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Assefa M, Amare A, Tigabie M, Girmay G, Setegn A, Wondmagegn YM, Tamir M, Belete D, Aynalem M, Belachew T, Biset S. Burden of multidrug-resistant bacteria among HIV-positive individuals in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0309418. [PMID: 39186717 PMCID: PMC11346931 DOI: 10.1371/journal.pone.0309418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 08/13/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Multidrug-resistant (MDR) bacteria are a significant cause of severe infections, particularly in human immunodeficiency virus (HIV)-positive individuals because of their weakened immunity. Since there was no previous pooled representative data regarding the MDR bacteria among HIV-positive individuals in Ethiopia, this systematic review and meta-analysis is required. METHODS This study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed using PubMed, Medline, EMBASE, Google Scholar, Hinari, Web of Science, Science Direct, and African Journals Online databases. Data were extracted using Microsoft Excel 2019 and analyzed using STATA version 11.0 software. A random-effects model was used to estimate the pooled effect size of outcome variables across studies with a 95% confidence interval. The I2 statistic was used to check for heterogeneity. The presence of publication bias was determined using a funnel plot and Egger's test with a p-value < 0.05 evidence of statistically significant bias. RESULTS The pooled prevalence of MDR was 58.02% (95% CI: 46.32-69.73%) with high heterogeneity (I2 = 97.1%, (p < 0.001). In subgroup analysis, the highest multi-drug resistance was observed in the Oromia region (80.95%), patients with multiple infections (82.35%), and studies identified both Gram-positive and Gram-negative bacteria (61.45%). Furthermore, the pooled prevalence of MDR bacteria colonizing HIV-positive individuals was 48.76%. Regarding MDR species, Enterococci (77.41%) and Pseudomonas spp. (84.60%) were commonly identified in individuals with HIV infection. CONCLUSION Our study indicates a high burden of MDR among HIV-positive individuals in Ethiopia. The Oromia region, HIV patients with multiple infections, Pseudomonas spp., and Enterococci showed the highest MDR in the subgroup analysis. Therefore, regional hospitals should implement strategies to tackle MDR such as vaccination program, appropriate use of antibiotics, and further study on the associated factors of MDR bacteria in HIV are required.
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Affiliation(s)
- Muluneh Assefa
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Azanaw Amare
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mitkie Tigabie
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getu Girmay
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebaw Setegn
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yenesew Mihret Wondmagegn
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mebratu Tamir
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Debaka Belete
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melak Aynalem
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Teshome Belachew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sirak Biset
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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McDonagh F, Cormican M, Morris D, Burke L, Singh NK, Venkateswaran K, Miliotis G. Medical Astro-Microbiology: Current Role and Future Challenges. J Indian Inst Sci 2023; 103:1-26. [PMID: 37362850 PMCID: PMC10082442 DOI: 10.1007/s41745-023-00360-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/03/2023] [Indexed: 06/28/2023]
Abstract
The second and third decades of the twenty-first century are marked by a flourishing of space technology which may soon realise human aspirations of a permanent multiplanetary presence. The prevention, control and management of infection with microbial pathogens is likely to play a key role in how successful human space aspirations will become. This review considers the emerging field of medical astro-microbiology. It examines the current evidence regarding the risk of infection during spaceflight via host susceptibility, alterations to the host's microbiome as well as exposure to other crew members and spacecraft's microbiomes. It also considers the relevance of the hygiene hypothesis in this regard. It then reviews the current evidence related to infection risk associated with microbial adaptability in spaceflight conditions. There is a particular focus on the International Space Station (ISS), as one of the only two crewed objects in low Earth orbit. It discusses the effects of spaceflight related stressors on viruses and the infection risks associated with latent viral reactivation and increased viral shedding during spaceflight. It then examines the effects of the same stressors on bacteria, particularly in relation to changes in virulence and drug resistance. It also considers our current understanding of fungal adaptability in spaceflight. The global public health and environmental risks associated with a possible re-introduction to Earth of invasive species are also briefly discussed. Finally, this review examines the largely unknown microbiology and infection implications of celestial body habitation with an emphasis placed on Mars. Overall, this review summarises much of our current understanding of medical astro-microbiology and identifies significant knowledge gaps. Graphical Abstract
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Affiliation(s)
- Francesca McDonagh
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, University of Galway, Galway, Ireland
| | - Martin Cormican
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, University of Galway, Galway, Ireland
- Department of Medical Microbiology, Galway University Hospitals, Galway, Ireland
| | - Dearbháile Morris
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, University of Galway, Galway, Ireland
| | - Liam Burke
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, University of Galway, Galway, Ireland
| | - Nitin Kumar Singh
- Biotechnology and Planetary Protection Group, NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA USA
| | - Kasthuri Venkateswaran
- Biotechnology and Planetary Protection Group, NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA USA
| | - Georgios Miliotis
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, University of Galway, Galway, Ireland
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3
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Hulme J. Staphylococcus Infection: Relapsing Atopic Dermatitis and Microbial Restoration. Antibiotics (Basel) 2023; 12:antibiotics12020222. [PMID: 36830133 PMCID: PMC9952585 DOI: 10.3390/antibiotics12020222] [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: 12/15/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Atopic Dermatitis (AD) skin is susceptible to Staphylococcus aureus (SA) infection, potentially exposing it to a plethora of toxins and virulent determinants, including Panton-Valentine leukocidin (PVL) (α-hemolysin (Hla) and phenol-soluble modulins (PSMs)), and superantigens. Depending on the degree of infection (superficial or invasive), clinical treatments may encompass permanganate (aq) and bleach solutions coupled with intravenous/oral antibiotics such as amoxicillin, vancomycin, doxycycline, clindamycin, daptomycin, telavancin, linezolid, or tigecycline. However, when the skin is significantly traumatized (sheathing of epidermal sections), an SA infection can rapidly ensue, impairing the immune system, and inducing local and systemic AD presentations in susceptible areas. Furthermore, when AD presents systemically, desensitization can be long (years) and intertwined with periods of relapse. In such circumstances, the identification of triggers (stress or infection) and severity of the flare need careful monitoring (preferably in real-time) so that tailored treatments targeting the underlying pathological mechanisms (SA toxins, elevated immunoglobulins, impaired healing) can be modified, permitting rapid resolution of symptoms.
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Affiliation(s)
- John Hulme
- Gachon Bio-Nano Institute, Gachon University, Seongnam-si 461-701, Republic of Korea
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4
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Abbara S, Guillemot D, Brun-Buisson C, Watier L. From Pathophysiological Hypotheses to Case-Control Study Design: Resistance from Antibiotic Exposure in Community-Onset Infections. Antibiotics (Basel) 2022; 11:201. [PMID: 35203803 PMCID: PMC8868523 DOI: 10.3390/antibiotics11020201] [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: 01/05/2022] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Antimicrobial resistance is a global public health concern, at least partly due to the misuse of antibiotics. The increasing prevalence of antibiotic-resistant infections in the community has shifted at-risk populations into the general population. Numerous case-control studies attempt to better understand the link between antibiotic use and antibiotic-resistant community-onset infections. We review the designs of such studies, focusing on community-onset bloodstream and urinary tract infections. We highlight their methodological heterogeneity in the key points related to the antibiotic exposure, the population and design. We show the impact of this heterogeneity on study results, through the example of extended-spectrum β-lactamases producing Enterobacteriaceae. Finally, we emphasize the need for the greater standardization of such studies and discuss how the definition of a pathophysiological hypothesis specific to the bacteria-resistance pair studied is an important prerequisite to clarify the design of future studies.
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Affiliation(s)
- Salam Abbara
- Anti-Infective Evasion and Pharmacoepidemiology Team, Inserm, UVSQ, University Paris-Saclay, CESP, 78180 Montigny-Le-Bretonneux, France; (S.A.); (D.G.); (C.B.-B.)
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), 75015 Paris, France
| | - Didier Guillemot
- Anti-Infective Evasion and Pharmacoepidemiology Team, Inserm, UVSQ, University Paris-Saclay, CESP, 78180 Montigny-Le-Bretonneux, France; (S.A.); (D.G.); (C.B.-B.)
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), 75015 Paris, France
- Public Health, Medical Information, Clinical Research, AP-HP, University Paris Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Christian Brun-Buisson
- Anti-Infective Evasion and Pharmacoepidemiology Team, Inserm, UVSQ, University Paris-Saclay, CESP, 78180 Montigny-Le-Bretonneux, France; (S.A.); (D.G.); (C.B.-B.)
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), 75015 Paris, France
| | - Laurence Watier
- Anti-Infective Evasion and Pharmacoepidemiology Team, Inserm, UVSQ, University Paris-Saclay, CESP, 78180 Montigny-Le-Bretonneux, France; (S.A.); (D.G.); (C.B.-B.)
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), 75015 Paris, France
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5
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Abstract
The pathogenic potential (PP) concept posits that all microorganisms have some pathogenic potential that can be calculated by an equation that includes the fraction symptomatic, inoculum, and mortality fraction. The PP concept dispenses with characterizing microbes as pathogens, nonpathogens, commensals, pathobionts, etc., by providing an alternative approach to the problem of virulence that considers the contributions of both the host and the microbe. Here, the PP concept is extended to incorporate the role of time in virulence by introducing a new parameter, fulminancy, which is a measure of the rapidity of the pathogenic process. Fulminancy allows PP calculations in situations where all hosts are affected equally, but the process occurs later for attenuated strains. Differences in the PP of wild-type and mutant microbes lacking virulence factors can be used to estimate the contribution of virulence factors to the pathogenic process, thus providing a new quantitative approach to these important pathogenicity parameters.
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6
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Pirofski LA, Casadevall A. The state of latency in microbial pathogenesis. J Clin Invest 2021; 130:4525-4531. [PMID: 32804154 DOI: 10.1172/jci136221] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The state of latency occurs when a microbe's persistence in a host produces host damage without perturbing homeostasis sufficiently to cause clinical symptoms or disease. The mechanisms contributing to latency are diverse and depend on the nature of both the microbe and the host. Latency has advantages for both host and microbe. The host avoids progressive damage caused by interaction with the microbe that may translate into disease, and the microbe secures a stable niche in which to survive. Latency is clinically important because some latent microbes can be transmitted to other hosts, and it is associated with a risk for recrudescent microbial growth and development of disease. In addition, it can predispose the host to other diseases, such as malignancies. Hence, latency is a temporally unstable state with an eventual outcome that mainly depends on host immunity. Latency is an integral part of the pathogenic strategies of microbes that require human (and/or mammalian) hosts, including herpesviruses, retroviruses, Mycobacterium tuberculosis, and Toxoplasma gondii. However, latency is also an outcome of infection with environmental organisms such as Cryptococcus neoformans, which require no host in their replicative cycles. For most microbes that achieve latency, there is a need for a better understanding and more investigation of host and microbial mechanisms that result in this state.
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Affiliation(s)
- Liise-Anne Pirofski
- Division of Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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7
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Antimicrobial Therapy in the Context of the Damage-Response Framework: the Prospect of Optimizing Therapy by Reducing Host Damage. Antimicrob Agents Chemother 2020; 64:AAC.01800-19. [PMID: 31740558 DOI: 10.1128/aac.01800-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
By design, antimicrobial agents act directly on microbial targets. These drugs aim to eliminate microbes and are remarkably effective against susceptible organisms. Nonetheless, some patients succumb to infectious diseases despite appropriate antimicrobial therapy. Today, with very few exceptions, physicians select antimicrobial therapy based on its activity against the targeted organism without consideration of how the regimen affects patients' immune responses. An important concept to emerge in the past few decades is that immune responses to microbes can be detrimental by enhancing host damage, which can translate into clinical disease. A central tenet of the damage-response framework (DRF) of microbial pathogenesis is that the relevant outcome of host-microbe interaction is the damage that occurs in the host, which can be due to microbial factors, host factors, or both. Given that host damage can make patients sick, reducing it should be a goal of treating infectious diseases. Inflammation and damage that stem from the host response to an infectious disease can increase during therapy with some antimicrobial agents and decrease during therapy with others. When a patient cannot eliminate a microbe with their own immune response, antimicrobial therapy is essential for microbial elimination, and yet it can affect the inflammatory response. In this essay, we discuss antimicrobial therapy in the context of the DRF and propose that consideration of the DRF may help tailor therapy to a patient's need to augment or reduce inflammation.
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8
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Alexander H, Paller AS, Traidl-Hoffmann C, Beck LA, De Benedetto A, Dhar S, Girolomoni G, Irvine AD, Spuls P, Su J, Thyssen JP, Vestergaard C, Werfel T, Wollenberg A, Deleuran M, Flohr C. The role of bacterial skin infections in atopic dermatitis: expert statement and review from the International Eczema Council Skin Infection Group. Br J Dermatol 2019; 182:1331-1342. [PMID: 31677162 PMCID: PMC7317931 DOI: 10.1111/bjd.18643] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/27/2022]
Abstract
Patients with atopic dermatitis (AD) have an increased risk of bacterial skin infections, which cause significant morbidity and, if untreated, may become systemic. Staphylococcus aureus colonizes the skin of most patients with AD and is the most common organism to cause infections. Overt bacterial infection is easily recognized by the appearance of weeping lesions, honey‐coloured crusts and pustules. However, the wide variability in clinical presentation of bacterial infection in AD and the inherent features of AD – cutaneous erythema and warmth, oozing associated with oedema, and regional lymphadenopathy – overlap with those of infection, making clinical diagnosis challenging. Furthermore, some features may be masked because of anatomical site‐ and skin‐type‐specific features, and the high frequency of S. aureus colonization in AD makes positive skin swab culture of suspected infection unreliable as a diagnostic tool. The host mechanisms and microbial virulence factors that underlie S. aureus colonization and infection in AD are incompletely understood. The aim of this article is to present the latest evidence from animal and human studies, including recent microbiome research, to define the clinical features of bacterial infections in AD, and to summarize our current understanding of the host and bacterial factors that influence microbial colonization and virulence.
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Affiliation(s)
- H Alexander
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, SE1 7EH, U.K
| | - A S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A
| | - C Traidl-Hoffmann
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München, Augsburg, Germany.,CK-CARE, Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
| | - L A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - A De Benedetto
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL, U.S.A
| | - S Dhar
- Department of Pediatric Dermatology, Institute of Child Health, Kolkata, India
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - A D Irvine
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.,Dermatology, Children's Health Ireland, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - P Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J Su
- Departments of Dermatology and Paediatrics, Murdoch Children's Research Institute, University of Melbourne and Monash University, Eastern Health, Melbourne, VIC, Australia
| | - J P Thyssen
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - C Vestergaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - T Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - A Wollenberg
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany
| | - M Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - C Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, SE1 7EH, U.K
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9
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Basein T, Gardiner BJ, Andujar Vazquez GM, Joel Chandranesan AS, Rabson AR, Doron S, Snydman DR. Microbial Identification Using DNA Target Amplification and Sequencing: Clinical Utility and Impact on Patient Management. Open Forum Infect Dis 2018; 5:ofy257. [PMID: 30539032 PMCID: PMC6284463 DOI: 10.1093/ofid/ofy257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/04/2018] [Indexed: 12/21/2022] Open
Abstract
Broad-range polymerase chain reaction (PCR) is increasingly used in patients with culture-negative infections; however, few studies have assessed the diagnostic utility of this test in this context. We performed a retrospective cohort study of patients who had clinical specimens sent for broad-range PCR, aiming to evaluate performance and determine impact on patient management. Organisms were identified in 21/71 samples. High numbers of polymorphonuclear leukocytes on Gram stain (odds ratio [OR], 4.17; P = .04) and acute inflammation on histopathology (OR, 5.69; P = .02) were significantly associated with a positive result. Management was altered in 18 patients, 11 with positive and 7 with negative results. Overall, broad-range PCR assay had the highest impact in patients with microscopic evidence of inflammation. Physicians ordering this complex, difficult to interpret, and expensive test should carefully consider all available clinical information on an individualized basis to optimize its performance.
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Affiliation(s)
- Tinzar Basein
- Division of Geographic Medicine and Infectious Diseases
| | | | | | | | - Arthur R Rabson
- Department of Pathology, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Shira Doron
- Division of Geographic Medicine and Infectious Diseases
| | - David R Snydman
- Division of Geographic Medicine and Infectious Diseases.,Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
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10
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Davy CM, Donaldson ME, Willis CKR, Saville BJ, McGuire LP, Mayberry H, Wilcox A, Wibbelt G, Misra V, Kyle CJ. Environmentally persistent pathogens present unique challenges for studies of host-pathogen interactions: Reply to Field (2018). Ecol Evol 2018; 8:5238-5241. [PMID: 29938048 PMCID: PMC6010918 DOI: 10.1002/ece3.4035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Linked article: https://doi.org/10.1002/ece3.4034.
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Affiliation(s)
- Christina M. Davy
- Environmental and Life Sciences Graduate ProgramTrent UniversityPeterboroughONCanada
- Wildlife Research and Monitoring SectionOntario Ministry of Natural Resources and ForestryPeterboroughONCanada
| | - Michael E. Donaldson
- Environmental and Life Sciences Graduate ProgramTrent UniversityPeterboroughONCanada
| | - Craig K. R. Willis
- Wildlife Research and Monitoring SectionOntario Ministry of Natural Resources and ForestryPeterboroughONCanada
| | | | - Liam P. McGuire
- Wildlife Research and Monitoring SectionOntario Ministry of Natural Resources and ForestryPeterboroughONCanada
- Department of Biological SciencesTexas Tech UniversityLubbockTXUSA
| | - Heather Mayberry
- Wildlife Research and Monitoring SectionOntario Ministry of Natural Resources and ForestryPeterboroughONCanada
| | - Alana Wilcox
- Wildlife Research and Monitoring SectionOntario Ministry of Natural Resources and ForestryPeterboroughONCanada
| | - Gudrun Wibbelt
- Leibniz Institute of Zoo and Wildlife ResearchBerlinGermany
| | - Vikram Misra
- Department of MicrobiologyWestern College of Vet. MedicineUniversity of SaskatchewanSaskatoonSKCanada
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Abstract
In every epidemic some individuals become sick and some may die, whereas others recover from illness and still others show no signs or symptoms of disease. These differences highlight a fundamental question of microbial pathogenesis: why are some individuals susceptible to infectious diseases while others who acquire the same microbe remain well? For most of human history, the answer assumed the hand of providence. With the advent of the germ theory of disease, the focus on disease causality became the microbe, but this did not explain how there can be different outcomes of infection in different individuals with the same microbe. Here we examine the attributes of susceptibility in the context of the "damage-response framework" of microbial pathogenesis. We identify 11 attributes that, although not independent, are sufficiently distinct to be considered separately: microbiome, inoculum, sex, temperature, environment, age, chance, history, immunity, nutrition, and genetics. We use the first letter of each to create the mnemonic MISTEACHING, underscoring the need for caution in accepting dogma and attributing disease causality to any single factor. For both populations and individuals, variations in the attributes that assemble into MISTEACHING can create an enormity of combinations that can in turn translate into different outcomes of host-microbe encounters. Combinatorial diversity among the 11 attributes makes identifying "signatures" of susceptibility possible. However, with their inevitable uncertainties and propensity to change, there may still be a low likelihood for prediction with regard to individual host-microbe interactions, although probabilistic prediction may be possible.
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12
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Hughes V, McNair J, Strain S, Barry C, McLuckie J, Nath M, Caldow G, Stevenson K. Gamma interferon responses to proteome-determined specific recombinant proteins in cattle experimentally- and naturally-infected with paratuberculosis. Res Vet Sci 2017; 114:244-253. [PMID: 28521263 DOI: 10.1016/j.rvsc.2017.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 11/19/2022]
Abstract
Johne's disease (JD), is a fatal enteritis of animals caused by infection with Mycobacterium avium subspecies paratuberculosis (Map). Diagnosis of subclinical JD is problematic as test sensitivity is limited. Th1 responses to Map are activated early, thus detection of a cell-mediated response, indicated by measuring interferon gamma (IFN-γ) stimulated by mycobacterial antigens, may give the first indication of sub-clinical infection. Crude extracts of Map (PPDJ) have been used to detect the cell-mediated response in infected cattle. More specific, quantifiable antigens may improve test specificity and reproducibility. Map-specific proteins, MAP_3651c and MAP_0268c, raised a cell-mediated immune response in sub-clinically infected sheep. Results presented in this manuscript demonstrate these proteins elicit a cell-mediated response in experimental and natural infections of cattle. Individual ranked IFN-γ responses of experimentally infected calves to PPDJ showed a high, statistically significant association with ranked responses of recombinant Map antigens. Responses of infected animals were higher than the control group. Threshold values determined using data from an experimental infection were applied to naturally infected animals. Some animals exhibited responses above these threshold values. Responses to MAP_3651c on a farm categorised as high-risk for JD showed strong evidence (P<0.001) that responses were significantly different to lower-risk farms. The IGRA test may prove to be an additional tool for the diagnosis of JD, and inclusion of specific antigens a refinement however, understanding and interpretation of IGRA results remain challenging and further investigation will be required to determine whether the IGRA test can detect exposure and hence predict clinical JD.
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Affiliation(s)
- Valerie Hughes
- Moredun Research Institute, Pentlands Science Park, Bush Loan, Penicuik EH26 0PZ, United Kingdom.
| | - Jim McNair
- Veterinary Sciences Division, Agri-Food and Biosciences Institute, Stoney Road, Stormont Belfast BT4 3SD, United Kingdom
| | - Samuel Strain
- Veterinary Sciences Division, Agri-Food and Biosciences Institute, Stoney Road, Stormont Belfast BT4 3SD, United Kingdom
| | - Claire Barry
- Veterinary Sciences Division, Agri-Food and Biosciences Institute, Stoney Road, Stormont Belfast BT4 3SD, United Kingdom
| | - Joyce McLuckie
- Moredun Research Institute, Pentlands Science Park, Bush Loan, Penicuik EH26 0PZ, United Kingdom
| | - Mintu Nath
- Biomathematics & Statistics Scotland, James Clerk Maxwell Building, The King's Building, Edinburgh EH9 3JZ, United Kingdom
| | - George Caldow
- SRUC, Greycrook, St Boswells, Roxburghshire TD6 0EQ, United Kingdom
| | - Karen Stevenson
- Moredun Research Institute, Pentlands Science Park, Bush Loan, Penicuik EH26 0PZ, United Kingdom
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Renk H, Stoll L, Neunhoeffer F, Hölzl F, Kumpf M, Hofbeck M, Hartl D. Suspicion of respiratory tract infection with multidrug-resistant Enterobacteriaceae: epidemiology and risk factors from a Paediatric Intensive Care Unit. BMC Infect Dis 2017; 17:163. [PMID: 28222699 PMCID: PMC5320655 DOI: 10.1186/s12879-017-2251-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 02/07/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Multidrug-resistant (MDR) infections are a serious concern for children admitted to the Paediatric Intensive Care Unit (PICU). Tracheal colonization with MDR Enterobacteriaceae predisposes to respiratory infection, but underlying risk factors are poorly understood. This study aims to determine the incidence of children with suspected infection during mechanical ventilation and analyses risk factors for the finding of MDR Enterobacteriaceae in tracheal aspirates. METHODS A retrospective single-centre analysis of Enterobacteriaceae isolates from the lower respiratory tract of ventilated PICU patients from 2005 to 2014 was performed. Resistance status was determined and clinical records were reviewed for potential risk factors. A classification and regression tree (CRT) to predict risk factors for infection with MDR Enterobacteriaceae was employed. The model was validated by simple and multivariable logistic regression. RESULTS One hundred sixty-seven Enterobacteriaceae isolates in 123 children were identified. The most frequent isolates were Enterobacter spp., Klebsiella spp. and E.coli. Among these, 116 (69%) isolates were susceptible and 51 (31%) were MDR. In the CRT analysis, antibiotic exposure for ≥ 7 days and presence of gastrointestinal comorbidity were the most relevant predictors for an MDR isolate. Antibiotic exposure for ≥ 7 days was confirmed as a significant risk factor for infection with MDR Enterobacteriaceae by a multivariable logistic regression model. CONCLUSIONS This study shows that critically-ill children with tracheal Enterobacteriaceae infection are at risk of carrying MDR isolates. Prior use of antibiotics for ≥ 7 days significantly increased the risk of finding MDR organisms in ventilated PICU patients with suspected infection. Our results imply that early identification of patients at risk, rapid microbiological diagnostics and tailored antibiotic therapy are essential to improve management of critically ill children infected with Enterobacteriaceae.
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Affiliation(s)
- Hanna Renk
- Dept. of Paediatric Cardiology, Pulmology and Intensive Care Medicine, University Children’s Hospital Tübingen, Hoppe-Seyler Str. 1, Tübingen, 72076 Germany
| | - Lenja Stoll
- Dept. of Paediatric Cardiology, Pulmology and Intensive Care Medicine, University Children’s Hospital Tübingen, Hoppe-Seyler Str. 1, Tübingen, 72076 Germany
| | - Felix Neunhoeffer
- Dept. of Paediatric Cardiology, Pulmology and Intensive Care Medicine, University Children’s Hospital Tübingen, Hoppe-Seyler Str. 1, Tübingen, 72076 Germany
| | - Florian Hölzl
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Elfriede-Aulhorn-Str.6, Tübingen, 72076 Germany
| | - Matthias Kumpf
- Dept. of Paediatric Cardiology, Pulmology and Intensive Care Medicine, University Children’s Hospital Tübingen, Hoppe-Seyler Str. 1, Tübingen, 72076 Germany
| | - Michael Hofbeck
- Dept. of Paediatric Cardiology, Pulmology and Intensive Care Medicine, University Children’s Hospital Tübingen, Hoppe-Seyler Str. 1, Tübingen, 72076 Germany
| | - Dominik Hartl
- Dept. of Paediatrics, Pediatric Infectious Diseases, Immunology & Pneumology/Cystic fibrosis, University Children’s Hospital Tübingen, Hoppe-Seyler Str. 1, Tübingen, 72076 Germany
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14
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Fthenakis GC. Preface. Vet Microbiol 2015; 181:1. [PMID: 26282246 DOI: 10.1016/j.vetmic.2015.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- G C Fthenakis
- Veterinary Faculty, University of Thessaly, Karditsa, Greece.
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15
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De la colonisation à l’infection par des bactéries multirésistantes aux antibiotiques : identification et maîtrise du risque chez les patients hospitalisés en réanimation. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-014-1011-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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The Exserohilum rostratum Incident. Emerg Infect Dis 2014. [DOI: 10.1016/b978-0-12-416975-3.00022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
Outcomes of fungal infections in immunocompromised individuals depend on a complex interplay between host and pathogen factors, as well as treatment modalities. Problems occur when host responses to an infection are either too weak to effectively help eradicate the pathogen, or when they become too strong and are associated with host damage rather than protection. Immune reconstitution syndrome (IRS) can be generally defined as a restoration of host immunity in a previously immunosuppressed patient that becomes dysregulated and overly robust, resulting in host damage and sometimes death. IRS associated with opportunistic mycoses presents as new or worsening clinical symptoms or radiographic signs consistent with an inflammatory process that occur during receipt of an appropriate antifungal, and that cannot be explained by a newly acquired infection. Because there are currently no established tests or biomarkers for IRS, it can be difficult to distinguish from progression of the original infection, although culture and biomarkers for the fungal pathogen or infection are typically negative during diagnostic workup. IRS was originally characterized in human immunodeficiency virus-infected patients receiving antiretroviral therapy, but has subsequently been described in solid-organ transplant recipients, neutropenic patients, women in the postpartum period, and recipients of tumor necrosis factor-α inhibitor therapy. In each of these cases, recovery of the host's immunity during treatment of an initial infection results in a powerful proinflammatory environment that overshoots and leads to host damage. Optimal management of IRS has not been established at present, but often involves treatment with a corticosteroid or other anti-inflammatory compounds. This article uses a number of patient cases to explore the intricacies of diagnosing and managing a patient with IRS, as well as the other extreme, namely patients who are so immunocompromised without immune recovery that they essentially become breeding grounds for a wide range of opportunistic pathogens, often simultaneously.
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Affiliation(s)
- John R Perfect
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina 27710, USA.
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18
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Ilkit M, Guzel AB. The epidemiology, pathogenesis, and diagnosis of vulvovaginal candidosis: A mycological perspective. Crit Rev Microbiol 2011; 37:250-61. [DOI: 10.3109/1040841x.2011.576332] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Kong W, Wang J, Xing X, Xiao X, Zhao Y, Zang Q, Zhang P, Jin C, Li Z, Liu W. Antifungal evaluation of cholic acid and its derivatives on Candida albicans by microcalorimetry and chemometrics. Anal Chim Acta 2011; 689:250-6. [DOI: 10.1016/j.aca.2011.01.050] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 01/22/2011] [Accepted: 01/27/2011] [Indexed: 11/29/2022]
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20
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Aschbacher R, Pagani L, Doumith M, Pike R, Woodford N, Spoladore G, Larcher C, Livermore D. Metallo-β-lactamases among Enterobacteriaceae from routine samples in an Italian tertiary-care hospital and long-term care facilities during 2008. Clin Microbiol Infect 2011. [DOI: 10.1111/j.1469-0691.2010.03225.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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López-Romero E, Reyes-Montes MDR, Pérez-Torres A, Ruiz-Baca E, Villagómez-Castro JC, Mora-Montes HM, Flores-Carreón A, Toriello C. Sporothrix schenckii complex and sporotrichosis, an emerging health problem. Future Microbiol 2011; 6:85-102. [DOI: 10.2217/fmb.10.157] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Sporothrix schenckii, now named the S. schenckii species complex, has largely been known as the etiological agent of sporotrichosis, which is an acute or chronic subcutaneous mycosis of humans and other mammals. Gene sequencing has revealed the following species in the S. schenckii complex: Sporothrix albicans, Sporothrix brasiliensis, Sporothrix globosa, Sporothrix luriei, Sporothrix mexicana and S. schenckii. The increasing number of reports of Sporothrix infection in immunocompromised patients, mainly the HIV-infected population, suggests sporotrichosis as an emerging global health problem concomitant with the AIDS pandemic. Molecular studies have demonstrated a high level of intraspecific variability. Components of the S. schenckii cell wall that act as adhesins and immunogenic inducers, such as a 70-kDa glycoprotein, are apparently specific to this fungus. The main glycan peptidorhamnomannan cell wall component is the only O-linked glycan structure known in S. schenckii. It contains an α-mannobiose core followed by one α-glucuronic acid unit, which may be mono- or di-rhamnosylated. The oligomeric structure of glucosamine-6-P synthase has led to a significant advance in the development of antifungals targeted to the enzyme’s catalytic domain in S. schenckii.
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Kong W, Jin C, Xiao X, Zhao Y, Li Z, Zhang P, Liu W, Li XF. Comparative study of effects of two bile acid derivatives on Staphylococcus aureus by multiple analytical methods. JOURNAL OF HAZARDOUS MATERIALS 2010; 179:742-747. [PMID: 20400224 DOI: 10.1016/j.jhazmat.2010.03.064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 03/12/2010] [Accepted: 03/13/2010] [Indexed: 05/27/2023]
Abstract
The effects of two bile acid derivatives, cholic acid (CA) and deoxycholic acid (DCA) on Staphylococcus aureus (S. aureus) growth were investigated and compared by microcalorimetry coupled with multiple analytical methods. The heat power (HP)-time curves of S. aureus growth affected by CA and DCA were studied by similarity analysis (SA), respectively. Then the quantitative thermo-kinetic parameters obtained from these curves were investigated by the multivariate analysis of variance (MANOVA) and principal component analysis (PCA). By analyzing the two main parameters, growth rate constant k(2) of the second exponential phase and the heat power P(2) of the second highest peak, together with the minimum inhibitory concentration (MIC) values of 10 microg/mL for CA and 20 microg/mL for DCA, it could be concluded that the antibacterial effect of CA was stronger than that of DCA. The existence of alpha-OH at C-7 position of steroid nucleus of bile acid derivatives enhanced the hydrophilicity of compound CA and its inhibitory effect on S. aureus. This study provides a useful method and idea to accurately evaluate the antibacterial effects of bile acid derivatives, which provides some references for screening out new antibacterial agents with high efficacy and low toxicity.
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Affiliation(s)
- Weijun Kong
- China Military Institute of Chinese Materia Medica, 302 Military Hospital of China, Beijing 100039, PR China
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Munford RS. Sensing gram-negative bacterial lipopolysaccharides: a human disease determinant? Infect Immun 2008; 76:454-65. [PMID: 18086818 PMCID: PMC2223455 DOI: 10.1128/iai.00939-07] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Robert S Munford
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas 75390-9113, USA.
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Pirofski LA, Casadevall A. The damage-response framework of microbial pathogenesis and infectious diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2008; 635:135-46. [PMID: 18841709 PMCID: PMC7123708 DOI: 10.1007/978-0-387-09550-9_11] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Historical and most currently held views of microbial pathogenesis and virulence are plagued by confusing and imprecise terminology and definitions that require revision and exceptions to accommodate new basic science and clinical information about microbes and infectious diseases. These views are also inherently unable to account for the ability of some microbes to cause disease in certain, but not other hosts, because they are grounded in singular, either microbe-or host-centric views. The damage-response framework is an integrated theory of microbial pathogenesis that puts forth the view that microbial pathogenesis reflects the outcome of an interaction between a host and a microbe, with each entity contributing to the nature of the outcome, which in turn depends on the amount of host damage that results from the host-microbe interaction. This view is able to accommodate new information and explain why infection with the same microbe can have different outcomes in different hosts. This chapter describes the origins and conceptual underpinnings of and the outcomes of infection put forth in, the damage-response framework.
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Affiliation(s)
- Liise-anne Pirofski
- Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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25
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Chandra J, McCormick TS, Imamura Y, Mukherjee PK, Ghannoum MA. Interaction of Candida albicans with adherent human peripheral blood mononuclear cells increases C. albicans biofilm formation and results in differential expression of pro- and anti-inflammatory cytokines. Infect Immun 2007; 75:2612-20. [PMID: 17339351 PMCID: PMC1865760 DOI: 10.1128/iai.01841-06] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Monocytes and macrophages are the cell types most commonly associated with the innate immune response against Candida albicans infection. Interactions between the host immune system and Candida organisms have been investigated for planktonic Candida cells, but no studies have addressed these interactions in a biofilm environment. In this study, for the first time, we evaluated the ability of C. albicans to form biofilms in the presence or absence of adherent peripheral blood mononuclear cells (PBMCs; enriched for monocytes and macrophages by adherence). Our analyses using scanning electron and confocal scanning laser microscopy showed that the presence of PBMCs enhanced the ability of C. albicans to form biofilms and that the majority of PBMCs were localized to the basal and middle layers of the biofilm. In contrast to the interactions of PBMCs with planktonic C. albicans, where PBMCs phagocytose fungal cells, PBMCs did not appear to phagocytose fungal cells in biofilms. Furthermore, time-lapse laser microscopy revealed dynamic interactions between C. albicans and PBMCs in a biofilm. Additionally, we found that (i) only viable PBMCs influence Candida biofilm formation, (ii) cell surface components of PBMCs did not contribute to the enhancement of C. albicans biofilm, (iii) the biofilm-enhancing effect of PBMCs is mediated by a soluble factor released into the coculture medium of PBMCs with C. albicans, and (iv) supernatant collected from this coculture contained differential levels of pro- and anti-inflammatory cytokines. Our studies provide new insight into the interaction between Candida biofilm and host immune cells and demonstrate that immunocytes may influence the ability of C. albicans to form biofilms.
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Affiliation(s)
- Jyotsna Chandra
- Center for Medical Mycology, University Hospitals Case Medical Center, Cleveland, OH, USA
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26
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Clancy CJ, Nguyen MH. Reply to Antinori. Clin Infect Dis 2006. [DOI: 10.1086/507553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Munford RS, Varley AW. Shield as signal: lipopolysaccharides and the evolution of immunity to gram-negative bacteria. PLoS Pathog 2006; 2:e67. [PMID: 16846256 PMCID: PMC1483240 DOI: 10.1371/journal.ppat.0020067] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Robert S Munford
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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28
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Vaerewijck MJM, Huys G, Palomino JC, Swings J, Portaels F. Mycobacteria in drinking water distribution systems: ecology and significance for human health. FEMS Microbiol Rev 2005; 29:911-34. [PMID: 16219512 DOI: 10.1016/j.femsre.2005.02.001] [Citation(s) in RCA: 212] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2004] [Revised: 11/29/2004] [Accepted: 02/05/2005] [Indexed: 01/04/2023] Open
Abstract
In contrast to the notorious pathogens Mycobacterium tuberculosis and M. leprae, the majority of the mycobacterial species described to date are generally not considered as obligate human pathogens. The natural reservoirs of these non-primary pathogenic mycobacteria include aquatic and terrestrial environments. Under certain circumstances, e.g., skin lesions, pulmonary or immune dysfunctions and chronic diseases, these environmental mycobacteria (EM) may cause disease. EM such as M. avium, M. kansasii, and M. xenopi have frequently been isolated from drinking water and hospital water distribution systems. Biofilm formation, amoeba-associated lifestyle, and resistance to chlorine have been recognized as important factors that contribute to the survival, colonization and persistence of EM in water distribution systems. Although the presence of EM in tap water has been linked to nosocomial infections and pseudo-infections, it remains unclear if these EM provide a health risk for immunocompromised people, in particular AIDS patients. In this regard, control strategies based on maintenance of an effective disinfectant residual and low concentration of nutrients have been proposed to keep EM numbers to a minimum in water distribution systems.
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Affiliation(s)
- Mario J M Vaerewijck
- Laboratory of Microbiology, Ghent University, K.L. Ledeganckstraat 35, 9000 Gent, Belgium
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29
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Heym B, Rimareix F, Lortat-Jacob A, Nicolas-Chanoine MH. Bacteriological investigation of infected pressure ulcers in spinal cord-injured patients and impact on antibiotic therapy. Spinal Cord 2004; 42:230-4. [PMID: 15060520 DOI: 10.1038/sj.sc.3101568] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective. OBJECTIVES To improve the use of bacteriological results for treating spinal cord-injured patients with infected pressure ulcers. SETTING Microbiology and Orthopaedics Department, Ambroise Paré University Hospital, Boulogne-Billancourt, France. METHODS Tissue specimens, sampled at the end of the surgical intervention from unbridled and cleaned ulcers were analysed. Drainage liquids were cultured at day 1 (D1) and day 5 (D5) postsurgery. For part of the patients, a presurgery superficial sample was analysed and compared with the surgical and postsurgical samples. RESULTS In all, 168 surgical samples from 101 patients, 183 D1 and 104 D5 wound drainage liquids were included in this study. Out of the 168 surgical samples 17 (10%) had a negative culture, whereas 151 (90%) had a positive culture. For drainage liquids, the culture was negative in 48% and 56% of the samples at D1 and D5, respectively. The most frequently isolated species were enterobacteria, followed by staphylococci and streptococci. CONCLUSION Culturing deep tissue specimens sampled from the surgically cleaned and unbridled ulcers allows for the isolation of the bacterial species that are really involved in the ulcer infection. As the identification of these bacteria and their antibiotic susceptibility are available, when the culture results of the D1 postsurgical drainage liquid is also available, it is easier to choose targeted antibiotic treatment.
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Affiliation(s)
- B Heym
- Service de Microbiologie-Hygiène, Hôpital Ambroise-Paré, Faculté de Médecine Paris Ile de France Ouest, France
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Abstract
The late twentieth century witnessed the emergence of numerous infectious diseases that are caused by microorganisms that rarely cause disease in normal, healthy immunocompetent hosts. The emergence of these diseases shows that the existing concepts of pathogenicity and virulence do not take into account the fact that both the microorganism and the host contribute to microbial pathogenesis. To address this impediment to studies of host-microorganism interactions, we propose a new theoretical approach to understanding microbial pathogenesis, known as the 'damage-response' framework.
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Affiliation(s)
- Arturo Casadevall
- Departments of Medicine (Division of Infectious Diseases) and Microbiology & Immunology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, New York 10461, USA.
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Steenbergen JN, Casadevall A. The origin and maintenance of virulence for the human pathogenic fungus Cryptococcus neoformans. Microbes Infect 2003; 5:667-75. [PMID: 12787743 DOI: 10.1016/s1286-4579(03)00092-3] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The origin of virulence in environmental fungi that have no requirement for animal hosts in their life cycle is enigmatic. Cryptococcus neoformans is a human pathogenic fungus with virulence factors for mammalian pathogenesis that also contribute to environmental survival. C. neoformans virulence may originate from selection pressures imposed by environmental predators.
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Affiliation(s)
- Judith N Steenbergen
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Casadevall A, Pirofski LA. Microbial virulence results from the interaction between host and microorganism. Trends Microbiol 2003; 11:157-8; author reply 158-9. [PMID: 12706990 DOI: 10.1016/s0966-842x(03)00008-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Romani L, Bistoni F, Puccetti P. Response from Romani et al.: Microbial virulence results from the interaction between host and microorganism. Trends Microbiol 2003. [DOI: 10.1016/s0966-842x(03)00009-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
The molecular aetiology of familial susceptibility to disseminated mycobacterial disease, usually involving weakly pathogenic strains of mycobacteria, has now been elucidated in more than 30 families. Mutations have been identified in five genes in the interleukin-12-dependent interferon-gamma pathway, highlighting the importance of this pathway in human mycobacterial immunity. Knowledge derived from the study of these rare patients contributes to our understanding of the immune response to common mycobacterial pathogens such as Mycobacterium tuberculosis and Mycobacterium leprae, which remain major public health problems globally. This knowledge can be applied to the rational development of novel therapies and vaccines for these important mycobacterial diseases.
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Affiliation(s)
- Melanie Newport
- Cambridge Institute for Medical Research, Addenbrookes Hospital, Hills Road, Cambridge, CB2 2XY, UK.
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