths has increased for the first time in over a decade. We and others have previously shown that a resolved prior or concurrent influenza A virus infection in Mycobacterium tuberculosis (Mtb)-infected mice resulted in increased pulmonary bacterial burden, partly through type I interferon (IFN-I)-dependent mechanisms. Here we investigated whether SARS-CoV-2 (SCV2) co-infection could also negatively affect bacterial control of Mtb. Importantly, we found that K18-hACE2 transgenic mice infected with SCV2 one month before, or months after aerosol Mtb exposure did not display exacerbated Mtb infection-associated pathology, weight loss, nor did they have increased pulmonary bacterial loads. However, pre-existing Mtb infection at the time of exposure to the ancestral SCV2 strain in infected K18-hACE2 transgenic mice or the beta variant (B.1.351) in WT C57Bl/6 mice significantly limited early SCV2 replication in the lung. Mtb-driven protection against SCV2 increased with higher bacterial doses and did not require IFN-I, TLR2 or TLR9 signaling. These data suggest that SCV2 co-infection does not exacerbate Mtb infection in mice, but rather the inflammatory response generated by Mtb infection in the lungs at the time of SCV2 exposure restricts viral replication.
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Affiliation(s)
- Paul J. Baker
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Eduardo P. Amaral
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Ehydel Castro
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Andrea C. Bohrer
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Flor Torres-Juárez
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Cassandra M. Jordan
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Christine E. Nelson
- T Lymphocyte Biology Section, Laboratory of Parasitic Diseases, NIAID, NIH, Bethesda, MD, United States
| | - Daniel L. Barber
- T Lymphocyte Biology Section, Laboratory of Parasitic Diseases, NIAID, NIH, Bethesda, MD, United States
| | - Reed F. Johnson
- SARS-CoV-2 Virology Core, Laboratory of Viral Diseases, NIAID, NIH, Bethesda, MD, United States
| | - Kerry L. Hilligan
- Immunobiology Section, Laboratory of Parasitic Diseases, NIAID, NIH, Bethesda, MD, United States
| | - Katrin D. Mayer-Barber
- Inflammation and Innate Immunity Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
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21
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Viret C, Lavedrine A, Lamiral G, Rozières A, Faure M. Contextual influence of mammalian macro-autophagy in virus-bacteria coinfected cell phenotypes. PLoS Pathog 2023; 19:e1011625. [PMID: 37733691 PMCID: PMC10513301 DOI: 10.1371/journal.ppat.1011625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Affiliation(s)
- Christophe Viret
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Aude Lavedrine
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Guénaëlle Lamiral
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Aurore Rozières
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Mathias Faure
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
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22
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Dibos M, Haschka SJ, Abbassi R, Schneider J, Schmid RM, Rasch S, Lahmer T. Influence of a Structured Microbiological Endotracheal Monitoring Program on the Outcome of Critically Ill COVID-19 Patients: An Observational Study. J Clin Med 2023; 12:5622. [PMID: 37685689 PMCID: PMC10488947 DOI: 10.3390/jcm12175622] [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: 08/07/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND In past influenza pandemics and the current COVID-19 pandemic, bacterial endotracheal superinfections are a well-known risk factor for higher morbidity and mortality. The goal of this study was to investigate the influence of a structured, objective, microbiological monitoring program on the prognosis of COVID-19 patients with mechanical ventilation. METHODS A structured microbiological monitoring program (at intubation, then every 3 days) included collection of endotracheal material. Data analysis focused on the spectrum of bacterial pathogens, mortality, as well as intensive care unit (ICU), hospital, and mechanical ventilation duration. RESULTS A total of 29% of the patients showed bacterial coinfection at the time of intubation, and within 48 h, 56% developed ventilator-associated pneumonia (VAP). Even though patients with VAP had significantly longer ICU, hospital, and mechanical ventilation durations, there was no significant difference in mortality between patients with VAP pneumonia and patients without bacterial infection. CONCLUSION VAP is a common complication in COVID-19 patients. In contrast to already published studies, in our study implementing a structured microbiological monitoring program, COVID-19 patients with bacterial coinfection or VAP did not show higher mortality. Thus, a standardized, objective, microbiological screening can help detect coinfection and ventilator-associated infections, refining anti-infective therapy and positively influencing patient outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Tobias Lahmer
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany; (M.D.)
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23
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Wang QY, Yuan L, Lin JY, Zhuo ZQ, Wang YM, Li SS, Zhang M, Wu XD. Clinical characteristics of severe influenza virus-associated pneumonia complicated with bacterial infection in children: a retrospective analysis. BMC Infect Dis 2023; 23:545. [PMID: 37605134 PMCID: PMC10440858 DOI: 10.1186/s12879-023-08536-x] [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: 02/20/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND We aimed to investigate the clinical characteristics of severe influenza virus-associated pneumonia complicated with bacterial infection in children. METHODS We retrospectively analysed data concerning 64 paediatric patients with severe influenza virus-associated pneumonia who had been treated at our hospital. The patients were divided into observation (44 patients) and control (20 patients) groups, based on the presence or absence of concomitant bacterial infection, and clinical data were compared between the groups. RESULTS The mean age in the observation group was 2.71 ± 1.44 years, 42 (95.45%) were aged ≤ 5 years, and 18 (40.9%) had underlying diseases. The mean age in the control group was 4.05 ± 2.21 years, 13 (65%) were aged ≤ 5 years, and 3 (15%) had underlying diseases. There was a statistically significant difference in patient age and the proportion of patients with underlying diseases (P < 0.05). The observation group had higher duration of fever values, a higher number of patients with duration of fever ≥ 7 days, a higher incidence of gasping, and a higher incidence of seizures/consciousness disturbance, and the differences were statistically significant (P < 0.05). Secondary bacterial infections in the observation group were mainly due to gram-negative bacteria, with Haemophilus influenzae and Moraxella catarrhalis being the most common pathogens. The observation group had a higher proportion of patients treated in the paediatric intensive care unit and a longer hospital stay, and the differences were statistically significant (P < 0.05). CONCLUSION Severe influenza virus-associated pneumonia complicated with bacterial infection was more common in children aged ≤ 5 years. Younger patients with underlying diseases were more susceptible to bacterial infection (mainly due to gram-negative bacteria). The timely administration of neuraminidase inhibitors and antibiotics against susceptible bacteria is likely to help improve cure rates.
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Affiliation(s)
- Qiong-Yu Wang
- Xiamen Children's Hospital/Children's Hospital of Fudan University at Xiamen, Xiamen, 361006, Fujian, China
| | - Lin Yuan
- Xiamen Children's Hospital/Children's Hospital of Fudan University at Xiamen, Xiamen, 361006, Fujian, China
| | - Jia-Yi Lin
- University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Zhi-Qiang Zhuo
- Xiamen Children's Hospital/Children's Hospital of Fudan University at Xiamen, Xiamen, 361006, Fujian, China
| | - Yong-Mei Wang
- Xiamen Children's Hospital/Children's Hospital of Fudan University at Xiamen, Xiamen, 361006, Fujian, China
| | - Si-Si Li
- Xiamen Children's Hospital/Children's Hospital of Fudan University at Xiamen, Xiamen, 361006, Fujian, China
| | - Min Zhang
- Xiamen Children's Hospital/Children's Hospital of Fudan University at Xiamen, Xiamen, 361006, Fujian, China.
| | - Xing-Dong Wu
- Xiamen Children's Hospital/Children's Hospital of Fudan University at Xiamen, Xiamen, 361006, Fujian, China.
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24
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Wei J, Zhang C, Ma W, Ma J, Liu Z, Ren F, Li N. Antibacterial Activity of Thesium chinense Turcz Extract Against Bacteria Associated with Upper Respiratory Tract Infections. Infect Drug Resist 2023; 16:5091-5105. [PMID: 37576521 PMCID: PMC10422991 DOI: 10.2147/idr.s425398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose The drug resistance of Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes and Haemophilus influenzae has become more and more serious, and it is urgent to seek new antibacterial drugs. In this study, Thesium chinense Turcz. extracts were tested for its potential antibacterial activities. Methods T. chinense powder was extracted with 5 solvents of different polarity (ethyl alcohol, petroleum ether, ethyl acetate, n-butyl alcohol and double distilled water), and their antibacterial activities were tested. The Broth dilution method was used to evaluate the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of highly active plant extracts with a concentration of 1g/mL. The inhibitory activity of this extract on biofilm formation was investigated. Afterwards, we investigated its effect on the transcriptome of S. aureus. Results The ethanol extract coded as BRY, only inhibited S. aureus, whereas the ethyl acetate extract coded as BY2 showed inhibitory effect on all the tested bacteria. The MIC of BRY on S. aureus was 128 mg/mL, and the MBC was 512 mg/mL. The MIC of BY2 against S. aureus, S. pneumoniae, S. pyogenes and H. influenzae were 8 mg/mL, 4 mg/mL, 4 mg/mL, and 4 mg/mL, respectively. The MBC of BY2 for these four bacteria ranged from 4 to 256 mg/mL. Mechanism studies have shown that BRY and BY2 have an impact on anti-formation of biofilms at MIC concentrations. Transcriptome sequencing results showed that 531 genes were up-regulated and 340 genes showed down-regulated expression in S. aureus after BY2 treatment. Conclusion BY2 has a broader antibacterial spectrum than BRY. Meanwhile, the inhibitory effect of BY2 on S. aureus is better than BRY. The mechanism of BY2 against S. aureus may relate to its inhibition of ribosome synthesis, restriction of key enzymes of citric acid cycle, decrease of pathogenicity and influence on biofilm formation. The results confirmed that BY2 was the main antibacterial part of T. chinense, which can be used as a source of antibacterial agents.
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Affiliation(s)
- Juanru Wei
- School of Pharmacy, Anhui Medical University, Hefei, 230032, People’s Republic of China
| | - Cong Zhang
- School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, People’s Republic of China
| | - Wei Ma
- School of Pharmacy, Anhui Medical University, Hefei, 230032, People’s Republic of China
| | - Juncheng Ma
- School of Pharmacy, Anhui Medical University, Hefei, 230032, People’s Republic of China
| | - Zhenzhen Liu
- School of Pharmacy, Anhui Medical University, Hefei, 230032, People’s Republic of China
| | - Fucai Ren
- School of Pharmacy, Anhui Medical University, Hefei, 230032, People’s Republic of China
| | - Ning Li
- School of Pharmacy, Anhui Medical University, Hefei, 230032, People’s Republic of China
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25
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Influence of a structured microbiological endotracheal monitoring on the outcome of critically ill COVID-19 patients: an observational study.. [DOI: 10.21203/rs.3.rs-2436406/v2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Abstract
The full text of this preprint has been withdrawn by the authors due to author disagreement with the posting of the preprint. Therefore, the authors do not wish this work to be cited as a reference. Questions should be directed to the corresponding author.
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26
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Xie L, Chen L, Li X, Zhou J, Tian H, Zhao J, Li Z, Li Y. Analysis of Lung Microbiome in COVID-19 Patients during Time of Hospitalization. Pathogens 2023; 12:944. [PMID: 37513791 PMCID: PMC10386632 DOI: 10.3390/pathogens12070944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the pathogenic agent of the rapidly spreading pneumonia called coronavirus disease 2019 (COVID-19), primarily infects the respiratory and digestive tract. Several studies have indicated the alterations of the bacterial microbiome in the lower respiratory tract during viral infection. However, both bacterial and fungal microbiota in the lung of COVID-19 patients remained to be explored. METHODS In this study, we conducted nanopore sequencing analyses of the lower respiratory tract samples from 38 COVID-19 patients and 26 non-COVID-19 pneumonia controls. Both bacterial and fungal microbiome diversities and microbiota abundances in the lung were compared. RESULTS Our results revealed significant differences in lung microbiome between COVID-19 patients and non-COVID-19 controls, which were strongly associated with SARS-CoV-2 infection and clinical status. COVID-19 patients exhibited a notably higher abundance of opportunistic pathogens, particularly Acinetobacter baumannii and Candida spp. Furthermore, the potential pathogens enriched in COVID-19 patients were positively correlated with inflammation indicators. CONCLUSIONS Our study highlights the differences in lung microbiome diversity and composition between COVID-19 patients and non-COVID-19 patients. This may contribute to predicting co-pathogens and selecting optimal treatments for respiratory infections caused by SARS-CoV-2.
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Affiliation(s)
- Linlin Xie
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Liangjun Chen
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Xinran Li
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Junying Zhou
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Hongpan Tian
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jin Zhao
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Zhiqiang Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yirong Li
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Wuhan Research Center for Infectious Diseases and Tumors, Chinese Academy of Medical Sciences, Wuhan 430071, China
- Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan 430071, China
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Schoettler JJ, Sandrio S, Boesing C, Bauer L, Miethke T, Thiel M, Krebs J. Bacterial Co- or Superinfection in Patients Treated in Intensive Care Unit with COVID-19- and Influenza-Associated Pneumonia. Pathogens 2023; 12:927. [PMID: 37513774 PMCID: PMC10385659 DOI: 10.3390/pathogens12070927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Viral pneumonia is frequently complicated by bacterial co- or superinfection (c/s) with adverse effects on patients' outcomes. However, the incidence of c/s and its impact on the outcomes of patients might be dependent on the type of viral pneumonia. We performed a retrospective observational study in patients with confirmed COVID-19 pneumonia (CP) or influenza pneumonia (IP) from 01/2009 to 04/2022, investigating the incidence of c/s using a competing risk model and its impact on mortality in these patients in a tertiary referral center using multivariate logistic regressions. Co-infection was defined as pulmonary pathogenic bacteria confirmed in tracheal aspirate or bronchoalveolar lavage within 48 h after hospitalization. Superinfection was defined as pulmonary pathogenic bacteria detected in tracheal aspirate or bronchoalveolar lavage 48 h after hospitalization. We examined 114 patients with CP and 76 patients with IP. Pulmonary bacterial co-infection was detected in 15 (13.2%), and superinfection was detected in 50 (43.9%) of CP patients. A total of 5 (6.6%) co-infections (p = 0.2269) and 28 (36.8%) superinfections (p = 0.3687) were detected in IP patients. The overall incidence of c/s did not differ between CP and IP patients, and c/s was not an independent predictor for mortality in a study cohort with a high disease severity. We found a significantly higher probability of superinfection for patients with CP compared to patients with IP (p = 0.0017).
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Affiliation(s)
- Jochen Johannes Schoettler
- Department of Anaesthesiology and Critical Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68165 Mannheim, Germany
| | - Stany Sandrio
- Department of Anaesthesiology and Critical Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68165 Mannheim, Germany
| | - Christoph Boesing
- Department of Anaesthesiology and Critical Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68165 Mannheim, Germany
| | - Lena Bauer
- Department of Anaesthesiology and Critical Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68165 Mannheim, Germany
| | - Thomas Miethke
- Mannheim Institute for Innate Immunoscience (MI3), Medical Faculty Mannheim, University of Heidelberg, Ludolf-Krehl-Str. 13-17, 68167 Mannheim, Germany
- Institute for Medical Microbiology and Hygiene, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68165 Mannheim, Germany
| | - Manfred Thiel
- Department of Anaesthesiology and Critical Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68165 Mannheim, Germany
- Mannheim Institute for Innate Immunoscience (MI3), Medical Faculty Mannheim, University of Heidelberg, Ludolf-Krehl-Str. 13-17, 68167 Mannheim, Germany
| | - Joerg Krebs
- Department of Anaesthesiology and Critical Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68165 Mannheim, Germany
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Wei L, Hongping H, Chufang L, Cuomu M, Jintao L, Kaiyin C, Lvyi C, Weiwu C, Zuguang Y, Nanshan Z. Effects of Shiwei Longdanhua formula on LPS induced airway mucus hypersecretion, cough hypersensitivity, oxidative stress and pulmonary inflammation. Biomed Pharmacother 2023; 163:114793. [PMID: 37121151 DOI: 10.1016/j.biopha.2023.114793] [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: 03/12/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/02/2023] Open
Abstract
Shiwei Longdanhua Granule (SWLDH) is a classic Tibetan medicine (TM) ranking in the top 20 Chinese patent medicines in prescription rate to treat respiratory diseases like pneumonia, acute and chronic tracheobronchitis, acute exacerbation of COPD and bronchial asthma in solution of inflammation, cough and phlegm obstruction in clinical practice. However, its systematic pharmacological mechanisms have not been elucidated yet. Here, we studied the therapeutic efficacy of SWLDH in treatment of acute respiratory diseases in BALB/c mice by comprehensive analysis of airway inflammation, oxidative stress, mucus hypersecretion, cough hypersensitivities and indicators associated with the development of chronic diseases. Our results show that SWLDH might exhibit its inhibitory effects on pulmonary inflammation by interference with arachidonic acid (AA) metabolism pathways. Oxidative stress that highly related to the degree of tissue injury could be alleviated by enhancing the reductive activities of glutathione redox system, thioredoxin system and the catalytic activities of catalase and superoxide dismutase (SOD) after SWLDH treatment. In addition, SWLDH could significantly abrogate the mucus hypersecretion induced bronchiole obstruction by inactivate the globlet cells and decrease the secretion of gel-forming mucins (MUC5AC and MUC5B) under pathological condition, demonstrating its mucoactive potency. SWLDH also showed reversed effects on the release of neuropeptides that are responsible for airway sensory hypersensitivity. Simultaneously observed inhibition of calcium influx, reduction in in vivo biosynthesis of acetylcholine and the recovery of the content of cyclic adenosine monophosphate (cAMP) might collaboratively contribute to cause airway smooth muscle cells (ASMCs) relexation. These findings indicated that SWLDH might exhibited antitussive potency via suppression of the urge to cough and ASMCs contraction. Moreover, SWLDH might affect airway remodeling. We found SWLDH could retard the elevation of TGF-β1 and α-SMA, which are important indicators for hyperplasia and contraction during the progression of the chronic airway inflammatory diseases like COPD and asthma.
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Affiliation(s)
- Liu Wei
- Guangzhou Laboratory, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Hou Hongping
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | | | - Mingji Cuomu
- The University of Tibetan Medicine, Lhasa, China
| | - Li Jintao
- Beijing International Science and Technology Cooperation Base of Antivirus Drug, Beijing University of Technology, Beijing, China
| | - Cai Kaiyin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China; Tibet Cheezheng Tibet Medicine Co.,Ltd., Beijing, China
| | - Chen Lvyi
- School of Pharmaceutical Sciences, South-Central Minzu University, Wuhan, China
| | - Chen Weiwu
- Tibet Cheezheng Tibet Medicine Co.,Ltd., Beijing, China
| | - Ye Zuguang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
| | - Zhong Nanshan
- Guangzhou Laboratory, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
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Debes S, Haug JB, De Blasio BF, Lindstrøm JC, Jonassen CM, Dudman SG. Antibiotic Consumption in a Cohort of Hospitalized Adults with Viral Respiratory Tract Infection. Antibiotics (Basel) 2023; 12:788. [PMID: 37107150 PMCID: PMC10135008 DOI: 10.3390/antibiotics12040788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Development of antibiotic resistance, a threat to global health, is driven by inappropriate antibiotic usage. Respiratory tract infections (RTIs) are frequently treated empirically with antibiotics, despite the fact that a majority of the infections are caused by viruses. The purpose of this study was to determine the prevalence of antibiotic treatment in hospitalized adults with viral RTIs, and to investigate factors influencing the antibiotic decision-making. We conducted a retrospective observational study of patients ≥ 18 years, hospitalized in 2015-2018 with viral RTIs. Microbiological data were taken from the laboratory information system and information on antibiotic treatment drawn from the hospital records. To investigate decisions for prescribing antibiotic treatment, we evaluated relevant factors such as laboratory and radiological results, in addition to clinical signs. In 951 cases without secondary bacterial RTIs (median age 73 years, 53% female), 720 (76%) were prescribed antibiotic treatment, most frequently beta-lactamase-sensitive penicillins, but cephalosporins were prescribed as first-line in 16% of the cases. The median length of treatment (LOT) in the patients treated with antibiotics was seven days. Patients treated with antibiotics had an average of two days longer hospital stay compared to patients with no such treatment, but no difference in mortality was found. Our study revealed that there is still a role for antimicrobial stewardship to further improve antibiotic use in patients admitted for viral RTIs in a country with relatively low antibiotic consumption.
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Affiliation(s)
- Sara Debes
- Center for Laboratory Medicine, Østfold Hospital Trust Kalnes, 1714 Grålum, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway
| | - Jon Birger Haug
- Department of Infection Control, Østfold Hospital Trust Kalnes, 1714 Grålum, Norway
| | - Birgitte Freiesleben De Blasio
- Division of Infection Control and Environmental Health, Department of Methods Development and Analytics, Norwegian Institute of Public Health, 0213 Oslo, Norway
- Institute of Basic Medical Sciences, Department of Biostatistics, Centre for Biostatistics and Epidemiology, University of Oslo, 0372 Oslo, Norway
| | - Jonas Christoffer Lindstrøm
- Division of Infection Control and Environmental Health, Department of Methods Development and Analytics, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | | | - Susanne Gjeruldsen Dudman
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway
- Department of Microbiology, Oslo University Hospital, 0372 Oslo, Norway
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Cut TG, Mavrea A, Cumpanas AA, Novacescu D, Oancea CI, Bratosin F, Marinescu AR, Laza R, Mocanu A, Pescariu AS, Manolescu D, Dumache R, Enache A, Hogea E, Lazureanu VE. A Retrospective Assessment of Sputum Samples and Antimicrobial Resistance in COVID-19 Patients. Pathogens 2023; 12:pathogens12040620. [PMID: 37111506 PMCID: PMC10143659 DOI: 10.3390/pathogens12040620] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/10/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Data on bacterial or fungal pathogens and their impact on the mortality rates of Western Romanian COVID-19 patients are scarce. As a result, the purpose of this research was to determine the prevalence of bacterial and fungal co- and superinfections in Western Romanian adults with COVID-19, hospitalized in in-ward settings during the second half of the pandemic, and its distribution according to sociodemographic and clinical conditions. The unicentric retrospective observational study was conducted on 407 eligible patients. Expectorate sputum was selected as the sampling technique followed by routine microbiological investigations. A total of 31.5% of samples tested positive for Pseudomonas aeruginosa, followed by 26.2% having co-infections with Klebsiella pneumoniae among patients admitted with COVID-19. The third most common Pathogenic bacteria identified in the sputum samples was Escherichia coli, followed by Acinetobacter baumannii in 9.3% of samples. Commensal human pathogens caused respiratory infections in 67 patients, the most prevalent being Streptococcus penumoniae, followed by methicillin-sensitive and methicillin-resistant Staphylococcus aureus. A total of 53.4% of sputum samples tested positive for Candida spp., followed by 41.1% of samples with Aspergillus spp. growth. The three groups with positive microbial growth on sputum cultures had an equally proportional distribution of patients admitted to the ICU, with an average of 30%, compared with only 17.3% among hospitalized COVID-19 patients with negative sputum cultures (p = 0.003). More than 80% of all positive samples showed multidrug resistance. The high prevalence of bacterial and fungal co-infections and superinfections in COVID-19 patients mandates for strict and effective antimicrobial stewardship and infection control policies.
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Affiliation(s)
- Talida Georgiana Cut
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Academy of Romanian Scientists, Splaiul Independentei, Nr. 54, 50085 Bucharest, Romania
| | - Adelina Mavrea
- Department VII, Internal Medicine II, Discipline of Cardiology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Alin Adrian Cumpanas
- Department XV, Discipline of Urology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Dorin Novacescu
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Academy of Romanian Scientists, Splaiul Independentei, Nr. 54, 50085 Bucharest, Romania
| | - Cristian Iulian Oancea
- Department XIII, Discipline of Pneumology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Felix Bratosin
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Adelina Raluca Marinescu
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Ruxandra Laza
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Alexandra Mocanu
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Alexandru Silvius Pescariu
- Academy of Romanian Scientists, Splaiul Independentei, Nr. 54, 50085 Bucharest, Romania
- Department VII, Internal Medicine II, Discipline of Cardiology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Diana Manolescu
- Department XV, Discipline of Radiology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Raluca Dumache
- Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Department VIII, Discipline of Forensic Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Alexandra Enache
- Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Department VIII, Discipline of Forensic Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Elena Hogea
- Department XIV, Discipline of Microbiology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Voichita Elena Lazureanu
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
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Liu YN, Zhang YF, Xu Q, Qiu Y, Lu QB, Wang T, Zhang XA, Lin SH, Lv CL, Jiang BG, Li H, Li ZJ, Gao GF, Yang WZ, Hay SI, Wang LP, Fang LQ, Liu W. Infection and co-infection patterns of community-acquired pneumonia in patients of different ages in China from 2009 to 2020: a national surveillance study. THE LANCET MICROBE 2023; 4:e330-e339. [PMID: 37001538 DOI: 10.1016/s2666-5247(23)00031-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Severe community-acquired pneumonia (SCAP) is associated with a substantial number of hospitalisations and deaths worldwide. Infection or co-infection patterns, along with their age dependence and clinical effects are poorly understood. We aimed to explore the causal and epidemiological characteristics by age, to better describe patterns of community-acquired pneumonia (CAP) and their association with severe disease. METHODS National surveillance of CAP was conducted through a network of hospitals in 30 provinces in China from 2009-20 inclusive. Patients with CAP were included if they had evidence of acute respiratory tract, had evidence of pneumonia by chest radiography, diagnosis of pneumonia within 24 h of hospital admission, and resided in the study catchment area. For the enrolled patients with CAP, nasopharyngeal and oral swabs were taken and tested for eight viral pathogens; and blood, urine, or expectorated sputum was tested for six bacterial pathogens. Clinical outcomes, including SCAP, were investigated with respect to age and patterns of infections or co-infections by performing binary logistic regression and multivariate analysis. FINDINGS Between January, 2009, and December, 2020, 18 807 patients with CAP (3771 [20·05%] with SCAP) were enrolled. For both children (aged ≤5 years) and older adults (aged >60 years), a higher overall rate of viral and bacterial infections, as well as viral-bacterial co-infections were seen in patients with SCAP than in patients with non-SCAP. For adults (aged 18-60 years), however, only a higher rate of bacterial-bacterial co-infection was observed. The most frequent pathogens associated with SCAP were respiratory syncytial virus (RSV; 21·30%) and Streptococcus pneumoniae (12·61%) among children, and influenza virus (10·94%) and Pseudomonas aeruginosa (15·37%) among older adults. Positive rates of detection of most of the tested pathogens decreased during 2020 compared with the 2009-19 period, except for RSV, P aeruginosa, and Klebsiella pneumoniae. Multivariate analyses showed SCAP was significantly associated with infection with human adenovirus, human rhinovirus, K pneumoniae, or co-infection of RSV and Haemophilus influenzae or RSV and Staphylococcus aureus in children and adolescents (aged <18 years), and significantly associated with infection with P aeruginosa, K pneumoniae, or S pneumoniae, or co-infection with P aeruginosa and K pneumoniae in adults (aged ≥18 years). INTERPRETATION Both prevalence and infection pattern of respiratory pathogens differed between patients with SCAP and patients with non-SCAP in an age-dependent manner. These findings suggest potential advantages to age-related strategies for vaccine schedules, as well as clinical diagnosis, treatment, and therapy. FUNDING China Mega-Project on Infectious Disease Prevention and The National Natural Science Funds of China. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Guo M, Yang K, Lin S, Tang J, Liu M, Zhou H, Lin H, Fan H. Coinfection with porcine circovirus type 2 and Glaesserella parasuis serotype 4 enhances pathogenicity in piglets. Vet Microbiol 2023; 278:109663. [PMID: 36680971 DOI: 10.1016/j.vetmic.2023.109663] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023]
Abstract
Coinfection of Porcine circovirus type 2 (PCV2) and Glaesserella parasuis type 4 (GPS4) is widespread clinically, resulting in high morbidity and mortality, however, interactions between the two pathogens during coinfection and the coinfection pathogenesis are poorly understood. In this study, a piglet model coinfected with PCV2 and GPS4 was established; coinfection of the piglets' group showed more obvious symptoms, such as high fever and emaciation, and more severe histological lesions appeared in various organs. Importantly, piglets in the coinfection group produced lower levels of PCV2 and GPS4 antibodies, and showed high levels of inflammatory cytokines, TLR2, and TLR4, while the levels of CD4, CD8, MHC II, costimulatory molecules, and IL-12p40 were decreased. In addition, a model of macrophage 3D4/21 cells coinfection with PCV2 and GPS4 was established, coinfected cells exhibited increased expression of the cytokines IL-6, IL-8, TNF-α, IL-1β, and the receptors TLR2, TLR4, while decreased MHC II. We further demonstrate that cytokine production is associated with the activation of NF-κB and NLRP3 inflammasome signaling pathways, and TLR4 is also involved. Altogether, our findings suggest that coinfection with PCV2 and GPS4 exacerbates the inflammatory response, resulting in severe tissue damage, and probably impaired macrophage antigen presentation and T cell activation, resulting in immune dysregulation, aggravating host infection.
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Affiliation(s)
- Mengru Guo
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Kaiyue Yang
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Shaojie Lin
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Jinsheng Tang
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Mingxing Liu
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Hong Zhou
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Huixing Lin
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Hongjie Fan
- MOE Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou 225009, China.
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The Activation of the RIG-I/MDA5 Signaling Pathway upon Influenza D Virus Infection Impairs the Pulmonary Proinflammatory Response Triggered by Mycoplasma bovis Superinfection. J Virol 2023; 97:e0142322. [PMID: 36692289 PMCID: PMC9972951 DOI: 10.1128/jvi.01423-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Concurrent infections with multiple pathogens are often described in cattle with respiratory illness. However, how the host-pathogen interactions influence the clinical outcome has been only partially explored in this species. Influenza D virus (IDV) was discovered in 2011. Since then, IDV has been detected worldwide in different hosts. A significant association between IDV and bacterial pathogens in sick cattle was shown in epidemiological studies, especially with Mycoplasma bovis. In an experimental challenge, IDV aggravated M. bovis-induced pneumonia. However, the mechanisms through which IDV drives an increased susceptibility to bacterial superinfections remain unknown. Here, we used the organotypic lung model precision-cut lung slices to study the interplay between IDV and M. bovis coinfection. Our results show that a primary IDV infection promotes M. bovis superinfection by increasing the bacterial replication and the ultrastructural damages in lung pneumocytes. In our model, IDV impaired the innate immune response triggered by M. bovis by decreasing the expression of several proinflammatory cytokines and chemokines that are important for immune cell recruitment and the bacterial clearance. Stimulations with agonists of cytosolic helicases and Toll-like receptors (TLRs) revealed that a primary activation of RIG-I/MDA5 desensitizes the TLR2 activation, similar to what was observed with IDV infection. The cross talk between these two pattern recognition receptors leads to a nonadditive response, which alters the TLR2-mediated cascade that controls the bacterial infection. These results highlight innate immune mechanisms that were not described for cattle so far and improve our understanding of the bovine host-microbe interactions and IDV pathogenesis. IMPORTANCE Since the spread of the respiratory influenza D virus (IDV) infection to the cattle population, the question about the impact of this virus on bovine respiratory disease (BRD) remains still unanswered. Animals affected by BRD are often coinfected with multiple pathogens, especially viruses and bacteria. In particular, viruses are suspected to enhance secondary bacterial superinfections. Here, we use an ex vivo model of lung tissue to study the effects of IDV infection on bacterial superinfections. Our results show that IDV increases the susceptibility to the respiratory pathogen Mycoplasma bovis. In particular, IDV seems to activate immune pathways that inhibit the innate immune response against the bacteria. This may allow M. bovis to increase its proliferation and to delay its clearance from lung tissue. These results suggest that IDV could have a negative impact on the respiratory pathology of cattle.
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Martikainen MV, Tossavainen T, Hannukka N, Roponen M. Pollen, respiratory viruses, and climate change: Synergistic effects on human health. ENVIRONMENTAL RESEARCH 2023; 219:115149. [PMID: 36566960 DOI: 10.1016/j.envres.2022.115149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
In recent years, evidence of the synergistic effects of pollen and viruses on respiratory health has begun to accumulate. Pollen exposure is a known risk factor for the incidence and severity of respiratory viral infections. However, recent evidence suggests that pollen exposure may also inhibit or weaken viral infections. A comprehensive summary has not been made and a consensus on the synergistic health effects has not been reached. It is highly possible that climate change will increase the significance of pollen exposure as a cause of respiratory problems and, at the same time, affect the risk of infectious disease outbreaks. It is important to accurately assess how these two factors affect human health separately and concurrently. In this review article, for the first time, the data from previous studies are combined and reviewed and potential research gaps concerning the synergistic effects of pollen and viral exposure are identified.
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Affiliation(s)
- Maria-Viola Martikainen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland.
| | - Tarleena Tossavainen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Noora Hannukka
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Marjut Roponen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
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Ahava MJ, Kortela E, Forsblom E, Pätäri-Sampo A, Friberg N, Meretoja A, Kivivuori SM, Lappalainen M, Kurkela S, Järvinen A, Jarva H. Low incidence of severe bacterial infections in hospitalised patients with COVID-19: A population-based registry study. Infect Dis (Lond) 2023; 55:132-141. [PMID: 36305894 DOI: 10.1080/23744235.2022.2138963] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Bacterial infections complicating COVID-19 are rare but present a challenging clinical entity. The aim of this study was to evaluate the incidence, aetiology and outcome of severe laboratory-verified bacterial infections in hospitalised patients with COVID-19. METHODS All laboratory-confirmed patients with COVID-19 admitted to specialised healthcare hospitals in the Capital Province of Finland during the first wave of COVID-19 between 27 February and 21 June 2020 were retrospectively studied. We gathered the blood and respiratory tract culture reports of these patients and analysed their association with 90-day case-fatality using multivariable regression analysis. RESULTS A severe bacterial infection was diagnosed in 40/585 (6.8%) patients with COVID-19. The range of bacteria was diverse, and the most common bacterial findings in respiratory samples were gram-negative, and in blood cultures gram-positive bacteria. Patients with severe bacterial infection had longer hospital stay (mean 31; SD 20 days) compared to patients without (mean 9; SD 9 days; p < 0.001). Case-fatality was higher with bacterial infection (15% vs 11%), but the difference was not statistically significant (OR 1.38 CI95% 0.56-3.41). CONCLUSIONS Severe bacterial infection complicating COVID-19 was a rare occurrence in our cohort. Our results are in line with the current understanding that antibiotic treatment for hospitalised COVID-19 patients should only be reserved for situations where a bacterial infection is strongly suspected. The ever-evolving landscape of the pandemic and recent advances in immunomodulatory treatment of COVID-19 patients underline the need for continuous vigilance concerning the possibility and frequency of nosocomial bacterial infections.
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Affiliation(s)
- M J Ahava
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - E Kortela
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - E Forsblom
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - A Pätäri-Sampo
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - N Friberg
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - A Meretoja
- General Administration, Helsinki University Hospital, Helsinki, Finland
| | - S-M Kivivuori
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - M Lappalainen
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - S Kurkela
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - A Järvinen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - H Jarva
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Translational Immunology Research Program, Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
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Chen J, Liu X, Liu W, Yang C, Jia R, Ke Y, Guo J, Jia L, Wang C, Chen Y. Comparison of the respiratory tract microbiome in hospitalized COVID-19 patients with different disease severity. J Med Virol 2022; 94:5284-5293. [PMID: 35838111 PMCID: PMC9349541 DOI: 10.1002/jmv.28002] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 12/15/2022]
Abstract
Little is known about the characteristics of respiratory tract microbiome in Coronavirus disease 2019 (COVID-19) inpatients with different severity. We conducted a study that expected to clarify these characteristics as much as possible. A cross-sectional study was conducted to characterize respiratory tract microbial communities of 69 COVID-19 inpatients from 64 nasopharyngeal swabs and 5 sputum specimens using 16S ribosomal RNA gene V3-V4 region sequencing. The bacterial profiles were analyzed to find potential biomarkers by the two-step method, the combination of random forest model and the linear discriminant analysis effect size, and explore the connections with clinical characteristics by Spearman's rank test. Compared with mild COVID-19 patients, severe patients had significantly decreased bacterial diversity (p-values were less than 0.05 in the alpha and beta diversity) and relative lower abundance of opportunistic pathogens, including Actinomyces, Prevotella, Rothia, Streptococcus, Veillonella. Eight potential biomarkers including Treponema, Leptotrichia, Lachnoanaerobaculum, Parvimonas, Alloprevotella, Porphyromonas, Gemella, and Streptococcus were found to distinguish the mild COVID-19 patients from the severe COVID-19 patients. The genera of Actinomyces and Prevotella were negatively correlated with age in two groups. Intensive care unit admission, neutrophil count, and lymphocyte count were significantly correlated with different genera in the two groups. In addition, there was a positive correlation between Klebsiella and white blood cell count in two groups. The respiratory tract microbiome had significant differences in COVID-19 patients with different severity. The value of the respiratory tract microbiome as predictive biomarkers for COVID-19 severity deserves further exploration.
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Affiliation(s)
- Jiali Chen
- Department of Emergency ResponseChinese PLA Center for Disease Control and PreventionBeijingChina
- School of Public HealthChina Medical UniversityShenyangChina
| | - Xiong Liu
- Department of Emergency ResponseChinese PLA Center for Disease Control and PreventionBeijingChina
| | - Wei Liu
- Department of Emergency ResponseChinese PLA Center for Disease Control and PreventionBeijingChina
| | - Chaojie Yang
- Department of Emergency ResponseChinese PLA Center for Disease Control and PreventionBeijingChina
| | - Ruizhong Jia
- Department of Emergency ResponseChinese PLA Center for Disease Control and PreventionBeijingChina
| | - Yuehua Ke
- Department of Emergency ResponseChinese PLA Center for Disease Control and PreventionBeijingChina
| | - Jinpeng Guo
- Department of Emergency ResponseChinese PLA Center for Disease Control and PreventionBeijingChina
| | - Leili Jia
- Department of Emergency ResponseChinese PLA Center for Disease Control and PreventionBeijingChina
| | - Changjun Wang
- Department of Emergency ResponseChinese PLA Center for Disease Control and PreventionBeijingChina
| | - Yong Chen
- Department of Emergency ResponseChinese PLA Center for Disease Control and PreventionBeijingChina
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The Prevalence of Bacterial and Fungal Coinfections among Critically Ill COVID-19 Patients in the ICU in Jordan. Int J Microbiol 2022; 2022:9992881. [PMID: 36353524 PMCID: PMC9640228 DOI: 10.1155/2022/9992881] [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: 09/09/2022] [Revised: 10/11/2022] [Accepted: 10/21/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Secondary bacterial and fungal coinfections have been reported among critically ill coronavirus disease-19 (COVID-19) patients and are associated with increased disease severity and mortality incidence (MI) rates. AIMS This study aimed to track bacterial and fungal coinfections among COVID-19 patients in the intensive care unit (ICU) and to assess the impact of these infections on disease prognosis and patient outcomes in Jordan. MATERIALS AND METHODS This was a single-center study that enrolled 46 ICU patients diagnosed with COVID-19. Microbiological and antimicrobial susceptibility results and inflammatory biomarker data were retrospectively analyzed. RESULTS The MI rate attributed to bacterial and fungal coinfections was 84.8%, and the highest rate was reported among patients older than 70 years (66.7%). The MI rate related to bacterial coinfections was 95.2%, whereas that of fungal coinfections was 4.8%. The most commonly isolated bacterium in the blood was a coagulase-negative staphylococcus (41%), followed by Klebsiella pneumoniae in nasopharyngeal swabs (34%) and Acinetobacter baumannii in sputum samples (31%). Candida species were the sole cause of fungal coinfections in the studied population. In particular, Candida albicans was isolated from 3% of patients with bacteremia, whereas Candida glabrata was isolated from 8% of nasopharyngeal swabs. Klebsiella pneumoniae was considered the major cause of upper respiratory tract infections (34%). Multifactorial infection was significantly associated with increased MI (p value <0.001). CONCLUSION COVID-19 MI is associated with respiratory bacterial/fungal coinfections. The ability to predict bacterial and fungal coinfections in ICU patients may be crucial to their survival and prognosis.
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Fazil M, Nikhat S. Therapeutic and palliative role of a Unani herbal decoction in COVID-19 and similar respiratory viral illnesses: Phytochemical & pharmacological perspective. JOURNAL OF ETHNOPHARMACOLOGY 2022; 297:115526. [PMID: 35843408 PMCID: PMC9281408 DOI: 10.1016/j.jep.2022.115526] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Outbreaks of respiratory viral infections like Severe Acute Respiratory Syndrome, Middle-East Respiratory Syndrome, and Coronavirus Disease-2019 have been a regular occurrence in the past 100 years. A significant proportion of the morbidity and mortality in influenza is attributed to the co-morbidities and complications induced by the disease, involving the vital organs and physiological functions. In this context, traditional medicines offer effective protective, palliative, and therapeutic benefits, as observed in several studies on various types of influenza, including COVID-19. The Unani herbal decoction comprising of 'Unnāb (Ziziphus jujuba Mill. fruit), Sapistān (Cordia dichotoma G. Forst. fruit), and Behīdāna (Cydonia oblonga Mill. seed) was originally prescribed by Hakim Ajmal Khan (1868-1927 AD) for various respiratory ailments as a bronchodilator, anti-inflammatory, and for clearing the respiratory tract. During COVID-19, the decoction was prescribed by the Ministry of Ayurveda, Yoga, Unani, Siddha, and Homeopathy (AYUSH), Government of India, for mild patients in home isolation, and also as a self-care drink for healthy people. Preliminary studies are of the view that the decoction could reduce COVID-19 incidence and prevent severe disease in the population where it was administered. AIMS OF THE STUDY We intend to review the pharmacological activity of the Unani decoction ingredients, i.e., Z. jujuba, C. dichotoma, and C. oblonga, in context with respiratory viral infections and their co-morbidities, to develop an understanding of its action mechanism. METHODOLOGY We reviewed Unani classical textbooks for information on the therapeutic activity of the decoction ingredients. Scientific studies published in English from the year 2000 onwards on leading scientific websites (PubMed, MEDLINE, Scopus, and Springer) were searched for information regarding the efficacy of the drugs in influenza and its common complications. Non-English language articles, or those published prior to 2000, and those which included plant parts other than those traditionally included in the decoction were excluded. OBSERVATIONS A wide range of therapeutic and palliative effects have been observed in the three herbs included in the Unani decoction, including anti-viral, anti-bacterial, immuno-modulatory, anti-inflammatory, hepato-, and nephroprotective, anti-atherosclerotic, anti-tussive, broncho-dilatory, and regulation of gut microbiota. Together, these effects can help to mitigate and prevent most of the complications caused as a result of respiratory viral infections. CONCLUSION The combined effects of ingredients in this Unani herbal decoction can potentially help to mitigate most of the pathological changes and complications caused by influenza viruses. With further clinical research, the decoction may be potentially utilized as a prophylactic and therapeutic against viral influenza.
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Affiliation(s)
- Mohammad Fazil
- Hakim Ajmal Khan Institute for Literary and Historical Research in Unani Medicine, CCRUM, Jamia Millia Islamia Campus, New Delhi, India.
| | - Sadia Nikhat
- Dept. of Ilaj bit Tadbeer, School of Unani Medical Education and Research, Jamia Hamdard, New Delhi, India.
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Bradley ES, Zeamer AL, Bucci V, Cincotta L, Salive MC, Dutta P, Mutaawe S, Anya O, Tocci C, Moormann A, Ward DV, McCormick BA, Haran JP. Oropharyngeal microbiome profiled at admission is predictive of the need for respiratory support among COVID-19 patients. Front Microbiol 2022; 13:1009440. [PMID: 36246273 PMCID: PMC9561819 DOI: 10.3389/fmicb.2022.1009440] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
The oropharyngeal microbiome, the collective genomes of the community of microorganisms that colonizes the upper respiratory tract, is thought to influence the clinical course of infection by respiratory viruses, including Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of Coronavirus Infectious Disease 2019 (COVID-19). In this study, we examined the oropharyngeal microbiome of suspected COVID-19 patients presenting to the Emergency Department and an inpatient COVID-19 unit with symptoms of acute COVID-19. Of 115 initially enrolled patients, 50 had positive molecular testing for COVID-19+ and had symptom duration of 14 days or less. These patients were analyzed further as progression of disease could most likely be attributed to acute COVID-19 and less likely a secondary process. Of these, 38 (76%) went on to require some form of supplemental oxygen support. To identify functional patterns associated with respiratory illness requiring respiratory support, we applied an interpretable random forest classification machine learning pipeline to shotgun metagenomic sequencing data and select clinical covariates. When combined with clinical factors, both species and metabolic pathways abundance-based models were found to be highly predictive of the need for respiratory support (F1-score 0.857 for microbes and 0.821 for functional pathways). To determine biologically meaningful and highly predictive signals in the microbiome, we applied the Stable and Interpretable RUle Set to the output of the models. This analysis revealed that low abundance of two commensal organisms, Prevotella salivae or Veillonella infantium (< 4.2 and 1.7% respectively), and a low abundance of a pathway associated with LPS biosynthesis (< 0.1%) were highly predictive of developing the need for acute respiratory support (82 and 91.4% respectively). These findings suggest that the composition of the oropharyngeal microbiome in COVID-19 patients may play a role in determining who will suffer from severe disease manifestations.
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Affiliation(s)
- Evan S. Bradley
- Department of Emergency Medicine, UMass Memorial Medical Center, Worcester, MA, United States
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, United States
- *Correspondence: Evan S. Bradley,
| | - Abigail L. Zeamer
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, United States
- Department of Microbiology and Physiologic Systems, University of Massachusetts Medical School, Worcester, MA, United States
| | - Vanni Bucci
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, United States
- Department of Microbiology and Physiologic Systems, University of Massachusetts Medical School, Worcester, MA, United States
| | - Lindsey Cincotta
- Department of Emergency Medicine, UMass Memorial Medical Center, Worcester, MA, United States
| | - Marie-Claire Salive
- Department of Emergency Medicine, UMass Memorial Medical Center, Worcester, MA, United States
| | - Protiva Dutta
- Department of Emergency Medicine, UMass Memorial Medical Center, Worcester, MA, United States
| | - Shafik Mutaawe
- Department of Emergency Medicine, UMass Memorial Medical Center, Worcester, MA, United States
| | - Otuwe Anya
- Department of Emergency Medicine, UMass Memorial Medical Center, Worcester, MA, United States
| | - Christopher Tocci
- Department of Biology and Biotechnology, Worcester Polytechnique Institute, Worcester, MA, United States
| | - Ann Moormann
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Doyle V. Ward
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, United States
- Department of Microbiology and Physiologic Systems, University of Massachusetts Medical School, Worcester, MA, United States
| | - Beth A. McCormick
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, United States
- Department of Microbiology and Physiologic Systems, University of Massachusetts Medical School, Worcester, MA, United States
| | - John P. Haran
- Department of Emergency Medicine, UMass Memorial Medical Center, Worcester, MA, United States
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, MA, United States
- Department of Microbiology and Physiologic Systems, University of Massachusetts Medical School, Worcester, MA, United States
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Lenhard A, Joma BH, Siwapornchai N, Hakansson AP, Leong JM, Bou Ghanem EN. A Mouse Model for the Transition of Streptococcus pneumoniae from Colonizer to Pathogen upon Viral Co-Infection Recapitulates Age-Exacerbated Illness. J Vis Exp 2022:10.3791/64419. [PMID: 36279528 PMCID: PMC11151369 DOI: 10.3791/64419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Abstract
Streptococcus pneumoniae (pneumococcus) is an asymptomatic colonizer of the nasopharynx in most individuals but can progress to a pulmonary and systemic pathogen upon influenza A virus (IAV) infection. Advanced age enhances host susceptibility to secondary pneumococcal pneumonia and is associated with worsened disease outcomes. The host factors driving those processes are not well defined, in part due to a lack of animal models that reproduce the transition from asymptomatic colonization to severe clinical disease. This paper describes a novel mouse model that recreates the transition of pneumococci from asymptomatic carriage to disease upon viral infection. In this model, mice are first intranasally inoculated with biofilm-grown pneumococci to establish asymptomatic carriage, followed by IAV infection of both the nasopharynx and lungs. This results in bacterial dissemination to the lungs, pulmonary inflammation, and obvious signs of illness that can progress to lethality. The degree of disease is dependent on the bacterial strain and host factors. Importantly, this model reproduces the susceptibility of aging, because compared to young mice, old mice display more severe clinical illness and succumb to disease more frequently. By separating carriage and disease into distinct steps and providing the opportunity to analyze the genetic variants of both the pathogen and the host, this S. pneumoniae/IAV co-infection model permits the detailed examination of the interactions of an important pathobiont with the host at different phases of disease progression. This model can also serve as an important tool for identifying potential therapeutic targets against secondary pneumococcal pneumonia in susceptible hosts.
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Affiliation(s)
- Alexsandra Lenhard
- Department of Microbiology and Immunology, University at Buffalo School of Medicine
| | - Basma H Joma
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine; Graduate Program in Immunology, Tufts Graduate School of Biomedical Sciences
| | - Nalat Siwapornchai
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine
| | | | - John M Leong
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine; Stuart B. Levy Center for the Integrated Management of Antimicrobial Resistance, Tufts University
| | - Elsa N Bou Ghanem
- Department of Microbiology and Immunology, University at Buffalo School of Medicine;
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Orsini EM, Sacha GL, Han X, Wang X, Duggal A, Rajendram P. Risk factors associated with development of coinfection in critically Ill patients with COVID-19. Acute Crit Care 2022; 37:312-321. [PMID: 36102003 PMCID: PMC9475158 DOI: 10.4266/acc.2022.00136] [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: 02/11/2022] [Accepted: 05/03/2022] [Indexed: 12/15/2022] Open
Abstract
Background At outset of the coronavirus disease 2019 (COVID-19) pandemic, the significance of bacterial and fungal coinfections in individuals with COVID-19 was unknown. Initial reports indicated that the prevalence of coinfection in the general population was low, but there was uncertainty regarding the risk of coinfection in critically ill patients. Methods Nine hundred critically ill adult patients with COVID-19 infection were enrolled in this observational case-control study. Patients with a coinfection (case) and patients without a coinfection (control) were compared using univariate and multivariable analyses. A subgroup analysis was performed on patients with coinfection, dividing them into early (infection within 7 days) and late (infection after 7 days) infection groups. Results Two hundred and thirty-three patients (25.9%) had a bacterial or fungal coinfection. Vasopressor use (P<0.001) and severity of illness (higher Acute Physiology and Chronic Health Evaluation III score, P=0.009) were risk factors for the development of a coinfection. Patients with coinfection had higher mortality and length of stay. Vasopressor and corticosteroid use and central line and foley catheter placement were risk factors for late infection (>7 days). There were high rates of drug-resistant infections. Conclusions Critically ill patients with COVID-19 are at risk for both community-acquired and hospital-acquired infections throughout their hospitalization for COVID-19. It is important to consider the development of a coinfection in clinically worsening critically ill patients with COVID-19 and consider the likelihood of drug-resistance when choosing an empiric regimen.
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Green Tea Polyphenol (-)-Epigallocatechin-3-Gallate (EGCG): A Time for a New Player in the Treatment of Respiratory Diseases? Antioxidants (Basel) 2022; 11:antiox11081566. [PMID: 36009285 PMCID: PMC9405266 DOI: 10.3390/antiox11081566] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 12/13/2022] Open
Abstract
(-)-Epigallocatechin-3-gallate (EGCG) is a major polyphenol of green tea that possesses a wide variety of actions. EGCG acts as a strong antioxidant which effectively scavenges reactive oxygen species (ROS), inhibits pro-oxidant enzymes including NADPH oxidase, activates antioxidant systems including superoxide dismutase, catalase, or glutathione, and reduces abundant production of nitric oxide metabolites by inducible nitric oxide synthase. ECGC also exerts potent anti-inflammatory, anti-fibrotic, pro-apoptotic, anti-tumorous, and metabolic effects via modulation of a variety of intracellular signaling cascades. Based on this knowledge, the use of EGCG could be of benefit in respiratory diseases with acute or chronic inflammatory, oxidative, and fibrotizing processes in their pathogenesis. This article reviews current information on the biological effects of EGCG in those respiratory diseases or animal models in which EGCG has been administered, i.e., acute respiratory distress syndrome, respiratory infections, COVID-19, bronchial asthma, chronic obstructive pulmonary disease, lung fibrosis, silicosis, lung cancer, pulmonary hypertension, and lung embolism, and critically discusses effectiveness of EGCG administration in these respiratory disorders. For this review, articles in English language from the PubMed database were used.
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Valeris-Chacin R, Powledge S, McAtee T, Morley PS, Richeson J. Mycoplasma bovis is associated with Mannheimia haemolytica during acute bovine respiratory disease in feedlot cattle. Front Microbiol 2022; 13:946792. [PMID: 35979489 PMCID: PMC9376970 DOI: 10.3389/fmicb.2022.946792] [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: 05/18/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Bovine Respiratory Disease (BRD) represents a significant burden to the health of feedlot cattle and the profitability of the beef industry in the US. Mannheimia haemolytica is widely regarded as the primary bacterial pathogen driving acute BRD. While Mycoplasma bovis is most commonly implicated in chronic cases of BRD, this agent's potential role in acute stages of BRD is unclear. Therefore, this study aimed to evaluate potential associations between M. bovis and M. haemolytica during acute BRD in feedlot cattle. Nasal swabs (n = 1,044) were collected over time from feedlot cattle (n = 270) enrolled in an experiment assessing the effect of vaccination for Bovine Respiratory Syncytial Virus (BRSV). Swabs were analyzed for detection of M. bovis, M. haemolytica, Pasteurella multocida, Histophilus somni, and BRSV via multiplex qPCR assays. Data were analyzed using inverse conditional probability weighted (ICPW) logistic regression models to investigate potential effects of M. bovis presence on arrival (d0), day seven (d7) and day 14 (d14) post-arrival on M. haemolytica prevalence on day 28 (d28) post-arrival, adjusting for the previous history of P. multocida, H. somni, BRSV, BRD morbidity, and body weight. The potential association between time-to-BRD detection and M. bovis presence on d0, d7, and d14 post-arrival, was inferred via an ICPW time-to-event model. The presence of M. bovis in nasal swabs collected on d7 post-arrival was significantly associated with an increase in the prevalence of M. haemolytica on d28 (prevalence difference: 45%; 95% Confidence Interval: 31%, 60%; P-value < 0.001). Significant time-varying coefficients for M. bovis presence were detected at d0, d7, and d14 post-arrival in the ICPW time-to-event model (P-value < 0.001). The shortest median time-to-BRD detection was 29 days in cattle that were M. bovis positive on d0, d7, and d14 post-arrival and in those that were positive on d0 and d14 post-arrival. Under the conditions of this study, our findings suggest that M. bovis may be influencing the respiratory environment during the acute phase of BRD, increasing the abundance of M. haemolytica, which could have important impacts on the occurrence of BRD.
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Affiliation(s)
- Robert Valeris-Chacin
- Veterinary Education, Research, and Outreach (VERO), Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
- *Correspondence: Robert Valeris-Chacin
| | - Sherri Powledge
- Department of Agricultural Sciences, Paul Engler College of Agriculture and Natural Sciences, West Texas A&M University, Canyon, TX, United States
| | - Taylor McAtee
- Department of Agricultural Sciences, Paul Engler College of Agriculture and Natural Sciences, West Texas A&M University, Canyon, TX, United States
| | - Paul S. Morley
- Veterinary Education, Research, and Outreach (VERO), Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, Canyon, TX, United States
| | - John Richeson
- Department of Agricultural Sciences, Paul Engler College of Agriculture and Natural Sciences, West Texas A&M University, Canyon, TX, United States
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Patel N, AL-Sayyed B, Gladfelter T, Tripathi S. Epidemiology and Outcomes of Bacterial Coinfection in Hospitalized Children With Respiratory Viral Infections: A Single Center Retrospective Chart Review. J Pediatr Pharmacol Ther 2022; 27:529-536. [DOI: 10.5863/1551-6776-27.6.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/05/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
Children with viral respiratory illness are often suspected of having bacterial coinfection. This study was designed to determine the impact of bacterial coinfection on hospital course and outcomes and the rate of antimicrobial misuse.
METHODS
Single-center retrospective chart review, including all hospitalized children who had a respiratory viral panel sent within 48 hours of admission from January 2015 to December 2019. Patients who had a positive respiratory, urine, blood culture within 24 hours of admission were identified. Demographics, resource utilization, and outcomes were compared between the 2 groups.
RESULTS
This study included 2192 patients. Of those, 269 patients had positive bacterial cultures. Out of these cultures from 192 patients were identified as contaminants. True bacterial coinfection was 3.5% (77/2192). Almost 1/3 of admitted patients were prescribed empiric antimicrobials. Children with bacterial coinfection tended to be younger (median age 8.4 months vs 16.3 months, p < 0.01) and had higher proportion of prematurity (23.3% vs 12.1%, p < 0.01). Children with bacterial coinfection were more likely to require ICU admission (37.6% vs 23.9%, p < 0.01) and intubation (28.5% vs 5.3 %, p < 0.01). They had higher ICU (5.7 days vs 1.9 days, p < 0.01) and hospital length of stay (4.0 days vs 2.0 days, p < 0.01), higher mortality (2.6% vs 0.2%, p = 0.02), and a higher median cost of hospital care ($3774.44 vs $2424.49.90, p < 0.01).
CONCLUSIONS
The rate of bacterial coinfection in hospitalized children with viral infections is very low, which contradicts the routine administration of empiric antimicrobials. Patients with coinfection require more hospital resources and have worse clinical outcomes.
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Affiliation(s)
- Nikita Patel
- Medical student (NP), University of Illinois College of Medicine at Peoria, IL
| | - Ban AL-Sayyed
- Department of Pediatrics (BAS), University of Illinois College of Medicine at Peoria, IL
| | | | - Sandeep Tripathi
- Pediatric Intensive Care, Department of Pediatrics (ST), University of Illinois College of Medicine at Peoria, IL
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Interference between avian corona and influenza viruses: The role of the epithelial architecture of the chicken trachea. Vet Microbiol 2022; 272:109499. [PMID: 35835006 DOI: 10.1016/j.vetmic.2022.109499] [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: 03/01/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 11/22/2022]
Abstract
Respiratory viral infections are among the major causes of disease in poultry. While viral dual infections are known to occur, viral interference in chicken airways is mechanistically hardly understood. The effects of infectious bronchitis virus (IBV) infection on tissue morphology, sialic acid (sia) expression and susceptibility of the chicken trachea for superinfection with IBV or avian influenza virus (AIV) were studied. In vivo, tracheal epithelium of chickens infected with IBV QX showed marked inflammatory cell infiltration and loss of cilia and goblet cells five days post inoculation. Plant lectin staining indicated that sialic acids redistributed from the apical membrane of the ciliated epithelium and the goblet cell cytoplasm to the basement membrane region of the epithelium. After administration of recombinant viral attachment proteins to slides of infected tissue, retained binding of AIV hemagglutinin, absence of binding of the receptor binding domain (RBD) of IBV M41 and partial reduction of IBV QX RBD were observed. Adult chicken trachea rings were used as ex vivo model to study the effects of IBV QX-induced pathological changes and receptor redistribution on secondary viral infection. AIV H9N2 infection after primary IBV infection was delayed; however, final viral loads reached similar levels as in previously uninfected trachea rings. In contrast, IBV M41 superinfection resulted in 1000-fold lower viral titers over the course of 48 h. In conclusion, epithelial changes in the chicken trachea after viral infection coincide with redistribution and likely specific downregulation of viral receptors, with the extend of subsequent viral interference dependent on viral species.
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Horemheb-Rubio G, Eggeling R, Schmeiβer N, Pfeifer N, Lengauer T, Gärtner BC, Prifert C, Kochanek M, Scheid C, Adams O, Kaiser R. Respiratory viruses dynamics and interactions: ten years of surveillance in central Europe. BMC Public Health 2022; 22:1167. [PMID: 35690802 PMCID: PMC9187845 DOI: 10.1186/s12889-022-13555-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/24/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Lower respiratory tract infections are among the main causes of death. Although there are many respiratory viruses, diagnostic efforts are focused mainly on influenza. The Respiratory Viruses Network (RespVir) collects infection data, primarily from German university hospitals, for a high diversity of infections by respiratory pathogens. In this study, we computationally analysed a subset of the RespVir database, covering 217,150 samples tested for 17 different viral pathogens in the time span from 2010 to 2019. METHODS We calculated the prevalence of 17 respiratory viruses, analysed their seasonality patterns using information-theoretic measures and agglomerative clustering, and analysed their propensity for dual infection using a new metric dubbed average coinfection exclusion score (ACES). RESULTS After initial data pre-processing, we retained 206,814 samples, corresponding to 1,408,657 performed tests. We found that Influenza viruses were reported for almost the half of all infections and that they exhibited the highest degree of seasonality. Coinfections of viruses are frequent; the most prevalent coinfection was rhinovirus/bocavirus and most of the virus pairs had a positive ACES indicating a tendency to exclude each other regarding infection. CONCLUSIONS The analysis of respiratory viruses dynamics in monoinfection and coinfection contributes to the prevention, diagnostic, treatment, and development of new therapeutics. Data obtained from multiplex testing is fundamental for this analysis and should be prioritized over single pathogen testing.
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Affiliation(s)
- Gibran Horemheb-Rubio
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, Köln, Germany
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, Mexico
- DZIF, Center for Infection Research, partner site Cologne Bonn, Cologne, Germany
| | - Ralf Eggeling
- Methods in Medical Informatics, Department of Computer Science, University of Tübingen, Tübingen, Germany
| | | | - Nico Pfeifer
- Methods in Medical Informatics, Department of Computer Science, University of Tübingen, Tübingen, Germany
- Faculty of Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research, Partner Site Tübingen, Tübingen, Germany
- Computational Biology, Max Planck Institute for Informatics, Saarland Informatics Campus, Saarbrücken, Germany
| | - Thomas Lengauer
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, Köln, Germany
- Computational Biology, Max Planck Institute for Informatics, Saarland Informatics Campus, Saarbrücken, Germany
| | - Barbara C Gärtner
- Institute of Medicine Microbiology and Hygiene, University of the Saarland Kirrberger Homburg/Saar, Homburg, Germany
| | - Christiane Prifert
- Faculty of Medicine, Institute for Virology and Immunobiology, Würzburg University, Würzburg, Germany
| | - Matthias Kochanek
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf, Cologne, Germany
| | - Christoph Scheid
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf, Cologne, Germany
| | - Ortwin Adams
- University of Düsseldorf, Medical Faculty, Institute for Virology, Düsseldorf, Germany
| | - Rolf Kaiser
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, Köln, Germany.
- DZIF, Center for Infection Research, partner site Cologne Bonn, Cologne, Germany.
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Stein RA, Bianchini EC. Bacterial-Viral Interactions: A Factor That Facilitates Transmission Heterogeneities. FEMS MICROBES 2022. [DOI: 10.1093/femsmc/xtac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The transmission of infectious diseases is characterized by heterogeneities that are shaped by the host, the pathogen, and the environment. Extreme forms of these heterogeneities are called super-spreading events. Transmission heterogeneities are usually identified retrospectively, but their contribution to the dynamics of outbreaks makes the ability to predict them valuable for science, medicine, and public health. Previous studies identified several factors that facilitate super-spreading; one of them is the interaction between bacteria and viruses within a host. The heightened dispersal of bacteria colonizing the nasal cavity during an upper respiratory viral infection, and the increased shedding of HIV-1 from the urogenital tract during a sexually transmitted bacterial infection, are among the most extensively studied examples of transmission heterogeneities that result from bacterial-viral interactions. Interrogating these transmission heterogeneities, and elucidating the underlying cellular and molecular mechanisms, are part of much-needed efforts to guide public health interventions, in areas that range from predicting or controlling the population transmission of respiratory pathogens, to limiting the spread of sexually transmitted infections, and tailoring vaccination initiatives with live attenuated vaccines.
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Affiliation(s)
- Richard A Stein
- NYU Tandon School of Engineering Department of Chemical and Biomolecular Engineering 6 MetroTech Center Brooklyn , NY 11201 USA
| | - Emilia Claire Bianchini
- NYU Tandon School of Engineering Department of Chemical and Biomolecular Engineering 6 MetroTech Center Brooklyn , NY 11201 USA
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48
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Delić N, Matetic A, Domjanović J, Kljaković-Gašpić T, Šarić L, Ilić D, Došenović S, Domazet J, Kovač R, Runjić F, Stipić SS, Duplančić B. Effects of Different Inhalation Therapy on Ventilator-Associated Pneumonia in Ventilated COVID-19 Patients: A Randomized Controlled Trial. Microorganisms 2022; 10:1118. [PMID: 35744636 PMCID: PMC9228146 DOI: 10.3390/microorganisms10061118] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
The effect of routine inhalation therapy on ventilator-associated pneumonia (VAP) in mechanically ventilated patients with the coronavirus disease (COVID-19) has not been well-defined. This randomized controlled trial included 175 eligible adult patients with COVID-19 who were treated with mechanical ventilation at the University Hospital of Split between October 2020 and June 2021. Patients were randomized and allocated to a control group (no routine inhalation) or one of the treatment arms (inhalation of N-acetylcysteine; 5% saline solution; or 8.4% sodium bicarbonate). The primary outcome was the incidence of VAP, while secondary outcomes included all-cause mortality. Routine inhalation therapy had no effect on the incidence of bacterial or fungal VAP nor on all-cause mortality (p > 0.05). Secondary analyses revealed a significant reduction of Gram-positive and methicillin-resistant Staphylococcus aureus (MRSA) VAP in the treatment groups. Specifically, the bicarbonate group had a statistically significantly lower incidence of Gram-positive bacterial VAP (4.8%), followed by the N-acetylcysteine group (10.3%), 5% saline group (19.0%), and control group (34.6%; p = 0.001). This difference was driven by a lower incidence of MRSA VAP in the bicarbonate group (2.4%), followed by the N-acetylcysteine group (7.7%), 5% saline group (14.3%), and control group (34.6%; p < 0.001). Longer duration of ventilator therapy was the only significant, independent predictor of any bacterial or fungal VAP in the multivariate analysis (aOR 1.14, 95% CI 1.01−1.29, p = 0.038 and aOR 1.05, 95% CI 1.01−1.10, p = 0.028, respectively). In conclusion, inhalation therapy had no effect on the overall VAP incidence or all-cause mortality. Further studies should explore the secondary findings of this study such as the reduction of Gram-positive or MRSA-caused VAP in treated patients.
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Affiliation(s)
- Nikola Delić
- Department of Anesthesiology, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; (T.K.-G.); (L.Š.); (D.I.); (S.D.); (J.D.); (R.K.); (S.S.S.); (B.D.)
| | - Andrija Matetic
- Department of Cardiology, University Hospital of Split, 21000 Split, Croatia; (A.M.); (F.R.)
| | - Josipa Domjanović
- Department of Nephrology, University Hospital of Split, 21000 Split, Croatia;
| | - Toni Kljaković-Gašpić
- Department of Anesthesiology, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; (T.K.-G.); (L.Š.); (D.I.); (S.D.); (J.D.); (R.K.); (S.S.S.); (B.D.)
| | - Lenko Šarić
- Department of Anesthesiology, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; (T.K.-G.); (L.Š.); (D.I.); (S.D.); (J.D.); (R.K.); (S.S.S.); (B.D.)
| | - Darko Ilić
- Department of Anesthesiology, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; (T.K.-G.); (L.Š.); (D.I.); (S.D.); (J.D.); (R.K.); (S.S.S.); (B.D.)
| | - Svjetlana Došenović
- Department of Anesthesiology, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; (T.K.-G.); (L.Š.); (D.I.); (S.D.); (J.D.); (R.K.); (S.S.S.); (B.D.)
| | - Josipa Domazet
- Department of Anesthesiology, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; (T.K.-G.); (L.Š.); (D.I.); (S.D.); (J.D.); (R.K.); (S.S.S.); (B.D.)
| | - Ruben Kovač
- Department of Anesthesiology, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; (T.K.-G.); (L.Š.); (D.I.); (S.D.); (J.D.); (R.K.); (S.S.S.); (B.D.)
| | - Frane Runjić
- Department of Cardiology, University Hospital of Split, 21000 Split, Croatia; (A.M.); (F.R.)
| | - Sanda Stojanović Stipić
- Department of Anesthesiology, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; (T.K.-G.); (L.Š.); (D.I.); (S.D.); (J.D.); (R.K.); (S.S.S.); (B.D.)
| | - Božidar Duplančić
- Department of Anesthesiology, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; (T.K.-G.); (L.Š.); (D.I.); (S.D.); (J.D.); (R.K.); (S.S.S.); (B.D.)
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49
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The Contribution of Viral Proteins to the Synergy of Influenza and Bacterial Co-Infection. Viruses 2022; 14:v14051064. [PMID: 35632805 PMCID: PMC9143653 DOI: 10.3390/v14051064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023] Open
Abstract
A severe course of acute respiratory disease caused by influenza A virus (IAV) infection is often linked with subsequent bacterial superinfection, which is difficult to cure. Thus, synergistic influenza-bacterial co-infection represents a serious medical problem. The pathogenic changes in the infected host are accelerated as a consequence of IAV infection, reflecting its impact on the host immune response. IAV infection triggers a complex process linked with the blocking of innate and adaptive immune mechanisms required for effective antiviral defense. Such disbalance of the immune system allows for easier initiation of bacterial superinfection. Therefore, many new studies have emerged that aim to explain why viral-bacterial co-infection can lead to severe respiratory disease with possible fatal outcomes. In this review, we discuss the key role of several IAV proteins-namely, PB1-F2, hemagglutinin (HA), neuraminidase (NA), and NS1-known to play a role in modulating the immune defense of the host, which consequently escalates the development of secondary bacterial infection, most often caused by Streptococcus pneumoniae. Understanding the mechanisms leading to pathological disorders caused by bacterial superinfection after the previous viral infection is important for the development of more effective means of prevention; for example, by vaccination or through therapy using antiviral drugs targeted at critical viral proteins.
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Wu L, Wu H, Ou T, Huang H, Duan L, Li W, Jiang W. Mapping theme trends and recognizing hot spots in viral pneumonia: a bibliometric analysis of global research. Am J Transl Res 2022; 14:2972-2987. [PMID: 35702075 PMCID: PMC9185022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The challenges that viral pneumonia poses to the global public health system remain daunting. In this study, an analysis of publications on viral pneumonia over the past two decades was conducted. Through this work, we hope to provide inspiration for future research on viral pneumonia. METHODS We extracted all of the English publications relevant to viral pneumonia published during 1999-2019 from Web of Science. GraphPad Prism, CiteSpace, and VOSviewer were used to collect and analyze the publication trends in related fields. RESULTS We identified 2,006 publications with 62,155 citations as of February 16, 2021. The United States accounted for the largest number of publications (34.2%), with the highest number of citations (27,616) and the highest h-index (78). China ranked second in the number of publications. Ctr Dis Control & Prevent proved to be the center of research cooperation. Clinical Infectious Diseases included the most papers published relating to the topic of viral pneumonia. Chan KH published the most papers in this field (25), while an article from Fouchier RAM presented the highest citation frequency (1,275). CONCLUSIONS According to the bibliometric analysis database and related software results, the United States dominates the field of viral pneumonia research. The key term extracted by VOSviewer has shifted to "Diagnosis and management", indicating a new trend for viral pneumonia research.
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Affiliation(s)
- Lixue Wu
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical UniversityShanghai, 200003, China
| | - Hao Wu
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical UniversityShanghai, 200003, China
| | - Tianle Ou
- College of Basic Medicine, Naval Medical UniversityShanghai, 200433, China
| | - Hao Huang
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical UniversityShanghai, 200003, China
| | - Liwei Duan
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical UniversityShanghai, 200003, China
| | - Wenfang Li
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical UniversityShanghai, 200003, China
| | - Weiwei Jiang
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical UniversityShanghai, 200003, China
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