Prevalence, probability, and outcomes of typhoidal/non-typhoidal Salmonella and malaria co-infection among febrile patients: a systematic review and meta-analysis

Fighting the enemy within: systemic immune defense against mucosal Salmonella infection

Salmonella infection remains a persistent global health threat, as different serovars induce a range of clinical disease, depending upon bacterial virulence and host susceptibility. While some Salmonella serovars induce gastroenteritis in healthy individuals, others can cause more serious systemic enteric fever or invasive nontyphoidal Salmonellosis. The rise of antibiotic resistance, coupled with the absence of effective vaccines for most serovars, perpetuates the spread of Salmonella in endemic regions. A detailed mechanistic understanding of immunity to Salmonella infections has been aided by the availability of mouse models that have served as a valuable tool for understanding host-pathogen interactions under controlled laboratory conditions. These mouse studies have delineated the processes by which early inflammation is triggered after infection, how adaptive immunity is initiated in lymphoid tissues, and the contribution of lymphocyte memory responses to resistance. While recent progress has been made in vaccine development for some causes of enteric fever, deeper understanding of Salmonella-specific immune memory might allow the formation of new vaccines for all serovars. This review will provide a summary of our understanding of vaccination and protective immunity to Salmonella with a focus on recent developments in T cell memory formation.

Metagenomic next generation sequencing of plasma RNA for diagnosis of unexplained, acute febrile illness in Uganda

Metagenomic next generation metagenomic sequencing (mNGS) has proven to be a useful tool in the diagnosis and identification of novel human pathogens and pathogens not identified on routine clinical microbiologic tests. In this study, we applied mNGS to characterize plasma RNA isolated from 42 study participants with unexplained acute febrile illness (AFI) admitted to tertiary referral hospitals in Mubende and Arua, Uganda. Study participants were selected based on clinical criteria suggestive of viral infection (i.e., thrombocytopenia, leukopenia). The study population had a median age of 28 years (IQR:24 to 38.5) and median platelet count of 114 x103 cells/mm3 (IQR:66,500 to 189,800). An average of 25 million 100 bp reads were generated per sample. We identified strong signals from diverse virus, bacteria, fungi, or parasites in 10 (23.8%) of the study participants. These included well recognized pathogens like Helicobacter pylori, human herpes virus-8, Plasmodium falciparum, Neisseria gonorrhoeae, and Rickettsia conorii. We further confirmed Rickettsia conorii infection, the cause of Mediterranean Spotted Fever (MSF), using PCR assays and Sanger sequencing. mNGS was a useful addition for detection of otherwise undetected pathogens and well-recognized non-pathogens. This is the first report to describe the molecular confirmation of a hospitalized case of MSF in sub-Saharan Africa (SSA). Further studies are needed to determine the utility of mNGS for disease surveillance in similar settings.

Deciphering Target Protein Cascade in Salmonella typhi Biofilm using Genomic Data Mining, and Protein-protein Interaction

Background

Salmonella typhi biofilm confers a serious public health issue for lengthy periods and the rise in antibiotic resistance and death rate. Biofilm generation has rendered even the most potent antibiotics ineffective in controlling the illness, and the S. typhi outbreak has turned into a fatal disease typhoid. S. typhi infection has also been connected to other deadly illnesses, such as a gall bladder cancer. The virulence of this disease is due to the interaction of numerous genes and proteins of S. typhi.

Objective

The study aimed to identify a cascade of target proteins in S. typhi biofilm condition with the help of genomic data mining and protein-protein interaction analysis.

Methods

The goal of this study was to notice some important pharmacological targets in S. typhi. using genomic data mining, and protein-protein interaction approaches were used so that new drugs could be developed to combat the disease.

Results

In this study, we identified 15 potential target proteins that are critical for S. typhi biofilm growth and maturation. Three proteins, CsgD, AdrA, and BcsA, were deciphered with their significant role in the synthesis of cellulose, a critical component of biofilm's extracellular matrix. The CsgD protein was also shown to have high interconnectedness and strong interactions with other important target proteins of S. typhi. As a result, it has been concluded that CsgD is involved in a range of activities, including cellulose synthesis, bacterial pathogenicity, quorum sensing, and bacterial virulence.

Conclusion

All identified targets in this study possess hydrophobic properties, and their cellular localization offered proof of a potent therapeutic target. Overall results of this study, drug target shortage in S. typhi is also spotlighted, and we believe that obtained result could be useful for the design and development of some potent anti-salmonella agents for typhoid fever in the future.

The role of tissue resident memory CD4 T cells in Salmonella infection: Implications for future vaccines

Salmonella infections cause a wide range of intestinal and systemic disease that affects global human health. While some vaccines are available, they do not mitigate the impact of Salmonella on endemic areas. Research using Salmonella mouse models has revealed the important role of CD4 T cells and antibody in the development of protective immunity against Salmonella infection. Recent work points to a critical role for hepatic tissue-resident memory lymphocytes in naturally acquired immunity to systemic infection. Thus, understanding the genesis and function of this Salmonella-specific population is an important objective and is the primary focus of this review. Greater understanding of how these memory lymphocytes contribute to bacterial elimination could suggest new approaches to vaccination against an important human pathogen.

Distinct cytokine profiles in malaria coinfections: A systematic review

BACKGROUND

Few data exist on the distinct cytokine profiles of individuals with malaria coinfections and other diseases. This study focuses on data collation of distinct cytokine profiles between individuals with malaria coinfections and monoinfections to provide evidence for further diagnostic or prognostic studies.

METHODS

We searched five medical databases, including Embase, MEDLINE, PubMed, Ovid, and Scopus, for articles on cytokines in malaria coinfections published from January 1, 1983 to May 3, 2022, after which the distinct cytokine patterns between malaria coinfection and monoinfection were illustrated in heat maps.

RESULTS

Preliminary searches identified 2127 articles, of which 34 were included in the systematic review. Distinct cytokine profiles in malaria coinfections with bacteremia; HIV; HBV; dengue; filariasis; intestinal parasites; and schistosomiasis were tumor necrosis factor (TNF), interferon (IFN)-γ, IFN-α, interleukin (IL)-1, IL-1 receptor antagonist (Ra), IL-4, IL-7, IL-12, IL-15, IL-17; TNF, IL-1Ra, IL-4, IL-10, IL-12, IL-18, CCL3, CCL5, CXCL8, CXCL9, CXCL11, granulocyte colony-stimulating factor (G-CSF); TNF, IFN-γ, IL-4, IL-6, IL-10, IL-12, CCL2; IFN-γ, IL-1, IL-4, IL-6, IL-10, IL-12, IL-13, IL-17, CCL2, CCL3, CCL4, G-CSF; IL-1Ra, IL-10, CXCL5, CXCL8, CXCL10; TNF, IL-2, IL-4, IL-6, IL-10; and TNF, IFN-γ, IL-4, IL-5, IL-10, transforming growth factor-β, CXCL8, respectively.

CONCLUSION

This systematic review provides information on distinct cytokine profiles of malaria coinfections and malaria monoinfections. Further studies should investigate whether specific cytokines for each coinfection type could serve as essential diagnostic or prognostic biomarkers for malaria coinfections.

The Prevalence of Malaria and Bacteremia Co-Infections among Febrile Patients: A Systematic Review and Meta-Analysis

Comprehensive data on the relative contribution of bacteremia to malaria outcomes in a large number of participants are lacking. Therefore, we collated data on the co-existence of malaria and bacteremia in the literature to provide evidence-based information for future studies investigating the clinical significance of this co-infection. The study protocol was registered at PROSPERO (ID: CRD42021287971). Relevant studies were identified from PubMed, Web of Science, and Scopus. The pooled prevalence of (1) co-existent malaria and bacteremia among febrile patients, (2) the pooled prevalence of bacteremia among patients with malaria, (3) the probability of co-infection, and (4) the pooled prevalence of deaths were estimated by the random-effects model. Fifty-one studies involving 1583 cases of co-infection were included in the analyses. Typhoidal Salmonella spp. and Staphylococcus aureus were the most common Gram-negative and Gram-positive bacteria, respectively. The prevalence of co-existent malaria and bacteremia among febrile patients was 1.9% (95% confidence interval (CI) = 1.5–2.2%, I² = 96.64%, 31 studies). The prevalence of bacteremia among patients with malaria was 7.6% (95% CI = 6.7–8.7%, and I² = 96.68%, 43 studies). Co-infection by malaria and bacteremia did not occur by chance (p = 0.024, odds ratio = 0.64, 95% CI = 0.43–0.94, and I² = 95.7%, 29 studies). The pooled prevalence of deaths among patients with co-infection was 15.0% (95% CI = 8.0–23.0%, I² = 75.23%, 8 studies). On the basis of this study, we conclude that although the prevalence of co-infection was low, patients with malaria appear at greater risk of bacteremia and death.

Procalcitonin as a Candidate Biomarker for Malarial Infection and Severe Malaria: A Meta-Analysis

Procalcitonin (PCT), as a marker of malaria severity, remains to be investigated. The present study collated and compared the levels of PCT between patients with severe malaria, uncomplicated malaria, and control participants to assess their role in predicting malaria infection and disease severity. The systematic review was registered at PROSPERO with registration number CRD42021297243. The search for relevant studies that reported PCT in patients with malaria was performed in PubMed, Scopus, and Web of Science. The following meta-analyses were conducted; (1) the pooled mean PCT levels in patients with severe and uncomplicated malaria, and (2) the pooled mean difference in PCT levels between patients with severe and uncomplicated malaria. Fifteen studies were included for qualitative and quantitative syntheses. The meta-analysis results show that the pooled mean PCT levels in patients with uncomplicated malaria were 3.92 ng/mL (95% CI: 2.26-5.58 ng/mL, I²: 96.5, five studies), whereas the pooled mean PCT levels in patients with severe malaria were 14.13 ng/mL (95% CI: 8.75-19.5 ng/mL, I²: 92.6, six studies). The meta-analysis showed that patients with severe malaria had an equal mean of PCT compared to those with uncomplicated malaria when the random-effects model was used (p: 0.055, weighted mean difference: 6.93, 95% CI: -0.16-14.02, I²: 84.6%, four studies). There were probable correlations between the level of parasitemia, immunity level, and possibly bacterial or other parasitic co-infection that could affect the PCT level among different clinical severities of malaria. Therefore, the PCT level alone does not seem to be a suitable biomarker to discriminate the severe/uncomplicated or infected/uninfected cases. Further studies should investigate the increased PCT levels in combination with other markers in association with malaria infection and severity.

Evaluation of Salmonella Typhimurium Lacking fruR, ssrAB, or hfq as a Prophylactic Vaccine against Salmonella Lethal Infection

Non-typhoidal Salmonella (NTS) is one of the primary causes of foodborne gastroenteritis; occasionally, it causes invasive infection in humans. Because of its broad host range, covering diverse livestock species, foods of animal origin pose a critical threat of NTS contamination. However, there is currently no licensed vaccine against NTS infection. FruR, also known as Cra (catabolite repressor/activator), was initially identified as the transcriptional repressor of the fructose (fru) operon, and then found to activate or repress the transcription of many different genes associated with carbon and energy metabolism. In view of its role as a global regulator, we constructed a live attenuated vaccine candidate, ΔfruR, and evaluated its prophylactic effect against NTS infection in mice. A Salmonella Typhimurium mutant strain lacking fruR was defective in survival inside macrophages and exhibited attenuated virulence in infected mice. Immunization with the ΔfruR mutant stimulated the production of antibodies, including the IgG, IgM, and IgG subclasses, and afforded a protection of 100% to mice against the challenge of lethal infection with a virulent Salmonella strain. The prophylactic effect obtained after ΔfruR immunization was also validated by the absence of signs of hepatosplenomegaly, as these mice had comparable liver and spleen weights in comparison with healthy mice. These results suggest that the ΔfruR mutant strain can be further exploited as a promising vaccine candidate against Salmonella lethal infection.

In Vitro Antibacterial Potential against Multidrug-Resistant Salmonella, Cytotoxicity, and Acute Biochemical Effects in Mice of Annona muricata Leaf Extracts

The treatment of Salmonella infections is threatened by multidrug resistance necessitating the search for alternative treatments, such as from medicinal plants. There are several reports on the antibacterial activity of Annona muricata. This study assessed the activity against multidrug-resistant (MDR) Salmonella and also the toxicity of the leaves of this plant. The hexane and methanol extracts of the leaves were screened against characterized MDR isolates by disc diffusion and microdilution methods. A cytotoxicity test was performed on monkey kidney epithelial cells; an acute toxicity test was conducted in BALB/c mice and the liver and kidney functions were assessed at the end of the test. Both extracts recorded weak activity in the disc test. Conversely, the extracts showed a wide range of activity against specific Salmonella isolates in the microdilution assay, and the lowest minimum inhibitory concentration value recorded was 0.0625 mg/mL. The hexane extract (ANO_HEX) was not cytotoxic (CC₅₀ = 57.7 µg/mL) and was also not toxic to the mice at 2000 mg/Kg bodyweight, while the methanol extract (ANO_MET) was cytotoxic (CC₅₀ = 18.44 µg/mL), and mortality was recorded at 2000 mg/Kg but not at 300 mg/Kg. There were no significant changes in biomarkers of the liver (alanine aminotransferase and aspartate aminotransferase) and kidney (creatinine and urea) functions (P > 0.05), except for ANO_HEX which significantly decreased creatinine (P = 0.01), in the test mice which was not considered a toxic effect. In conclusion, this study has demonstrated high bacteriostatic activity against MDR Salmonella and a low risk of toxicity of A. muricata leaves. Hence, the leaves are a potential alternative treatment for resistant Salmonella infection. The natural products should be further investigated in vitro and in vivo.

A systematic review and meta-analysis of blood interleukin-4 levels concerning malaria infection and severity

Background

Interleukin (IL)-4 had been linked to malaria severity, but the findings are controversial, and the evidence is inconsistent and imprecise. In the current investigation, data on IL-4 levels in patients with severe and uncomplicated malaria were compiled.

Methods

The systematic review was registered at PROSPERO (CRD42022323387). Searches for relevant articles on IL-4 levels in patients with severe malaria and studies that examined IL-4 levels in both uncomplicated malaria and healthy controls were performed in PubMed, Embase, and Scopus using the search strategy without limitation to publication years or language. The quality of all included studies was evaluated using The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: standards for reporting observational studies. Qualitative and quantitative data syntheses were performed. The random-effects model, which weights each study according to its between- and within-study variance, was used to pool the mean difference (MD) of individual studies. The degree of heterogeneity was determined using Cochran's Q and I² statistics. Additionally, meta-regression and subgroup analyses were perfomed to investigate possible sources of heterogeneity. The outliers were identified using the leave-one-out method and assessed publication bias using funnel plots, Egger’s test, and a contour-enhanced funnel plot.

Results

A total of 2300 studies were identified through database searches, and 36 were included for analyses. The meta-analysis results showed lower mean IL-4 levels in severe malaria (434 cases) than in uncomplicated malaria (611 cases) (P = 0.01, pooled MD: −3.36 pg/mL, 95% confidence intervals CI −5.55 to −1.16 pg/mL, I²: 98.15%, 11 studies). The meta-analysis results showed no difference in mean IL-4 levels between cerebral malaria (96 cases) and noncerebral severe malaria (108 cases) (P = 0.71, pooled MD: 0.86 pg/mL, 95% CI −3.60 to 5.32 pg/mL, I² 92.13%, four studies). Finally, no difference was found in mean IL-4 levels between uncomplicated malaria (635 cases) and healthy controls (674 cases) (P = 0.57, pooled MD: 0.79 pg/mL, 95% CI −1.92 to 3.50 pg/mL, I²: 99.89%, 11 studies).

Conclusion

The meta-analysis revealed lower IL-4 levels in patients with severe malaria than in those with uncomplicated malaria, though a trend toward comparable IL-4 levels between both groups was more likely because several sources of heterogeneities were observed. Based on the limited number of studies included in the meta-analysis, until additional investigations have been conducted, IL-4 consideration as an alternative prognostic factor for malaria severity is not warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12936-022-04237-z.

Prevalence and effect of Plasmodium spp. and hookworm co-infection on malaria parasite density and haemoglobin level: a meta-analysis

The dual effects of co-infection of Plasmodium spp. and hookworm on malaria remain under debate. This study investigated prevalence, prevalence odds ratio (POR) of co-infection and impact of co-infection on malaria parasite density and haemoglobin levels in comparison to Plasmodium mono-infection. The protocol for this systematic review and meta-analysis is registered at PROPERO under ID: CRD42020202156. Relevant literatures were obtained from PubMed, ISI Web of Science, and Scopus on 25 December 2020. Mean difference (MD) and confidence interval (CI) of malaria parasite density and haemoglobin were compared using a random effect model. Heterogeneity was assessed using Cochrane Q and I2 statistics. Publication bias was determined by visualising funnel plot asymmetry. Of 1756 articles examined, 22,191 malaria cases across 37 studies included 6096 cases of co-infection of Plasmodium spp. and hookworm. The pooled prevalence was 20% (95% CI 15-26%, I2 99.6%, 37 studies) and was varied in terms of geographical region. Co-infection occurred by chance (OR 0.97, p 0.97, 95% CI 0.73-1.27, I2 95%, 30 studies). The mean malaria parasite density for co-infection (478 cases) was similar to Plasmodium mono-infection (920 cases) (p 0.24, MD 0.86, 95% CI - 0.58-2.29, I2 100%, 7 studies). The mean haemoglobin level for co-infection (90 cases) was similar to Plasmodium mono-infection (415 cases) (p 0.15, MD - 0.63, 95% CI - 1.49-0.23, I2 98%, 4 studies). Co-infection was common and occurred by chance but varied by geographic region. Further studies are required to investigate the mechanism of hookworm infection on malaria severity. Additionally, detection of hookworm infections among patients with malaria in endemic areas of both diseases is recommended to prevent severe malaria.