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Yun KW. Community-acquired pneumonia in children: updated perspectives on its etiology, diagnosis, and treatment. Clin Exp Pediatr 2024; 67:80-89. [PMID: 37321577 PMCID: PMC10839192 DOI: 10.3345/cep.2022.01452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/19/2023] [Accepted: 02/08/2023] [Indexed: 06/17/2023] Open
Abstract
Pneumonia is a common pediatric infectious disease that is familiar to pediatricians and a major cause of hospitalization worldwide. Recent well-designed epidemiologic studies in developed countries indicated that respiratory viruses are detected in 30%-70%, atypical bacteria in 7%-17%, and pyogenic bacteria in 2%-8% of children hospitalized with community-acquired pneumonia (CAP). The etiological distribution of CAP varies widely by child age and the epidemiological season of the respiratory pathogen. Moreover, diagnostic tests, particularly for the detection of Streptococcus pneumoniae and Mycoplasma pneumoniae, the 2 major bacterial pathogens involved in pediatric CAP, have several limitations. Therefore, management and empirical antimicrobial therapy for children with CAP should be applied in a stepwise manner based on recent epidemiological, etiological, and microbiological evidence.
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Affiliation(s)
- Ki Wook Yun
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
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Tzialla C, Auriti C, Aversa S, Merazzi D, Martinelli S, Araimo G, Massenzi L, Cavallaro G, Gagliardi L, Giuffrè M, Mosca F, Cetin I, Trojano V, Valensise H, Colacurci N, Orfeo L, Mondì V. Intersociety Position Statement on the Prevention of Ophthalmia Neonatorum in Italy. Microorganisms 2023; 12:15. [PMID: 38276184 PMCID: PMC10818411 DOI: 10.3390/microorganisms12010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
There is currently no worldwide agreement on the real need to administer conjunctival antibiotics to neonates at birth to prevent neonatal conjunctivitis (usually defined as ophthalmia neonatorum) by Chlamydia trachomatis and Neisseria gonorrhoeae. Therefore, there is wide variability in antibiotic administration, conditioned mainly by the social and health context. In Italy, a law enacted in 1940 required doctors and midwives to administer ophthalmic prophylaxis with 2% silver nitrate to all newborns at birth. This law was repealed in 1975 and since then there has been no clear guidance on the use of ophthalmia neonatorum prophylaxis at birth. Since neonatal conjunctivitis caused by C. trachomatis and N. gonorrhoeae is not reported, we carried out a nationwide survey of 1,041,384 neonates across all Italian birth centers to evaluate the incidence of ophthalmia neonatorum and the current practice of prophylaxis. After analyzing the results, we formulated an intersociety position statement on the prevention of ophthalmia neonatorum to update and standardize this prevention strategy in Italy.
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Affiliation(s)
- Chryssoula Tzialla
- Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, Via Volturno 14, 27058 Voghera, Italy;
| | - Cinzia Auriti
- Faculty of Medicine, UniCamillus-Saint Camillus International University of Health Sciences, Via di Sant’Alessandro 8, 00131 Rome, Italy
- Neonatologic Unit, Villa Margherita Private Clinic, Viale di Villa Massimo 48, 00161 Rome, Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children’s Hospital, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123 Brescia, Italy;
| | - Daniele Merazzi
- Division of Neonatology, ‘Valduce’ Hospital, Via Dante Alighieri 11, 22100 Como, Italy;
| | - Stefano Martinelli
- Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore 3, 20162 Milan, Italy;
| | - Gabriella Araimo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy; (G.A.); (G.C.); (F.M.)
| | - Luca Massenzi
- Division of Neonatology, Central Teaching Hospital of Bolzano, Via Lorenz Böhler 5, 39100 Bolzano, Italy;
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy; (G.A.); (G.C.); (F.M.)
| | - Luigi Gagliardi
- Department of Mother and Child Health, Azienda USL Toscana Nord Ovest, Via A. Cocchi, 7/9, 56121 Pisa, Italy;
| | - Mario Giuffrè
- Neonatal Intensive Care Unit, A.U.O.Policlinico ‘Paolo Giaccone’, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties ‘G. D’Alessandro’, University of Palermo, Via del Vespro 129, 90126 Palermo, Italy;
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy; (G.A.); (G.C.); (F.M.)
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy
| | - Irene Cetin
- Department of BioMedical and Clinical Sciences, University of Milan, Via Gian Battista Grassi 74, 20122 Milan, Italy;
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Via Lodovico Castelvetro 32, 20154 Milan, Italy
| | - Vito Trojano
- Department of Obstetrics and Gynaecology, Mater Dei Hospital, Via Samuel F. Hahnemann 10, 70125 Bari, Italy;
| | - Herbert Valensise
- Department of Surgical Sciences, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy;
- Obstetrics and Gynecology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Via Luigi De Crecchio 2, 80138 Naples, Italy;
| | - Luigi Orfeo
- Neonatal Intensive Care Unit, Fatebenefratelli Isola Tiberina—Gemelli Isola, Via di Ponte Quattro Capi 39, 00186 Rome, Italy;
| | - Vito Mondì
- Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy;
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Mondì V, Tzialla C, Aversa S, Merazzi D, Martinelli S, Araimo G, Massenzi L, Cavallaro G, Gagliardi L, Piersigilli F, Giuffrè M, Lozzi S, Manzoni P, Mosca F, Cetin I, Trojano V, Valensise H, Colacurci N, Orfeo L, Auriti C. Antibiotic prophylaxis for ophthalmia neonatorum in Italy: results from a national survey and the Italian intersociety new position statements. Ital J Pediatr 2023; 49:117. [PMID: 37697419 PMCID: PMC10494339 DOI: 10.1186/s13052-023-01507-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/08/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Ophthalmia neonatorum is an acute conjunctivitis that occurs in newborns within the first month of life. The most serious infections are due to Chlamydia trachomatis and Neisseria gonorrhoeae, that may cause permanent damages. The use of ophthalmic prophylaxis varies widely around the world, according to the different health and socio-economic contexts. To date in Italy there is no a clear legislation regarding ophthalmia neonatorum prophylaxis at birth. METHODS We invited all birth centers in Italy to carry out a retrospective survey relating the last three years. We collected data regarding demographics of neonates, drugs used for ophthalmic prophylaxis and results of the screening of pregnant women for Chlamydia trachomatis and Neisseria gonorrhoeae vaginal infections. RESULTS Among 419 birth centers, 302 (72,1%) responded to the survey. Overall 1041384 neonates, 82,3% of those born in the three years considered, received ophthalmic prophylaxis. Only 4,585 (0,4%) of them received one of the drugs recommended by the WHO. The Centers that participated to the survey reported 12 episodes of Chlamydial conjunctivitis and no Gonococcal infection in the three years. Only 38% of the Centers performed vaginal swabs to pregnant women: 2,6% screened only for Neisseria, 9,6% only for Chlamydia and 25,8% for both germs. CONCLUSIONS The data obtained from the survey showed a low incidence of neonatal conjunctivitis due to either Neisseria gonorrhoeae or Chlamydia trachomatis in Italy. Due to the lack of legislation regulating the prophylaxis of ophthalmia neonatorum in newborns, the Italian Society of Neonatology, the Italian Society of Obstetrics and Gynecology and the Italian Society of Perinatal Medicine have recently issued new recommendations on this topic.
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Affiliation(s)
- Vito Mondì
- Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino, Via Casilina 1049, Rome, Italy
| | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, ASST Pavia, Via Volturno 14, Voghera, Italy.
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Piazzale Spedali Civili 1, Brescia, Italy
| | - Daniele Merazzi
- Division of Neonatology, 'Valduce' Hospital, Via Dante Alighieri 11, Como, Italy
| | - Stefano Martinelli
- Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore 3, Milan, Italy
| | - Gabriella Araimo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, Milan, Italy
| | - Luca Massenzi
- Division of Neonatology, Central Teaching Hospital of Bolzano, Via Lorenz Böhler 5, Bolzano, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, Milan, Italy
| | - Luigi Gagliardi
- Division of Neonatology and Pediatrics, Versilia Hospital, Azienda USL Toscana Nord Ovest, SS1 335, ViareggioPisa, Italy
| | - Fiammetta Piersigilli
- Section of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, Brussels, Belgium
| | - Mario Giuffrè
- Neonatal Intensive Care Unit, A.U.O.P. 'P. Giaccone,' Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Via del Vespro 129, Palermo, Italy
| | - Simona Lozzi
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant - "Bambino Gesù" Children's Hospital IRCCS,, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy
| | - Paolo Manzoni
- Department of Maternal, Neonatal and Infant Medicine, University Hospital "Degli Infermi", Via Dei Ponderanesi 2, Ponderano, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via Della Commenda 19, Milan, Italy
| | - Irene Cetin
- Department of BioMedical and Clinical Sciences, University of Milan, Via Givan Battista Grassi 74, Milan, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Via Lodovico Castelvetro 32, Milan, Italy
| | - Vito Trojano
- Department of Obstetrics and Gynaecology, Mater Dei Hospital, Via Samuel F. Hahnemann 10, Bari, Italy
| | - Herbert Valensise
- Department of Surgical Sciences, University of Rome Tor Vergata, Via Montpellier, 1, Rome, Italy
- Obstetrics and Gynecology, Policlinico Casilino, Via Casilina 1049, Rome, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, Naples, Italy
| | - Luigi Orfeo
- Neonatal Intensive Care Unit, Fatebenefratelli Isola Tiberina - Gemelli Isola, Via Di Ponte Quattro Capi 39, Rome, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant - "Bambino Gesù" Children's Hospital IRCCS,, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy
- Villa Margherita Private Clinic, Via Di Villa Massimo 48, 00161, Rome, Italy
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4
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Cheong HC, Sulaiman S, Looi CY, Chang LY, Wong WF. Chlamydia Infection Remodels Host Cell Mitochondria to Alter Energy Metabolism and Subvert Apoptosis. Microorganisms 2023; 11:1382. [PMID: 37374883 DOI: 10.3390/microorganisms11061382] [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: 04/07/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Chlamydia infection represents an important cause for concern for public health worldwide. Chlamydial infection of the genital tract in females is mostly asymptomatic at the early stage, often manifesting as mucopurulent cervicitis, urethritis, and salpingitis at the later stage; it has been associated with female infertility, spontaneous abortion, ectopic pregnancy, and cervical cancer. As an obligate intracellular bacterium, Chlamydia depends heavily on host cells for nutrient acquisition, energy production, and cell propagation. The current review discusses various strategies utilized by Chlamydia in manipulating the cell metabolism to benefit bacterial propagation and survival through close interaction with the host cell mitochondrial and apoptotic pathway molecules.
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Affiliation(s)
- Heng Choon Cheong
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Sofiah Sulaiman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Chung Yeng Looi
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya 47500, Selangor, Malaysia
| | - Li-Yen Chang
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Won Fen Wong
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
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5
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Grygiel-Górniak B, Folga BA. Chlamydia trachomatis-An Emerging Old Entity? Microorganisms 2023; 11:1283. [PMID: 37317257 DOI: 10.3390/microorganisms11051283] [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: 03/06/2023] [Revised: 04/04/2023] [Accepted: 05/12/2023] [Indexed: 06/16/2023] Open
Abstract
Chlamydia trachomatis is an evasive pathogen that can prompt severe clinical manifestations in humans such as vaginitis, epididymitis, lymphogranuloma venereum, trachoma, conjunctivitis and pneumonia. If left untreated, chronic infections with C. trachomatis can give rise to long-lasting and even permanent sequelae. To shed some light on its widespread nature, data from original research, systematic reviews and meta-analyses from three databases was collected and analyzed in the context of chlamydial infection, related symptoms and appropriate treatment modalities. This review describes the bacterium's pervasiveness on a global scale, especially in developing countries, and suggests ways to halt its transmission and spread. Infections with C. trachomatis often go unnoticed, as many individuals are asymptomatic and unaware of their diagnosis, contributing to a delay in diagnosis and treatment. The high prevalence of chlamydial infection highlights the need for a universal screening and detection method enabling immediate treatment at its onset. Prognosis is favorable with antibiotic therapy and education for high-risk groups and their sexual partners. In the future, a quick, easily accessible, and inexpensive test should be developed to diagnose and treat infected individuals early on. Along with a vaccine against C. trachomatis, it would halt the transmission and spread of the pathogen worldwide.
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Affiliation(s)
- Bogna Grygiel-Górniak
- Department of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Barbara Anna Folga
- Department of Rheumatology, Rehabilitation and Internal Diseases, Poznan University of Medical Sciences, 61-701 Poznań, Poland
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6
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Stein RA, Thompson LM. Epigenetic changes induced by pathogenic Chlamydia spp. Pathog Dis 2023; 81:ftad034. [PMID: 38031337 DOI: 10.1093/femspd/ftad034] [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: 06/15/2023] [Revised: 11/16/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023] Open
Abstract
Chlamydia trachomatis, C. pneumoniae, and C. psittaci, the three Chlamydia species known to cause human disease, have been collectively linked to several pathologies, including conjunctivitis, trachoma, respiratory disease, acute and chronic urogenital infections and their complications, and psittacosis. In vitro, animal, and human studies also established additional correlations, such as between C. pneumoniae and atherosclerosis and between C. trachomatis and ovarian cancer. As part of their survival and pathogenesis strategies as obligate intracellular bacteria, Chlamydia spp. modulate all three major types of epigenetic changes, which include deoxyribonucleic acid (DNA) methylation, histone post-translational modifications, and microRNA-mediated gene silencing. Some of these epigenetic changes may be implicated in key aspects of pathogenesis, such as the ability of the Chlamydia spp. to induce epithelial-to-mesenchymal transition, interfere with DNA damage repair, suppress cholesterol efflux from infected macrophages, act as a co-factor in human papillomavirus (HPV)-mediated cervical cancer, prevent apoptosis, and preserve the integrity of mitochondrial networks in infected host cells. A better understanding of the individual and collective contribution of epigenetic changes to pathogenesis will enhance our knowledge about the biology of Chlamydia spp. and facilitate the development of novel therapies and biomarkers. Pathogenic Chlamydia spp. contribute to epigenetically-mediated gene expression changes in host cells by multiple mechanisms.
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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, United States
| | - Lily M Thompson
- NYU Tandon School of Engineering, Department of Chemical and Biomolecular Engineering, 6 MetroTech Center, Brooklyn, NY 11201, United States
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7
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Nguyen PTK, Robinson PD, Fitzgerald DA, Marais BJ. The dilemma of improving rational antibiotic use in pediatric community-acquired pneumonia. Front Pediatr 2023; 11:1095166. [PMID: 36846166 PMCID: PMC9945262 DOI: 10.3389/fped.2023.1095166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/10/2023] [Indexed: 02/11/2023] Open
Abstract
Pneumonia is the number one cause of disease and deaths in children under five years old, outside the neonatal period, with the greatest number of cases reported from resource-limited settings. The etiology is variable, with not much information on the local etiology drug resistance profile in many countries. Recent studies suggest an increasing contribution from respiratory viruses, also in children with severe pneumonia, with an increased relative contribution in settings that have good vaccine coverage against common bacterial pathogens. Respiratory virus circulation was greatly reduced during highly restrictive measures to contain the spread of COVID-19 but rebounded once COVID-19 restrictions were relaxed. We conducted a comprehensive literature review of the disease burden, pathogens, case management and current available prevention of community acquired childhood pneumonia, with a focus on rational antibiotic use, since the treatment of respiratory infections is the leading cause of antibiotic use in children. Consistent application of revised World Health Organisation (WHO) guidance that children presenting with coryzal symptoms or wheeze can be managed without antibiotics in the absence of fever, will help to reduce unnecessary antibiotic use, as will increased availability and use of bedside inflammatory marker tests, such as C-reactive protein (CRP) in children with respiratory symptoms and fever.
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Affiliation(s)
- Phuong T K Nguyen
- Department of General Medicine, The Children's Hospital Westmead, Westmead, NSW, Australia
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital Westmead, NSW, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital Westmead, NSW, Australia.,The University of Sydney, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Ben J Marais
- The University of Sydney, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Sydney, NSW, Australia.,Department of Infectious Diseases, The Children's Hospital Westmead, Westmead, NSW, Australia
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8
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Bothun CE, Mansukhani SA, Xu TT, Hendricks TM, Hodge DO, Mohney BG. Incidence and Clinical Characteristics of Infantile Conjunctivitis in a Western Population. Am J Ophthalmol 2022; 241:145-148. [PMID: 35469786 PMCID: PMC10441006 DOI: 10.1016/j.ajo.2022.04.008] [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] [Received: 11/30/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the incidence and clinical characteristics of conjunctivitis in the first year of life. DESIGN Population-based cohort study. PARTICIPANTS All infant (≤12 months of age) residents of Olmsted County, Minnesota, diagnosed with conjunctivitis from January 1, 2005, through December 31, 2014. METHODS The medical records of all potential cases identified by the Rochester Epidemiology Project database were reviewed. MAIN OUTCOME MEASURES Incidence rate and clinical features of infantile conjunctivitis. RESULTS A total of 2175 infants were diagnosed during the 10-year period, yielding an incidence of 10,422 per 100,000 children or approximately 1 in 10 infants by 1 year of age. The mean age at diagnosis was 4.9 months (range, 1 day-12 months), and 1001 (46.0%) were female. Both eyes were involved in 1180 (54.3%), the right eye alone in 506 (23.3%), and 489 (22.5%) in the left. Five hundred seventy-six (26.5%) of the 2175 were diagnosed at ≤30 days of life, from which topical cultures were obtained in 111 (19.7%). Only 36 (32.4%) of the cultures showed bacterial agents, with Chlamydia present in 3. Treatment for infantile conjunctivitis, where recorded, included topical antibiotics in 523 (90.8%) and simple observation in 47 (8.2%). CONCLUSIONS Conjunctivitis in the first year of life occurred in approximately 10% of infants in this population-based cohort. More than half involved both eyes, one-quarter were identified in the first 30 days of life, and sight-threatening infectious agents were rare.
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Affiliation(s)
- Cole E Bothun
- From the Department of Ophthalmology, Mayo Clinic (C.E.B., S.A.M., B.G.M.), Rochester, Minnesota
| | - Sasha A Mansukhani
- From the Department of Ophthalmology, Mayo Clinic (C.E.B., S.A.M., B.G.M.), Rochester, Minnesota
| | - Timothy T Xu
- College of Medicine, Mayo Clinic (T.T.X., T.M.H.), Rochester, Minnesota
| | - Tina M Hendricks
- College of Medicine, Mayo Clinic (T.T.X., T.M.H.), Rochester, Minnesota
| | - David O Hodge
- Department of Quantitative Health Sciences, Mayo Clinic (D.O.H.), Jacksonville, Florida, USA
| | - Brian G Mohney
- From the Department of Ophthalmology, Mayo Clinic (C.E.B., S.A.M., B.G.M.), Rochester, Minnesota.
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9
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Affiliation(s)
| | - Sajeevika Amarakoon
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | - Arundhati Dev Borman
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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10
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Nyemba DC, Peters RPH, Medina-Marino A, Klausner JD, Ngwepe P, Myer L, Johnson LF, Joseph Davey DL. Impact of aetiological screening of sexually transmitted infections during pregnancy on pregnancy outcomes in South Africa. BMC Pregnancy Childbirth 2022; 22:194. [PMID: 35264142 PMCID: PMC8908701 DOI: 10.1186/s12884-022-04520-6] [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: 10/15/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) during pregnancy may increase the risk of adverse pregnancy outcomes. STI syndromic management is standard of care in South Africa but has its limitations. We evaluated the impact of diagnosing and treating curable STIs during pregnancy on adverse pregnancy and birth outcomes. METHODS We combined data from two prospective studies of pregnant women attending public sector antenatal care (ANC) clinics in Tshwane District and Cape Town, South Africa. Pregnant women were enrolled, tested and treated for STIs. We evaluated the association between any STI at the first ANC visit and a composite adverse pregnancy outcome (miscarriage, stillbirth, preterm birth, early neonatal death, or low birthweight) using modified Poisson regression models, stratifying by HIV infection and adjusting for maternal characteristics. RESULTS Among 619 women, 61% (n = 380) were from Tshwane District and 39% (n = 239) from Cape Town; 79% (n = 486) were women living with HIV. The prevalence of any STI was 37% (n = 228); C. trachomatis, 26% (n = 158), T. vaginalis, 18% (n = 120) and N. gonorrhoeae, 6% (n = 40). There were 93% (n = 574) singleton live births, 5% (n = 29) miscarriages and 2% (n = 16) stillbirths. Among the live births, there were 1% (n = 3) neonatal deaths, 7% (n = 35) low birthweight in full-term babies and 10% (n = 62) preterm delivery. There were 24% (n = 146) for the composite adverse pregnancy outcome. Overall, any STI diagnosis and treatment at first ANC visit was not associated with adverse outcomes in women living with HIV (adjusted relative risk (aRR); 1.43, 95% CI: 0.95-2.16) or women without HIV (aRR; 2.11, 95% CI: 0.89-5.01). However, C. trachomatis (aRR; 1.57, 95% CI: 1.04-2.39) and N. gonorrhoeae (aRR; 1.69, 95% CI: 1.09-3.08), were each independently associated with the composite adverse outcome in women living with HIV. CONCLUSION Treated STIs at the first ANC visit were not associated with adverse pregnancy outcome overall. In women living with HIV, C. trachomatis or N. gonorrhoeae at first ANC were each independently associated with adverse pregnancy outcome. Our results highlights complex interactions between the timing of STI detection and treatment, HIV infection and pregnancy outcomes, which warrants further investigation.
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Affiliation(s)
- Dorothy C Nyemba
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. .,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Remco P H Peters
- Research Unit, Foundation for Professional Development, East London, South Africa.,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.,Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Andrew Medina-Marino
- Research Unit, Foundation for Professional Development, East London, South Africa.,Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, University of Southern California, Keck School of Medicine, Los Angeles, USA
| | - Phuti Ngwepe
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Dvora L Joseph Davey
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Department of Preventive Medicine, Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA
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11
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Kim G, Kim TK, Carlson L. The Red Eye. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Nyemba DC, Haddison EC, Wang C, Johnson LF, Myer L, Davey DJ. Prevalence of curable STIs and bacterial vaginosis during pregnancy in sub-Saharan Africa: a systematic review and meta-analysis. Sex Transm Infect 2021; 98:484-491. [PMID: 34887350 DOI: 10.1136/sextrans-2021-055057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/12/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE STIs remain a global public health problem with a high burden among pregnant women. STIs in pregnant women may lead to various adverse pregnancy outcomes. In most sub-Saharan African countries, syndromic management is used for screening and treatment of STIs. We aimed to update and summarise pooled prevalence of curable STIs and bacterial vaginosis (BV) among pregnant women in sub-Saharan Africa. METHODS Electronic databases and reference lists of relevant published and unpublished studies were searched from March 2015 to October 2020. Studies were included if they estimated prevalence of Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), Neisseria gonorrhoeae (NG), Treponema pallidum (syphilis), Mycoplasma genitalium (MG) and BV among pregnant women in sub-Saharan Africa. Meta-analyses were performed with observed prevalences corrected for diagnostic errors to estimate the pooled prevalence of diagnosed infections by region. RESULTS A total of 48 studies met the inclusion criteria, providing 85-point prevalence estimates for curable STIs and BV. Pooled prevalence estimates (with 95% CI and number of women tested) were as follows: MG: 13.5% (4.0-27.2, n=1076); CT: 10.8% (6.9-15.5, n=6700); TV: 13.8% (10.0-18.0, n=9264); NG: 3.3% (2.1-4.7, n=6019); syphilis: 2.9% (2.0-4.0, n=95 308) and BV: 36.6% (27.1-46.6, n=5042). By region, BV was the most prevalent and ranged from 28.5% (24.5-32.8, n=1030) in Eastern Africa to 52.4% (33.5-70.9, n=2305) in Southern Africa; NG had the lowest prevalence, ranging from 1.4% (95% CI 0.1 to 3.1, n=367) in Central Africa to 4.4% (95% CI 2.6 to 6.4, n=4042) in Southern Africa. CONCLUSION The prevalence of curable STIs and BV in sub-Saharan Africa is substantial in pregnant women but most prevalent in Southern Africa where HIV prevalence is highest. It is crucial to integrate screening of curable STIs into antenatal care programmes that have previously focused on diagnosis and treatment of syphilis and HIV.
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Affiliation(s)
- Dorothy Chiwoniso Nyemba
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa .,Centre for Infectious Disease Epidemiology, University of Cape Town, Rondebosch, South Africa
| | - Eposi C Haddison
- Saa Health District, Centre Regional Delegation of Public Health, Buea, Cameroon
| | - Colin Wang
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Leigh Francis Johnson
- Centre for Infectious Disease Epidemiology, University of Cape Town, Rondebosch, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
| | - Dvora Joseph Davey
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa.,Department of Epidemiology, University of California Los Angeles, Los Angeles, California, USA
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Development and Evaluation of a Point-of-Care Test in a Low-Resource Setting with High Rates of Chlamydia trachomatis Urogenital Infections in Fiji. J Clin Microbiol 2021; 59:e0018221. [PMID: 33910964 PMCID: PMC8218753 DOI: 10.1128/jcm.00182-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Rapid and precise detection of Chlamydia trachomatis, the leading global cause of sexually transmitted infections (STI), at the point of care (POC) is required for treatment decisions to prevent transmission and sequelae, including pelvic inflammatory disease, ectopic pregnancy, tubal factor infertility, and preterm birth. We developed a rapid POC test (POCT), termed LH-POCT, which uses loop-mediated amplification (LAMP) of nucleic acids. We performed a head-to-head comparison with the Cepheid Xpert CT/NG assay using clinician-collected, deidentified paired vaginal samples from a parent study that consecutively enrolled symptomatic and asymptomatic females over 18 years of age from the Ministry of Health and Medical Services Health Centers in Fiji. Samples were processed by the Xpert CT/NG assay and LH-POCT, blinded to the comparator. Discrepant samples were resolved by quantitative PCR. Deidentified clinical data and tests for Trichomonas vaginalis, Candida, and bacterial vaginosis (BV) were provided. There were a total of 353 samples from 327 females. C. trachomatis positivity was 16.7% (59/353), while the prevalence was 16.82% (55/327) after discrepant resolution. Seven discrepant samples resolved to four false negatives, two false positives, and one true positive for the LH-POCT. The sensitivity of the LH-POCT was 93.65% (95% confidence interval [CI], 84.53% to 98.24%), and specificity was 99.31% (95% CI, 97.53% to 99.92%). Discrepant samples clustered among women with vaginal discharge and/or BV. The prototype LH-POCT workflow has excellent performance, meeting many World Health Organization ASSURED criteria for POC tests, including a sample-to-result time of 35 min. Our LH-POCT holds promise for improving clinical practice to prevent and control C. trachomatis STIs in diverse health care settings globally.
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Prophylactic Multi-Subunit Vaccine against Chlamydia trachomatis: In Vivo Evaluation in Mice. Vaccines (Basel) 2021; 9:vaccines9060609. [PMID: 34204170 PMCID: PMC8226540 DOI: 10.3390/vaccines9060609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 01/08/2023] Open
Abstract
Chlamydia trachomatis is the most frequent sexually-transmitted disease-causing bacterium. Urogenital serovars of this intracellular pathogen lead to urethritis and cervicitis. Ascending infections result in pelvic inflammatory disease, salpingitis, and oophoritis. One of 200 urogenital infections leads to tubal infertility. Serovars A–C cause trachoma with visual impairment. There is an urgent need for a vaccine. We characterized a new five-component subunit vaccine in a mouse vaccination-lung challenge infection model. Four recombinant Pmp family-members and Ctad1 from C. trachomatis serovar E, all of which participate in adhesion and binding of chlamydial elementary bodies to host cells, were combined with the mucosal adjuvant cyclic-di-adenosine monophosphate. Intranasal application led to a high degree of cross-serovar protection against urogenital and ocular strains of C. trachomatis, which lasted at least five months. Critical evaluated parameters were body weight, clinical score, chlamydial load, a granulocyte marker and the cytokines IFN-γ/TNF-α in lung homogenate. Vaccine antigen-specific antibodies and a mixed Th1/Th2/Th17 T cell response with multi-functional CD4+ and CD8+ T cells correlate with protection. However, serum-transfer did not protect the recipients suggesting that circulating antibodies play only a minor role. In the long run, our new vaccine might help to prevent the feared consequences of human C. trachomatis infections.
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15
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Boadi-Kusi SB, Kyei S, Holdbrook S, Abu EK, Ntow J, Ateko AM. A study of Ophthalmia Neonatorum in the Central Reion of Ghana: Causative Agents and Antibiotic Susceptibility Patterns. Glob Pediatr Health 2021; 8:2333794X211019700. [PMID: 34104699 PMCID: PMC8165866 DOI: 10.1177/2333794x211019700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In developing countries such as Ghana, ophthalmia neonatorum (ON) remains a public health concern. This is because of its unknown etiology patterns, the growing concerns of antibiotic resistance strains and the contribution of ON to childhood blindness. This study was therefore conducted to determine the causative agents, risk factors and the antibiotic sensitivity patterns of micro-organisms associated with ON. A clinic-based prospective study was conducted in the Maternal and Child Health units of 6 health care facilities in the Central region of Ghana over a period of 17 months. Conjunctival swabs were taken from all neonates with clinical signs of ON. Isolation and characterization of bacteria were done using standard microbiological methods. Additionally, data were collected and analyzed on neonate's demographics and clinical features of ON. Microbial growth was recorded in 86 cases (52.4%) out of the 110 neonates assessed. Staphylococcus spp. (39.2% of all positive cultures) was the most common causative organism. No case of gonococcus was isolated. Delivery method, vaginal discharge, administration of prophylaxis and weight of neonate were the risk factors associated with the development of ON (P < .05). The level of resistance to Tetracycline was found to be 73%. Neonatal conjunctivitis is more likely to be acquired postnatal. Culture and sensitivity testing are required as an important guide for treatment. The commonest causative organism, Staphylococcus spp., were found to be resistant to Teteracyline, therefore is the need to consider alternatives measures in the prevention and control of ON.
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Affiliation(s)
- Samuel Bert Boadi-Kusi
- Department of Optometry and Vision Science, School of Allied Health Science, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Kyei
- Department of Optometry and Vision Science, School of Allied Health Science, University of Cape Coast, Cape Coast, Ghana
| | - Selina Holdbrook
- Department of Optometry and Vision Science, School of Allied Health Science, University of Cape Coast, Cape Coast, Ghana
| | - Emmanuel Kwasi Abu
- Department of Optometry and Vision Science, School of Allied Health Science, University of Cape Coast, Cape Coast, Ghana
| | - Jonathan Ntow
- Department of Laboratory Technology, School of Physical Sciences, University of Cape Coast, Accra, Ghana
| | - Abena Mantebea Ateko
- Department of Optometry and Vision Science, School of Allied Health Science, University of Cape Coast, Cape Coast, Ghana
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16
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A primary Chlamydia trachomatis genital infection of rhesus macaques identifies new immunodominant B-cell antigens. PLoS One 2021; 16:e0250317. [PMID: 33886668 PMCID: PMC8061917 DOI: 10.1371/journal.pone.0250317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/05/2021] [Indexed: 01/09/2023] Open
Abstract
To identify immunodominant antigens that elicit a humoral immune response following a primary and a secondary genital infection, rhesus monkeys were inoculated cervically with Chlamydia trachomatis serovar D. Serum samples were collected and probed with a protein microarray expressing 864/894 (96.4%) of the open reading frames of the C. trachomatis serovar D genome. The antibody response to the primary infection was analyzed in 72 serum samples from 12 inoculated monkeys. The following criteria were utilized to identify immunodominant antigens: proteins found to be recognized by at least 75% (9/12) of the infected monkeys with at least 15% elevations in signal intensity from week 0 to week 8 post infection. All infected monkeys developed Chlamydia specific serum antibodies. Eight proteins satisfied the selection criteria for immunodominant antigens: CT242 (OmpH-like protein), CT541 (mip), CT681 (ompA), CT381 (artJ), CT443 (omcB), CT119 (incA), CT486 (fliY), and CT110 (groEL). Of these, three antigens, CT119, CT486 and CT381, were not previously identified as immunodominant antigens using non-human primate sera. Following the secondary infection, the antibody responses to the eight immunodominant antigens were analyzed and found to be quite different in intensity and duration to the primary infection. In conclusion, these eight immunodominant antigens can now be tested for their ability to identify individuals with a primary C. trachomatis genital infection and to design vaccine strategies to protect against a primary infection with this pathogen.
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17
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Peters RP, Feucht UD, de Vos L, Ngwepe P, McIntyre JA, Klausner JD, Medina-Marino A. Mother-to-child transmission of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis in HIV-infected pregnant women in South Africa. Int J STD AIDS 2021; 32:799-805. [PMID: 33769901 DOI: 10.1177/0956462421990218] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) can be transmitted from mother to neonate. We determined the frequency of mother-to-child transmission (MTCT) of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis to the newborn nasopharynx. METHODS This study was nested in a cohort study of etiologic testing versus syndromic management for STIs among pregnant women living with human immunodeficiency virus in South Africa. Mothers were tested for STIs using the GeneXpert platform within 60 days after delivery. Nasopharyngeal swabs were obtained from newborns of mothers with a positive STI test; these were then tested by Xpert® on the same day based on the maternal STI diagnosis. RESULTS We tested nasopharyngeal swabs from 85 STI-exposed newborns; 74 (87%) were tested within 2 weeks after birth (median five; range 2-12 days). MTCT frequency of any STI was 30/74 (41%); 43% (23/53) for C. trachomatis, 29% (2/7) for N. gonorrhoeae, and 24% (6/25) for T. vaginalis. Also, 4/11 (36%) swabs obtained between 14 and 60 days after delivery tested positive for STI. CONCLUSIONS There was a high frequency of MTCT of STIs to the nasopharynx of newborns in our setting. The impact of nasopharyngeal colonization and the benefits of STI testing on newborn health remain to be determined.
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Affiliation(s)
- Remco Ph Peters
- Foundation for Professional Development, Research Unit, East London, South Africa.,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.,Department of Medical Microbiology, Maastricht University Medical Centre, CAPRHI School of Public Health and Primary Care, Maastricht, South Africa
| | - Ute D Feucht
- Gauteng Department of Health, Pretoria, Tshwane District Clinical Specialist Team, Tshwane District Health Services, South Africa.,Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, Department of Paediatrics, University of Pretoria, Pretoria, South Africa.,Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Lindsey de Vos
- Foundation for Professional Development, Research Unit, East London, South Africa
| | - Phuti Ngwepe
- Foundation for Professional Development, Research Unit, East London, South Africa
| | - James A McIntyre
- Main Office, Anova Health Institute, Johannesburg, South Africa.,School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jeffrey D Klausner
- David Geffen School of Medicine, Division of Infectious Diseases: Global Health, University of California Los Angeles, Los Angeles, CA, USA.,Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrew Medina-Marino
- Foundation for Professional Development, Research Unit, East London, South Africa.,Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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18
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Poli-Neto OB, Carlos D, Favaretto A, Rosa-E-Silva JC, Meola J, Tiezzi D. Eutopic endometrium from women with endometriosis and chlamydial endometritis share immunological cell types and DNA repair imbalance: A transcriptome meta-analytical perspective. J Reprod Immunol 2021; 145:103307. [PMID: 33725527 DOI: 10.1016/j.jri.2021.103307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/03/2021] [Accepted: 03/01/2021] [Indexed: 12/21/2022]
Abstract
The aim of this study was to identify the key similarities between the eutopic endometrium of women with endometriosis and chlamydia-induced endometritis taking into account tissue microenvironment heterogeneity, transcript gene profile, and enriched pathways. A meta-analysis of whole transcriptome microarrays was performed using publicly available data, including samples containing both glandular and stromal endometrial components. Control samples were obtained from women without any reported pathological condition. Only samples obtained during the proliferative menstrual phase were included. Cellular tissue heterogeneity was predicted using a method that integrates gene set enrichment and deconvolution approaches. The batch effect was estimated by principal variant component analysis and removed using an empirical Bayes method. Differentially expressed genes were identified using an adjusted p-value < 0.05 and fold change = 1.5. The protein-protein interaction network was built using the STRING database and interaction score over 400. The Molecular Signatures Database was used to analyse the functional enrichment analysis. Both conditions showed similarities in cell types in the microenvironment, particularly CD4+ and CD8+ Tem cells, NKT cells, Th2 cells, basophils, and eosinophils. With regards to the regulation of cellular senescence and DNA integrity/damage checkpoint, which are commonly enriched pathways, 21 genes were down-regulated and directly related to DNA repair. Compared to the endometriosis samples, some chlamydial endometritis samples presented a lack of enriched immune pathways. Our results suggest that both conditions show similar distributions of microenvironment cell types, the downregulation of genes involved in DNA repair and cell cycle control, and pathways involved in immune response evasion.
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Affiliation(s)
- Omero Benedicto Poli-Neto
- Gynecological and Obstetrics Department, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, SP, Brazil.
| | - Daniela Carlos
- Biochemistry and Immunology Department, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, SP, 14049-900, Brazil
| | - Aureo Favaretto
- Gynecological and Obstetrics Department, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, SP, Brazil
| | - Julio Cesar Rosa-E-Silva
- Gynecological and Obstetrics Department, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, SP, Brazil
| | - Juliana Meola
- Gynecological and Obstetrics Department, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, SP, Brazil
| | - Daniel Tiezzi
- Gynecological and Obstetrics Department, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, SP, Brazil
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Kucova P, Kantor L, Fiserova K, Lasak J, Röderova M, Kolar M. Bacterial Pathogens and Evaluation of a Cut-Off for Defining Early and Late Neonatal Infection. Antibiotics (Basel) 2021; 10:278. [PMID: 33803288 PMCID: PMC7998728 DOI: 10.3390/antibiotics10030278] [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: 02/16/2021] [Revised: 03/04/2021] [Accepted: 03/07/2021] [Indexed: 12/02/2022] Open
Abstract
Bacterial infections are an important cause of mortality and morbidity in newborns. The main risk factors include low birth weight and prematurity. The study identified the most common bacterial pathogens causing neonatal infections including their resistance to antibiotics in the Neonatal Department of the University Hospital Olomouc. Additionally, the cut-off for distinguishing early- from late-onset neonatal infections was assessed. The results of this study show that a cut-off value of 72 h after birth is more suitable. Only in case of early-onset infections arising within 72 h of birth, initial antibiotic therapy based on gentamicin with ampicillin or amoxicillin/clavulanic acid may be recommended. It has been established that with the 72-h cut-off, late-onset infections caused by bacteria more resistant to antibiotics may be detected more frequently, a finding that is absolutely crucial for antibiotic treatment strategy.
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Affiliation(s)
- Pavla Kucova
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic; (P.K.); (K.F.); (M.R.); (M.K.)
| | - Lumir Kantor
- Neonatal Department, University Hospital Olomouc, 779 00 Olomouc, Czech Republic;
| | - Katerina Fiserova
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic; (P.K.); (K.F.); (M.R.); (M.K.)
| | - Jakub Lasak
- Neonatal Department, University Hospital Olomouc, 779 00 Olomouc, Czech Republic;
| | - Magdalena Röderova
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic; (P.K.); (K.F.); (M.R.); (M.K.)
| | - Milan Kolar
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic; (P.K.); (K.F.); (M.R.); (M.K.)
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20
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Gildea D, Goetz R, Drew R, Chamney S. Ophthalmia neonatorum in a tertiary referral children's hospital: A retrospective study. Eur J Ophthalmol 2021; 32:587-591. [PMID: 33583215 DOI: 10.1177/1120672121994734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the aetiology, investigation and management of ophthalmia neonatorum (ON) presenting to a tertiary referral children's hospital over 5 years. METHODS The eye swab data of all neonates presenting to Children's Health Ireland at Temple Street (Dublin, Ireland) between 1st January 2013 and 3rd September 2018 was analysed. The medical records of all patients with positive eye swab results were retrospectively reviewed. RESULTS A total of 157 neonates had positive eye swab results. 54 cases were identified as ON. Chlamydia trachomatis (20.4%) was the most common organism identified, followed by Staphylococcus aureus (18.5%), Haemophilus influenzae (14.8%), Moraxella catarrhalis (7.4%), Streptococcus pneumoniae (5.6%), Escherischia coli (3.7%), Klebsiella pneumoniae (1.9%) and Pseudomonas aeruginosa (1.9%). A bacterial culture swab was tested in all cases (100%), a C. trachomatis/N. gonorrhoeae PCR swab in 70.4% and a viral PCR swab in 35.2%. On subanalysis of the cases that had C. trachomatis/N. gonorrhoeae PCR testing, C. trachomatis was responsible for 28.9% of cases. 50% of cases were hospitalised, intravenous antibiotics were administered in 46.3% and macrolide therapy was prescribed in 38.9%. CONCLUSIONS C. trachomatis was the most common cause of ON in this study and may be responsible for an even higher proportion of cases due to incomplete testing. In keeping with studies in different populations, S. aureus, H. influenzae and S. pneumoniae were also common. As a result, an improved management algorithm for cases of ON has been introduced in this centre.
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Affiliation(s)
- David Gildea
- Department of Ophthalmology, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Reinold Goetz
- Department of Ophthalmology, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Richard Drew
- Children's Health Ireland at Temple Street, Dublin, Ireland.,Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland.,Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sarah Chamney
- Department of Ophthalmology, Children's Health Ireland at Temple Street, Dublin, Ireland
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21
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Infección respiratoria por Chlamydia trachomatis, a propósito de 4 casos. Enferm Infecc Microbiol Clin 2020; 38:454-455. [DOI: 10.1016/j.eimc.2020.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Ophthalmia neonatorum is an infection of the eyes in newborns that can lead to blindness, particularly if the infection is caused by Neisseria gonorrhoeae. Antiseptic or antibiotic medication is dispensed into the eyes of newborns, or dispensed systemically, soon after delivery to prevent neonatal conjunctivitis and potential vision impairment. OBJECTIVES 1. To determine if any type of systemic or topical eye medication is better than placebo or no prophylaxis in preventing ophthalmia neonatorum. 2. To determine if any one systemic or topical eye medication is better than any other medication in preventing ophthalmia neonatorum. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, LILACS, and three trials registers, date of last search 4 October 2019. We also searched references of included studies and contacted pharmaceutical companies. SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials of any topical, systemic, or combination medical interventions used to prevent ophthalmia neonatorum in newborns compared with placebo, no prophylaxis, or with each other. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. Outcomes were: blindness or any adverse visual outcome at 12 months, conjunctivitis at 1 month (gonococcal (GC), chlamydial (CC), bacterial (BC), any aetiology (ACAE), or unknown aetiology (CUE)), and adverse effects. MAIN RESULTS: We included 30 trials with a total of 79,198 neonates. Eighteen studies were conducted in high-income settings (the USA, Europe, Israel, Canada), and 12 were conducted in low- and middle-income settings (Africa, Iran, China, Indonesia, Mexico). Fifteen of the 30 studies were quasi-randomised. We judged every study to be at high risk of bias in at least one domain. Ten studies included a comparison arm with no prophylaxis. There were 14 different prophylactic regimens and 12 different medications in the 30 included studies. Any prophylaxis compared to no prophylaxis Unless otherwise indicated, the following evidence comes from studies assessing one or more of the following interventions: tetracycline 1%, erythromycin 0.5%, povidone-iodine 2.5%, silver nitrate 1%. None of the studies reported data on the primary outcomes: blindness or any adverse visual outcome at any time point. There was only very low-certainty evidence on the risk of GC with prophylaxis (4/5340 newborns) compared to no prophylaxis (5/2889) at one month (risk ratio (RR) 0.79, 95% confidence interval (CI) 0.24 to 2.65, 3 studies). Low-certainty evidence suggested there may be little or no difference in effect on CC (RR 0.96, 95% CI 0.57 to 1.61, 4874 newborns, 2 studies) and BC (RR 0.84, 95% CI 0.37 to 1.93, 3685 newborns, 2 studies). Moderate-certainty evidence suggested a probable reduction in risk of ACAE at one month (RR 0.65, 95% 0.54 to 0.78, 9666 newborns, 8 studies assessing tetracycline 1%, erythromycin 0.5%, povidone-iodine 2.5%, silver nitrate 1%, colostrum, bacitracin-phenacaine ointment). There was only very low-certainty evidence on CUE (RR 1.75, 95% CI 0.37 to 8.28, 330 newborns, 1 study). Very low-certainty evidence on adverse effects suggested no increased nasolacrimal duct obstruction (RR 0.93, 95% CI 0.68 to 1.28, 404 newborns, 1 study of erythromycin 0.5% and silver nitrate 1%) and no increased keratitis (single study of 40 newborns assessing silver nitrate 1% with no events). Any prophylaxis compared to another prophylaxis Overall, evidence comparing different interventions did not suggest any consistently superior intervention. However, most of this evidence was of low-certainty and was extremely limited. AUTHORS' CONCLUSIONS There are no data on whether prophylaxis for ophthalmia neonatorum prevents serious outcomes such as blindness or any adverse visual outcome. Moderate-certainty evidence suggests that the use of prophylaxis may lead to a reduction in the incidence of ACAE in newborns but the evidence for effect on GC, CC or BC was less certain. Comparison of individual interventions did not suggest any consistently superior intervention, but data were limited. A trial comparing tetracycline, povidone-iodine (single administration), and chloramphenicol for GC and CC could potentially provide the community with an effective, universally applicable prophylaxis against ophthalmia neonatorum.
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Affiliation(s)
| | - Jennifer R Evans
- Cochrane Eyes and Vision, ICEH, London School of Hygiene & Tropical Medicine, London, UK
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23
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Azari AA, Arabi A. Conjunctivitis: A Systematic Review. J Ophthalmic Vis Res 2020; 15:372-395. [PMID: 32864068 PMCID: PMC7431717 DOI: 10.18502/jovr.v15i3.7456] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/25/2020] [Indexed: 01/10/2023] Open
Abstract
Conjunctivitis is a commonly encountered condition in ophthalmology clinics throughout the world. In the management of suspected cases of conjunctivitis, alarming signs for more serious intraocular conditions, such as severe pain, decreased vision, and painful pupillary reaction, must be considered. Additionally, a thorough medical and ophthalmic history should be obtained and a thorough physical examination should be done in patients with atypical findings and chronic course. Concurrent physical exam findings with relevant history may reveal the presence of a systemic condition with involvement of the conjunctiva. Viral conjunctivitis remains to be the most common overall cause of conjunctivitis. Bacterial conjunctivitis is encountered less frequently and it is the second most common cause of infectious conjunctivitis. Allergic conjunctivitis is encountered in nearly half of the population and the findings include itching, mucoid discharge, chemosis, and eyelid edema. Long-term usage of eye drops with preservatives in a patient with conjunctival irritation and discharge points to the toxic conjunctivitis as the underlying etiology. Effective management of conjunctivitis includes timely diagnosis, appropriate differentiation of the various etiologies, and appropriate treatment.
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Affiliation(s)
- Amir A Azari
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Arabi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Pal S, Ausar SF, Tifrea DF, Cheng C, Gallichan S, Sanchez V, de la Maza LM, Visan L. Protection of outbred mice against a vaginal challenge by a Chlamydia trachomatis serovar E recombinant major outer membrane protein vaccine is dependent on phosphate substitution in the adjuvant. Hum Vaccin Immunother 2020; 16:2537-2547. [PMID: 32118511 PMCID: PMC7644203 DOI: 10.1080/21645515.2020.1717183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
Chlamydia trachomatis is the most common bacterial sexually-transmitted pathogen for which there is no vaccine. We previously demonstrated that the degree of phosphate substitution in an aluminum hydroxide adjuvant in a TLR-4-based C. trachomatis serovar E (Ser E) recombinant major outer membrane protein (rMOMP) formulation had an impact on the induced antibody titers and IFN-γ levels. Here, we have extended these observations using outbreed CD-1 mice immunized with C. trachomatis Ser E rMOMP formulations to evaluate the impact on bacterial challenge. The results confirmed that the rMOMP vaccine containing the adjuvant with the highest phosphate substitution induced the highest neutralizing antibody titers while the formulation with the lowest phosphate substitution induced the highest IFN-γ production. The most robust protection was observed in mice vaccinated with the formulation containing the adjuvant with the lowest phosphate substitution, as shown by the number of mice with positive vaginal cultures, number of positive cultures and number of C. trachomatis inclusion forming units recovered. This is the first report showing that vaccination of an outbred strain of mice with rMOMP induces protection against a vaginal challenge with C. trachomatis.
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Affiliation(s)
- Sukumar Pal
- Department of Pathology and Laboratory Medicine, University of California , Irvine, CA, USA
| | | | - Delia F Tifrea
- Department of Pathology and Laboratory Medicine, University of California , Irvine, CA, USA
| | - Chunmei Cheng
- Department of Pathology and Laboratory Medicine, University of California , Irvine, CA, USA
| | - Scott Gallichan
- Analytical Research and Development Department, Sanofi Pasteur , Toronto, Ontario, Canada
| | - Violette Sanchez
- Research & Non Clinical Safety Department, Sanofi Pasteur , Marcy l'Etoile, France
| | - Luis M de la Maza
- Department of Pathology and Laboratory Medicine, University of California , Irvine, CA, USA
| | - Lucian Visan
- Research & Non Clinical Safety Department, Sanofi Pasteur , Marcy l'Etoile, France
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25
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The Red Eye. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_76-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Characterization of the Horizontal and Vertical Sexual Transmission of Chlamydia Genital Infections in a New Mouse Model. Infect Immun 2019; 87:IAI.00834-18. [PMID: 30833332 DOI: 10.1128/iai.00834-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/19/2019] [Indexed: 12/20/2022] Open
Abstract
Chlamydia trachomatis is the most common sexually transmitted bacterial pathogen worldwide, and there is a need to control this epidemic. So far there is no established animal model in which both the horizontal and the vertical transmission of Chlamydia can be studied. To implement a horizontal sexual transmission model, male mice were inoculated in the meatus urethra with Chlamydia muridarum and they were caged with naive female mice. Urine and vaginal swab specimens were collected for culture. To study vertical transmission, newborns were euthanized and specimens were cultured. As controls, females were mated with sham-infected male mice. All C. muridarum-inoculated male mice had positive urine cultures. As determined by serology, all females caged with C. muridarum-inoculated males became infected, and 93% of them had positive vaginal swab specimen cultures. More females mated with C. muridarum-infected male mice (35%) than females mated with sham-infected male mice (0%) were infertile (P < 0.05). Also, C. muridarum-infected females delivered significantly fewer pups (3.8 ± 3.2/mouse) than control females (6.3 ± 1.6/mouse) (P < 0.05). Of the newborn mice, 32% were C. muridarum positive either in the lungs or in the intestines. Female mice housed with sham-infected males had no positive vaginal swab specimen cultures or C. muridarum-positive pups. This new mouse model of horizontal and vertical sexual transmission of Chlamydia closely parallels C. trachomatis sexual transmission in humans and may be a good model system to better understand the pathogenesis of these infections.
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Panzetta ME, Luján AL, Bastidas RJ, Damiani MT, Valdivia RH, Saka HA. Ptr/CTL0175 Is Required for the Efficient Recovery of Chlamydia trachomatis From Stress Induced by Gamma-Interferon. Front Microbiol 2019; 10:756. [PMID: 31024512 PMCID: PMC6467971 DOI: 10.3389/fmicb.2019.00756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/26/2019] [Indexed: 12/26/2022] Open
Abstract
Chlamydia trachomatis is the most common sexually transmitted bacterial pathogen in humans and a frequent cause of asymptomatic, persistent infections leading to serious complications, particularly in young women. Chlamydia displays a unique obligate intracellular lifestyle involving the infectious elementary body and the replicative reticulate body. In the presence of stressors such as gamma-interferon (IFNγ) or beta-lactam antibiotics, C. trachomatis undergoes an interruption in its replication cycle and enters a viable but non-cultivable state. Upon removal of the stressors, surviving C. trachomatis resume cell division and developmental transitions. In this report, we describe a genetic screen to identify C. trachomatis mutants with defects in recovery from IFNγ- and/or penicillin-induced stress and characterized a chemically derived C. trachomatis mutant strain that exhibited a significant decrease in recovery from IFNγ- but not penicillin-induced stress. Through lateral gene transfer and targeted insertional gene inactivation we identified ptr, encoding a predicted protease, as a gene required for recovery from IFNγ-induced stress. A C. trachomatis LGV-L2 ptr-null strain displayed reduced generation of infectious progeny and impaired genome replication upon removal of IFNγ. This defect was restored by introducing a wild type copy of ptr on a plasmid, indicating that Ptr is required for a rapid growth upon removal of IFNγ. Ptr was expressed throughout the developmental cycle and localized to the inclusion lumen. Overall, our findings indicate that the putative secreted protease Ptr is required for C. trachomatis to specifically recover from IFNγ- but not penicillin-induced stress.
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Affiliation(s)
- María E Panzetta
- Centro de Investigaciones en Bioquímica Clínica e Inmunología, CONICET, Córdoba, Argentina.,Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Agustín L Luján
- Instituto de Medicina y Biología Experimental de Cuyo, CONICET, Mendoza, Argentina.,Área de Química Biológica, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Mendoza, Argentina
| | - Robert J Bastidas
- Center for Host-Microbe Interactions, Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, United States
| | - María T Damiani
- Instituto de Medicina y Biología Experimental de Cuyo, CONICET, Mendoza, Argentina.,Área de Química Biológica, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Mendoza, Argentina
| | - Raphael H Valdivia
- Center for Host-Microbe Interactions, Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, United States
| | - Héctor A Saka
- Centro de Investigaciones en Bioquímica Clínica e Inmunología, CONICET, Córdoba, Argentina.,Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
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Sánchez-Anguiano LF, Velázquez-Hernández N, Guerra-Infante FM, Aguilar-Durán M, Pérez-Álamos AR, Estrada-Martínez S, Navarrete-Flores JA, Sandoval-Carrillo AA, Antuna-Salcido EI, Hernández-Tinoco J, Alvarado-Esquivel C. Prevalence of Chlamydia trachomatis Infection Diagnosed by Polymerase Chain Reaction in Female Sex Workers in a Northern Mexican City. Eur J Microbiol Immunol (Bp) 2019; 9:5-8. [PMID: 30967969 PMCID: PMC6444802 DOI: 10.1556/1886.2018.00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 01/21/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose We aimed to determine the association between Chlamydia trachomatis infection and female sex work, and the association between sociodemographic, obstetric, and behavioral characteristics of female sex workers and C. trachomatis infection. Methods Through a case–control study design, we studied 201 female sex workers and 201 age-matched women without sex work in Durango City, Mexico. C. trachomatis DNA was detected in cervical swab samples using polymerase chain reaction. Results C. trachomatis DNA was detected in 32 (15.9%) of the 201 cases and in 6 (3.0%) of the 201 controls (odds ratio [OR] = 6.15; 95% confidence interval [CI]: 2.5–15.0; P < 0.001). The frequency of infection with C. trachomatis in female sex workers did not vary (P > 0.05) regardless of the history of pregnancies, deliveries, cesarean sections, or miscarriages. Regression analysis of the behavioral characteristics showed that infection with C. trachomatis was associated only with consumption of alcohol (OR = 2.39; 95% CI: 1.0–5.71; P = 0.04). Conclusions: We conclude that C. trachomatis infection is associated with female sex work in Durango City, Mexico. This is the first age-matched case–control study on the prevalence of C. trachomatis infection in female sex workers in Mexico using detection of C. trachomatis DNA in cervical samples.
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Affiliation(s)
- Luis Francisco Sánchez-Anguiano
- Institute for Scientific Research "Dr. Roberto Rivera-Damm ", Juárez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - Nadia Velázquez-Hernández
- Institute for Scientific Research "Dr. Roberto Rivera-Damm ", Juárez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - Fernando Martín Guerra-Infante
- Departamento de Infectología, Laboratorio de Virología del Instituto Nacional de Perinatología, Departamento de Microbiología de la Escuela Nacional de Ciencias Biólogicas, Instituto Politécnico Nacional, D.F México
| | - Marisela Aguilar-Durán
- Institute for Scientific Research "Dr. Roberto Rivera-Damm ", Juárez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - Alma Rosa Pérez-Álamos
- Institute for Scientific Research "Dr. Roberto Rivera-Damm ", Juárez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - Sergio Estrada-Martínez
- Institute for Scientific Research "Dr. Roberto Rivera-Damm ", Juárez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - José Antonio Navarrete-Flores
- Institute for Scientific Research "Dr. Roberto Rivera-Damm ", Juárez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - Ada Agustina Sandoval-Carrillo
- Institute for Scientific Research "Dr. Roberto Rivera-Damm ", Juárez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - Elizabeth Irasema Antuna-Salcido
- Institute for Scientific Research "Dr. Roberto Rivera-Damm ", Juárez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - Jesús Hernández-Tinoco
- Faculty of Medicine and Nutrition, Juárez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - Cosme Alvarado-Esquivel
- Faculty of Medicine and Nutrition, Juárez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
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Panzetta ME, Valdivia RH, Saka HA. Chlamydia Persistence: A Survival Strategy to Evade Antimicrobial Effects in-vitro and in-vivo. Front Microbiol 2018; 9:3101. [PMID: 30619180 PMCID: PMC6299033 DOI: 10.3389/fmicb.2018.03101] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/30/2018] [Indexed: 11/13/2022] Open
Abstract
The Chlamydiaceae comprise a group of highly adapted bacterial pathogens sharing a unique intracellular lifestyle. Three Chlamydia species are pathogenic to humans: Chlamydia trachomatis, Chlamydia pneumoniae, and Chlamydia psittaci. C. trachomatis is the leading bacterial cause of sexually-transmitted infections and infectious blindness worldwide. Chlamydia pneumoniae is a major cause of community-acquired atypical pneumonia. C. psittaci primarily affects psittacine birds and can be transmitted to humans causing psittacosis, a potentially fatal form of pneumonia. As opposed to other bacterial pathogens, the spread of clinically relevant antimicrobial resistance genes does not seem to be a major problem for the treatment of Chlamydia infections. However, when exposed to stressing conditions, like those arising from exposure to antimicrobial stimuli, these bacteria undergo a temporary interruption in their replication cycle and enter a viable but non-cultivable state known as persistence. When the stressing conditions are removed, Chlamydia resumes replication and generation of infectious particles. This review gives an overview of the different survival strategies used by Chlamydia to evade the deleterious effects of penicillin and IFNγ, with a focus on the different models used to study Chlamydia persistence, their contribution to elucidating the molecular basis of this complex phenomenon and their potential implications for studies in animal models of infection.
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Affiliation(s)
- Maria Emilia Panzetta
- CIBICI-CONICET, Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Raphael H. Valdivia
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, United States
| | - Hector Alex Saka
- CIBICI-CONICET, Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
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30
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Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections among pregnant women and eye colonization of their neonates at birth time, Shiraz, Southern Iran. BMC Infect Dis 2018; 18:477. [PMID: 30249196 PMCID: PMC6154405 DOI: 10.1186/s12879-018-3382-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 09/13/2018] [Indexed: 11/19/2022] Open
Abstract
Background Chlamydia trachomatis and Neisseria gonorrhoeae are the two common transmissible pathogens from pregnant women to their neonates. Given the lack of routine screening and treatment of pregnant women in some areas, the possibility of transmission rises. This study seeks to determine the prevalence of C. trachomatis and N. gonorrhoeae in the pregnant women with no clinical symptoms and the vertical transmission rate to their neonates. Methods The study was conducted on endocervical and eye swab samples of 239 pregnant women and their neonates. Identification was based on PCR method. Results The prevalence rates of C.trachomatis in women and neonates were 37/239 (15.5%) and 28/239 (11.7%), and for N. gonorrhoeae 3/239 (1.3%), 1/239 (0.4%), respectively. The vertical transmission rates to the neonates were 28/37(75.6%) for C. trachomatis and 1/3 for N. gonorrhoeae. Conclusions In the areas with a high prevalence of chlamydial or gonococcal infections, and in the absence of screening and treatment of the pregnant women, ocular prophylaxis with antibiotics is suggested as a part of routine neonatal care program for the prevention of chlamydial and gonococcal ophthalmia.
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Zikic A, Schünemann H, Wi T, Lincetto O, Broutet N, Santesso N. Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-analysis. J Pediatric Infect Dis Soc 2018; 7:e107-e115. [PMID: 30007329 PMCID: PMC6097578 DOI: 10.1093/jpids/piy060] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/25/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND With the continued high prevalence of chlamydia worldwide and high risk of transfer from mothers to their infant during delivery, a need for safe and effective therapies for infants who acquire a chlamydial infection remains. We conducted a systematic review and meta-analysis of antibiotic treatments, including oral erythromycin, azithromycin, and trimethoprim, for neonatal chlamydial conjunctivitis. METHODS We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) from their inception to July 14, 2017. We included randomized and nonrandomized studies that evaluated the effects of erythromycin, azithromycin, or trimethoprim in neonates with chlamydial conjunctivitis. A meta-analysis using a random-effects generic inverse-variance method was performed, and the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS We found 12 studies (n = 292 neonates) and were able to meta-analyze 7 studies that used erythromycin at a dose of 50 mg/kg body weight per day for 14 days. The clinical and microbiological cure were 96% (95% confidence interval [CI], 94%-100%) and 97% (95% CI, 95%-99%), respectively, and adverse gastrointestinal effects occurred in 14% (95% CI, 1%-28%) of the neonates. The microbiological cure in the study that assessed azithromycin at 20 mg/kg per day were 60% (95% CI, 27%-93%) when it was given in a single dose and 86% (95% CI, 61%-100%) when given in a 3-day course. Two studies reported compliance with treatments, and 1 study reported no pyloric stenosis events. Because of the risk of bias and the few neonates included across the studies, the certainty of evidence is low to very low. No studies assessed trimethoprim. CONCLUSIONS Although evidence suggests that erythromycin at 50 mg/kg per day for 14 days results in higher numbers of cure than does azithromycin, compliance and risk of pyloric stenosis related to their use for other infections in neonates will factor into treatment recommendations. More data are needed to compare these treatments directly.
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Affiliation(s)
- Andrew Zikic
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Teodora Wi
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ornella Lincetto
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Influence of different delivery modes on the clinical characteristics of Chlamydia trachomatis pneumonia. Eur J Pediatr 2018; 177:1255-1260. [PMID: 29850935 DOI: 10.1007/s00431-018-3147-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/28/2018] [Accepted: 04/05/2018] [Indexed: 10/14/2022]
Abstract
UNLABELLED We analyzed the effects of delivery methods on Chlamydia trachomatis pneumonia in infants. Three hundred forty-four children hospitalized with Chlamydia trachomatis pneumonia were enrolled. They were divided into the vaginal delivery group and the cesarean delivery group. We compared and analyzed their age of onset, peripheral blood white blood cell count, liver enzymes, chlamydia trachomatis titers, and chest radiograph scores. Seventy-eight (22.7%) were delivered by a cesarean, and 266 (77.3%) were delivered vaginally. There were no statistically significant differences between groups when compared by sex and age (P > 0.05). Copy numbers and white blood cell counts in the peripheral blood of children with Chlamydia trachomatis in respiratory secretions of the vaginal delivery group were significantly higher than those of the cesarean delivery group (P < 0.05). The alanine aminotransferase and aspartate aminotransferase levels between groups were not statistically significant. Comparisons of admission chest radiography scores, discharge radiography scores, and score differences showed no statistical differences (P > 0.05). CONCLUSION Infants delivered by cesarean comprise approximately one-fifth of those affected. The Chlamydia trachomatis titers and peripheral blood leukocyte counts of the vaginal delivery group were higher than those of the cesarean delivery group. Age of onset, liver enzymes, pulmonary inflammation, and pneumonia absorption were not different between groups. What is Known: • Chlamydia trachomatis is an important pathogen that causes lower respiratory tract infections in infants. • C. trachomatis is primarily transmitted to infants through the infected mother, resulting in Chlamydia trachomatis pneumonia subsequently. What is New: • Vaginal delivery and cesarean delivery can result in Chlamydia trachomatis pneumonia transmission; however, cesarean delivery accounts for ~ 20% of cases. • C. trachomatis volume in the respiratory tract and the number of peripheral blood leukocytes in infants delivered vaginally were higher than those in infants delivered by cesarean.
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Honkila M, Renko M, Ikäheimo I, Pokka T, Uhari M, Tapiainen T. Aetiology of neonatal conjunctivitis evaluated in a population-based setting. Acta Paediatr 2018; 107:774-779. [PMID: 29345007 PMCID: PMC7159510 DOI: 10.1111/apa.14227] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/21/2017] [Accepted: 01/12/2018] [Indexed: 12/05/2022]
Abstract
Aim Our aim was to study prospectively the aetiology of neonatal conjunctivitis in a population‐based setting. Methods Altogether 173 neonates with clinical conjunctivitis aged on average 20 (SD 10) days were recruited from child welfare clinics in Oulu, Finland, in 2010–2015. Conjunctival specimens were collected from 167 neonates for multiplex polymerase chain reaction to detect 16 respiratory viruses, from 163 for polymerase chain reaction to detect Chlamydia trachomatis and Neisseria gonorrhoeae and from 160 for bacterial culture studies. The cases were followed up until the age of 18 months. Results Viral conjunctivitis was diagnosed in 8/167 (4.8%; 95% CI 2.1–9.2%), chlamydial or gonococcal conjunctivitis in 0/163 cases (0%; 95% CI 0–2.2%) and other bacterial conjunctivitis in 58/160 (36%; 95% CI 29–44%). Rhinovirus was found at the ocular site in 4/167 (2.4%) neonates, adenovirus in 3/167 (1.8%) and bocavirus in 1/167 (0.6%). The most commonly isolated bacteria included Staphylococcus aureus (16%), Moraxella catarrhalis (9.4%) and Streptococcus pneumoniae (3.1%). None of these pathogens was associated with the 4/173 (2.3%) cases later operated on for persistent nasolacrimal duct obstruction. Conclusion Chlamydia trachomatis was a rare pathogen in neonatal conjunctivitis in a population‐based setting, but respiratory viruses were detected more frequently than indicated earlier.
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Affiliation(s)
- Minna Honkila
- Department of Children and Adolescents; Oulu University Hospital; Oulu Finland
- PEDEGO Research Unit and Medical Research Center Oulu; University of Oulu; Oulu Finland
| | - Marjo Renko
- Department of Children and Adolescents; Oulu University Hospital; Oulu Finland
- PEDEGO Research Unit and Medical Research Center Oulu; University of Oulu; Oulu Finland
| | - Irma Ikäheimo
- NordLab Oulu; Oulu University Hospital; Oulu Finland
| | - Tytti Pokka
- Department of Children and Adolescents; Oulu University Hospital; Oulu Finland
- PEDEGO Research Unit and Medical Research Center Oulu; University of Oulu; Oulu Finland
| | - Matti Uhari
- Department of Children and Adolescents; Oulu University Hospital; Oulu Finland
- PEDEGO Research Unit and Medical Research Center Oulu; University of Oulu; Oulu Finland
| | - Terhi Tapiainen
- Department of Children and Adolescents; Oulu University Hospital; Oulu Finland
- PEDEGO Research Unit and Medical Research Center Oulu; University of Oulu; Oulu Finland
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Hansbro PM, Kim RY, Starkey MR, Donovan C, Dua K, Mayall JR, Liu G, Hansbro NG, Simpson JL, Wood LG, Hirota JA, Knight DA, Foster PS, Horvat JC. Mechanisms and treatments for severe, steroid-resistant allergic airway disease and asthma. Immunol Rev 2018; 278:41-62. [PMID: 28658552 DOI: 10.1111/imr.12543] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Severe, steroid-resistant asthma is clinically and economically important since affected individuals do not respond to mainstay corticosteroid treatments for asthma. Patients with this disease experience more frequent exacerbations of asthma, are more likely to be hospitalized, and have a poorer quality of life. Effective therapies are urgently required, however, their development has been hampered by a lack of understanding of the pathological processes that underpin disease. A major obstacle to understanding the processes that drive severe, steroid-resistant asthma is that the several endotypes of the disease have been described that are characterized by different inflammatory and immunological phenotypes. This heterogeneity makes pinpointing processes that drive disease difficult in humans. Clinical studies strongly associate specific respiratory infections with severe, steroid-resistant asthma. In this review, we discuss key findings from our studies where we describe the development of representative experimental models to improve our understanding of the links between infection and severe, steroid-resistant forms of this disease. We also discuss their use in elucidating the mechanisms, and their potential for developing effective therapeutic strategies, for severe, steroid-resistant asthma. Finally, we highlight how the immune mechanisms and therapeutic targets we have identified may be applicable to obesity-or pollution-associated asthma.
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Affiliation(s)
- Philip M Hansbro
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and The University of Newcastle, Newcastle, NSW, Australia
| | - Richard Y Kim
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and The University of Newcastle, Newcastle, NSW, Australia
| | - Malcolm R Starkey
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and The University of Newcastle, Newcastle, NSW, Australia
| | - Chantal Donovan
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and The University of Newcastle, Newcastle, NSW, Australia
| | - Kamal Dua
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and The University of Newcastle, Newcastle, NSW, Australia
| | - Jemma R Mayall
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and The University of Newcastle, Newcastle, NSW, Australia
| | - Gang Liu
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and The University of Newcastle, Newcastle, NSW, Australia
| | - Nicole G Hansbro
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and The University of Newcastle, Newcastle, NSW, Australia
| | - Jodie L Simpson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and The University of Newcastle, Newcastle, NSW, Australia
| | - Lisa G Wood
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and The University of Newcastle, Newcastle, NSW, Australia
| | - Jeremy A Hirota
- James Hogg Research Centre, University of British Columbia, Vancouver, BC, Canada
| | - Darryl A Knight
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and The University of Newcastle, Newcastle, NSW, Australia
| | - Paul S Foster
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and The University of Newcastle, Newcastle, NSW, Australia
| | - Jay C Horvat
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and The University of Newcastle, Newcastle, NSW, Australia
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Surface enhanced Raman spectroscopy of Chlamydia trachomatis and Neisseria gonorrhoeae for diagnostics, and extra-cellular metabolomics and biochemical monitoring. Sci Rep 2018; 8:5163. [PMID: 29581560 PMCID: PMC5980109 DOI: 10.1038/s41598-018-23562-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/13/2018] [Indexed: 12/11/2022] Open
Abstract
SERS spectra excited at 785 nm of the bacteria Chlamydia trahomatis (elementary bodies, EB) and Neisseria gonorrheoae, the causative pathogens for the two most common sexually transmitted diseases (STD), chlamydia and gonorrhea, respectively, are reported. Although both are Gram-negative bacteria, the SERS signatures of C. trachomatis and N. gonorrheoae are completely different. N. gonorrheoae SERS spectra are due to the starvation induced nucleotide metabolites adenine and guanine, and the surface associated co-enzyme nicotinamide adenine dinucleotide and are very similar on Au and Ag although the spectrum appears more rapidly on Ag. The C. trachomatis SERS spectrum is dominated by the vibrational features of cell surface proteins. While features attributable to specific residues and the amide backbone characterize the C. trachomatis spectrum on Ag, the corresponding SERS spectrum on Au substrates displays vibrational characteristics of aggregated proteins. The prospects for the development of a SERS based platform for rapid (<one hour), low-cost bacterial STD diagnostics are promising based on these initial studies. Furthermore, this biomedical application demonstrates the potential for SERS to be a sensitive real time probe of the dynamics of biochemical activity in the cell wall and extracellular regions of microorganisms.
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Bühl H, Eibach D, Nagel M, Greub G, Borel N, Sarpong N, Rettig T, Pesch T, Aeby S, Klöckner A, Brunke M, Krannich S, Kreuels B, Owusu-Dabo E, Hogan B, May J, Henrichfreise B. Chlamydiae in febrile children with respiratory tract symptoms and age-matched controls, Ghana. New Microbes New Infect 2018; 22:44-48. [PMID: 29511568 PMCID: PMC5832669 DOI: 10.1016/j.nmni.2017.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/30/2017] [Accepted: 12/21/2017] [Indexed: 11/29/2022] Open
Abstract
Members of the Chlamydiales order are obligate intracellular pathogens causing acute and chronic infectious diseases. Chlamydiaceae are established agents of community- and zoonotically acquired respiratory tract infections, and emerging pathogens among the Chlamydia-related bacteria have been implicated in airway infections. The role of both in airway infections in Africa is underexplored. We performed a case -control study on the prevalence of Chlamydiaceae and Chlamydia-related emerging pathogens in children with febrile respiratory tract infections in West Africa, Ghana. Using a pan-Chlamydiales broad-range real-time PCR, we detected chlamydial DNA in 11 (1.9%) of 572 hospitalized febrile children with respiratory tract symptoms and in 24 (4.3%) of 560 asymptomatic age-matched controls (p 0.03). Chlamydiaceae were found to be common among both symptomatic and healthy Ghanaian children, with Chlamydia pneumoniae being the most prevalent species. Parachlamydiaceae were detected in two children without symptoms but not in the symptomatic group. We identified neither Chlamydia psittaci nor Simkania negevensis but a member of a new chlamydial family that shared 90.2% sequence identity with the 16S rRNA gene of the zoonotic pathogen Chlamydia pecorum. In addition, we found a new Chlamydia-related species that belonged to a novel family sharing 91.3% 16S rRNA sequence identity with Candidatus Syngnamydia venezia. The prevalence and spectrum of chlamydial species differed from previous results obtained from children of other geographic regions and our study indicates that both, Chlamydiaceae and Chlamydia-related bacteria, are not clearly linked to clinical symptoms in Ghanaian children.
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Affiliation(s)
- H Bühl
- Institute for Pharmaceutical Microbiology, University Clinic, University of Bonn, Germany
| | - D Eibach
- Bernhard Nocht Institute for Tropical Medicine, University Medical Centre Hamburg Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Germany
| | - M Nagel
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
| | - G Greub
- Institute of Microbiology, University Hospital Center and University of Lausanne, Switzerland
| | - N Borel
- Institute of Veterinary Pathology, University of Zurich, Vetsuisse Faculty, Zurich, Switzerland
| | - N Sarpong
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Germany.,Agogo Presbyterian Hospital, Department of Child Health, Agogo, Ghana
| | - T Rettig
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
| | - T Pesch
- Institute of Veterinary Pathology, University of Zurich, Vetsuisse Faculty, Zurich, Switzerland
| | - S Aeby
- Institute of Microbiology, University Hospital Center and University of Lausanne, Switzerland
| | - A Klöckner
- Institute for Pharmaceutical Microbiology, University Clinic, University of Bonn, Germany.,German Center for Infection Research (DZIF), Bonn, Germany
| | - M Brunke
- Institute for Pharmaceutical Microbiology, University Clinic, University of Bonn, Germany
| | - S Krannich
- Institute for Pharmaceutical Microbiology, University Clinic, University of Bonn, Germany
| | - B Kreuels
- Division of Tropical Medicine, I. Department of Internal Medicine, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
| | - E Owusu-Dabo
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana.,Department of Global Health, School of Public Health, College of Health Sciences, KNUST, Kumasi, Ghana
| | - B Hogan
- Bernhard Nocht Institute for Tropical Medicine, University Medical Centre Hamburg Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Germany
| | - J May
- Bernhard Nocht Institute for Tropical Medicine, University Medical Centre Hamburg Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Germany
| | - B Henrichfreise
- Institute for Pharmaceutical Microbiology, University Clinic, University of Bonn, Germany
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Nyari S, Waugh CA, Dong J, Quigley BL, Hanger J, Loader J, Polkinghorne A, Timms P. Epidemiology of chlamydial infection and disease in a free-ranging koala (Phascolarctos cinereus) population. PLoS One 2017; 12:e0190114. [PMID: 29281731 PMCID: PMC5744985 DOI: 10.1371/journal.pone.0190114] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 12/10/2017] [Indexed: 12/01/2022] Open
Abstract
Chlamydial disease continues to be one of the main factors threatening the long-term survival of the koala (Phascolarctos cinereus). Despite this, large epidemiological studies of chlamydial infection and disease in wild koala populations are lacking. A better understanding of the prevalence, transmission and pathogenesis is needed to improve control measures, such as the development of vaccines. We investigated the prevalence of Chlamydia pecorum infection and disease in 160 koalas in a peri-urban wild population in Queensland, Australia and found that 31% of koalas were Chlamydia PCR positive and 28% had clinically detectable chlamydial disease. Most infections were at the urogenital site (27%; both males and females) with only 14% at the ocular site. Interestingly, we found that 27% (4/15) of koalas considered to be sexually immature (9–13 months) were already infected with C. pecorum, suggesting that a significant percentage of animals are infected directly from their mother. Ocular infection levels were less prevalent with increasing age (8% in koalas older than 4 years), whereas the prevalence of urogenital tract infections remained high into older age (26% in koalas older than 4 years), suggesting that, after mother-to-young transmission, C. pecorum is predominantly a sexually transmitted infection. While 28% of koalas in this population had clinically detectable chlamydial disease (primarily urogenital tract disease), many PCR positive koalas had no detectable disease and importantly, not all diseased animals were PCR positive. We also observed higher chlamydial loads in koalas who were C. pecorum infected without clinical disease than in koalas who were C. pecorum infected with clinical disease. These results shed light on the potential mechanisms of transmission of C. pecorum in koalas and also guide future control measures, such as vaccination.
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Affiliation(s)
- Sharon Nyari
- Centre for Animal Health Innovation, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Courtney A. Waugh
- Centre for Animal Health Innovation, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Jianbao Dong
- Centre for Animal Health Innovation, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Bonnie L. Quigley
- Centre for Animal Health Innovation, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Jonathan Hanger
- Endeavour Veterinary Ecology, Toorbul, Queensland, Australia
| | - Joanne Loader
- Endeavour Veterinary Ecology, Toorbul, Queensland, Australia
| | - Adam Polkinghorne
- Centre for Animal Health Innovation, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Peter Timms
- Centre for Animal Health Innovation, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- * E-mail:
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Babinská I, Halánová M, Kalinová Z, Čechová L, Čisláková L, Madarasová Gecková A. Prevalence of Chlamydia trachomatis Infection and Its Association with Sexual Behaviour and Alcohol Use in the Population Living in Separated and Segregated Roma Settlements in Eastern Slovakia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1579. [PMID: 29240704 PMCID: PMC5750997 DOI: 10.3390/ijerph14121579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 12/14/2022]
Abstract
The aim of the study was to explore sexual behaviour and the occurrence of Chlamydia trachomatis (CT) infection in the population living in Roma settlements compared to the majority population in Slovakia and to assess the association between alcohol use and sexual behaviour within both populations. A cross-sectional population-based Hepa-Meta study was conducted in Slovakia in 2011. The final sample comprised 452 Roma and 403 non-Roma respondents. The occurrence of CT was detected by direct proof of the pathogen by PCR. The association between alcohol use and the prevalence of risky sexual behaviour were assessed using a logistic regression. First intercourse at age 15 or younger was reported by 27.9% of Roma (vs. 4.5% of non-Roma); 93.4% of Roma (vs. 77.9% of non-Roma) used condom inconsistently, 22.8% of Roma (vs. 43.9% of non-Roma) used a condom for protection from unwanted pregnancies and only 8.8% of Roma (vs. 21.8% of non-Roma) due to protection against infectious diseases. However, Roma reported having had five or more sexual partners less often compared to the majority (11.5% of Roma vs. 20.6% of non-Roma). Binge drinking at least once a month was associated with a higher number of sexual partners in both groups, but not with condom non-use. The prevalence of CT infection in the Roma population was higher (3.8%) compared to non-Roma (2.7%); however, the difference was not statistically significant. Our study found no differences in the prevalence of CT infection between Roma and non-Roma despite differences in sexual behaviour. Roma begin their sexual life earlier and have unprotected sex more often, but on the other hand, they seem to be much more restrained in terms of the number of sexual partners compared to the majority population.
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Affiliation(s)
- Ingrid Babinská
- Department of Epidemiology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, 041 80 Košice, Slovakia.
| | - Monika Halánová
- Department of Epidemiology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, 041 80 Košice, Slovakia.
| | - Zuzana Kalinová
- Department of Epidemiology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, 041 80 Košice, Slovakia.
| | - Lenka Čechová
- Department of Epidemiology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, 041 80 Košice, Slovakia.
| | - Lýdia Čisláková
- Department of Epidemiology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, 041 80 Košice, Slovakia.
| | - Andrea Madarasová Gecková
- Department of Health Psychology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, 040 11 Košice, Slovakia.
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Smelov V, Vrbanac A, van Ess EF, Noz MP, Wan R, Eklund C, Morgan T, Shrier LA, Sanders B, Dillner J, de Vries HJC, Morre SA, Dean D. Chlamydia trachomatis Strain Types Have Diversified Regionally and Globally with Evidence for Recombination across Geographic Divides. Front Microbiol 2017; 8:2195. [PMID: 29180986 PMCID: PMC5693916 DOI: 10.3389/fmicb.2017.02195] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/25/2017] [Indexed: 11/17/2022] Open
Abstract
Chlamydia trachomatis (Ct) is the leading cause of bacterial sexually transmitted diseases worldwide. The Ct Multi Locus Sequence Typing (MLST) scheme is effective in differentiating strain types (ST), deciphering transmission patterns and treatment failure, and identifying recombinant strains. Here, we analyzed 323 reference and clinical samples, including 58 samples from Russia, an area that has not previously been represented in Ct typing schemes, to expand our knowledge of the global diversification of Ct STs. The 323 samples resolved into 84 unique STs, a 3.23 higher typing resolution compared to the gold standard single locus ompA genotyping. Our MLST scheme showed a high discriminatory index, D, of 0.98 (95% CI 0.97-0.99) confirming the validity of this method for typing. Phylogenetic analyses revealed distinct branches for the phenotypic diseases of lymphogranuloma venereum, urethritis and cervicitis, and a sub-branch for ocular trachoma. Consistent with these findings, single nucleotide polymorphisms were identified that significantly correlated with each phenotype. While the overall number of unique STs per region was comparable across geographies, the number of STs was greater for Russia with a significantly higher ST/sample ratio of 0.45 (95% CI: 0.35-0.53) compared to Europe or the Americas (p < 0.009), which may reflect a higher level of sexual mixing with the introduction of STs from other regions and/or reassortment of alleles. Four STs were found to be significantly associated with a particular geographic region. ST23 [p = 0.032 (95% CI: 1-23)], ST34 [p = 0.019 (95% CI: 1.1-25)]; and ST19 [p = 0.001 (95% CI: 1.7-34.7)] were significantly associated with Netherlands compared to Russia or the Americas, while ST 30 [p = 0.031 (95% CI: 1.1-17.8)] was significantly associated with the Americas. ST19 was significantly associated with Netherlands and Russia compared with the Americans [p = 0.001 (95% CI: 1.7-34.7) and p = 0.006 (95% CI: 1.5-34.6), respectively]. Additionally, recombinant strains were ubiquitous in the data set [106 (32.8%)], although Europe had a significantly higher number than Russia or the Americas (p < 0.04), the majority of which were from Amsterdam [43 (87.8%) of 49)]. The higher number of recombinants in Europe indicates selective pressure and/or adaptive diversification that will require additional studies to elucidate.
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Affiliation(s)
- Vitaly Smelov
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Karolinska Institute, Stockholm, Sweden
- North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - Alison Vrbanac
- UCSF Benioff Children’s Hospital Oakland Research Institute, Oakland, CA, United States
| | - Eleanne F. van Ess
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, Netherlands
| | - Marlies P. Noz
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, Netherlands
| | - Raymond Wan
- UCSF Benioff Children’s Hospital Oakland Research Institute, Oakland, CA, United States
| | | | - Tyler Morgan
- UCSF Benioff Children’s Hospital Oakland Research Institute, Oakland, CA, United States
| | - Lydia A. Shrier
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
| | - Blake Sanders
- UCSF Benioff Children’s Hospital Oakland Research Institute, Oakland, CA, United States
| | | | - Henry J. C. de Vries
- Center for Infection and Immunology Amsterdam, Academic Medical Center, Amsterdam, Netherlands
- Department of Dermatology, Academic Medical Center, Amsterdam, Netherlands
- STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, Netherlands
| | - Servaas A. Morre
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, Netherlands
- Institute of Public Health Genomics, Department of Genetics and Cell Biology, Research Institute GROW (School for Oncology and Developmental Biology), Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, Netherlands
| | - Deborah Dean
- UCSF Benioff Children’s Hospital Oakland Research Institute, Oakland, CA, United States
- Department of Bioengineering, University of California, Berkeley, Berkeley, CA, United States
- Department of Bioengineering, University of California, San Francisco, San Francisco, CA, United States
- Departments of Medicine and Pediatrics, University of California, San Francisco, San Francisco, CA, United States
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40
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Balla E, Petrovay F, Erdősi T, Balázs A, Henczkó J, Urbán E, Donders GGG. Distribution of Chlamydia trachomatis genotypes in neonatal conjunctivitis in Hungary. J Med Microbiol 2017; 66:915-918. [DOI: 10.1099/jmm.0.000523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Eszter Balla
- Department of Bacteriology II, National Public Health Institute, Budapest, Hungary
| | - Fruzsina Petrovay
- Department of Bacteriology II, National Public Health Institute, Budapest, Hungary
| | - Tímea Erdősi
- Department of Phage and Molecular Typing, National Public Health Institute, Budapest, Hungary
| | - Andrea Balázs
- Department of Bacteriology II, National Public Health Institute, Budapest, Hungary
| | - Judit Henczkó
- Department of Bacteriology II, National Public Health Institute, Budapest, Hungary
| | - Edit Urbán
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Gilbert G. G. Donders
- Femicare Clinical Research for Women, Tienen, Belgium
- Department of Obstetrics and Gynecology, University Hospital Antwerp, Edegem, Belgium
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Pal S, Favaroni A, Tifrea DF, Hanisch PT, Luczak SET, Hegemann JH, de la Maza LM. Comparison of the nine polymorphic membrane proteins of Chlamydia trachomatis for their ability to induce protective immune responses in mice against a C. muridarum challenge. Vaccine 2017; 35:2543-2549. [PMID: 28385608 DOI: 10.1016/j.vaccine.2017.03.070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/06/2017] [Accepted: 03/22/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To test vaccines, formulated with novel antigens, to protect mice against Chlamydia infections. METHODS To determine the ability of polymorphic membrane proteins (Pmps) to induce cross-species protective immune responses, recombinant fragments from all nine C. trachomatis serovar E Pmps were used to vaccinate BALB/c mice utilizing CpG-1826 and Montanide ISA 720 as adjuvants. C. muridarum recombinant MOMP and PBS, formulated with the same adjuvants, were used as positive and negative controls, respectively. Mice were challenged intranasally with 104 inclusion-forming units (IFU) of C. muridarum. Animals were weighed daily and at 10days post-challenge, they were euthanized, their lungs harvested, weighed and the number of chlamydial IFU counted. RESULTS Following vaccination the nine Pmps elicited immune responses. Based on body weight changes, or number of IFU recovered from lungs, mice vaccinated with Pmp C, G or H were the best protected. For example, over the 10-day period, the negative control group vaccinated with PBS lost significantly more body weight than mice immunized with PmpC or G (P<0.05). C. muridarum MOMP vaccinated mice were better protected against body weight losses than any group immunized with Pmps. Also, the median number of IFU recovered from the lungs of mice vaccinated with PmpC (72×106) or PmpH (61×106) was significantly less than from mice immunized with PBS (620×106; P<0.05). As determined by the number of IFU, all Pmps elicited less protection than C. muridarum MOMP (0.078×106 IFU; P<0.05). CONCLUSIONS This is the first time PmpC has been shown to elicit cross-species protection against a respiratory challenge. Additional work with Pmps C, G and H is recommended to determine their ability to protect animal models against genital and ocular challenges.
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Affiliation(s)
- Sukumar Pal
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, CA, USA
| | - Alison Favaroni
- Institut für Funktionelle Genomforschung der Mikroorganismen, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Delia F Tifrea
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, CA, USA
| | - Philipp T Hanisch
- Institut für Funktionelle Genomforschung der Mikroorganismen, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Sören E T Luczak
- Institut für Funktionelle Genomforschung der Mikroorganismen, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Johannes H Hegemann
- Institut für Funktionelle Genomforschung der Mikroorganismen, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Luis M de la Maza
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, CA, USA.
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Kim G, Kim TK. The Red Eye. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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43
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Joseph Davey D, Medline A, Klausner JD. Screening pregnant women in the 2015 European guideline on the management of Chlamydia trachomatis infections. Int J STD AIDS 2016; 27:1134-1136. [PMID: 27694561 PMCID: PMC5810553 DOI: 10.1177/0956462416650600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- D Joseph Davey
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - A Medline
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - J D Klausner
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Kapoor VS, Whyte R, Vedula SS. Interventions for preventing ophthalmia neonatorum. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd001862.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Robin Whyte
- Halifax Dalhousie University, IWK Health Centre; Department of Neonatal Pediatrics; 5850/5980 University Avenue Halifax NS Canada B3K 6R8
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Meyer T. Diagnostic Procedures to Detect Chlamydia trachomatis Infections. Microorganisms 2016; 4:microorganisms4030025. [PMID: 27681919 PMCID: PMC5039585 DOI: 10.3390/microorganisms4030025] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/20/2022] Open
Abstract
The intracellular life style of chlamydia and the ability to cause persistent infections with low-grade replication requires tests with high analytical sensitivity to directly detect C. trachomatis (CT) in medical samples. Nucleic acid amplification tests (NAATs) are the most sensitive assays with a specificity similar to cell culture and are considered the method of choice for CT detection. In addition, NAATs can be performed on various clinical specimens that do not depend on specific transport and storage conditions, since NAATs do not require infectious bacteria. In the case of lower genital tract infections, first void urine and vaginal swabs are the recommended specimens for testing males and females, respectively. Infections of anorectal, oropharyngeal and ocular epithelia should also be tested by NAAT analysis of corresponding mucosal swabs. In particular, anorectal infections of men who have sex with men (MSM) should include evaluation of lymphogranuloma venereum (LGV) by identification of genotypes L1, L2 or L3. Detection of CT antigens by enzyme immunoassay (EIAs) or rapid diagnostic tests (RDTs) are unsuitable due to insufficient sensitivity and specificity. Recent PCR-based RDTs, however, are non-inferior to standard NAATs, and might be used at the point-of-care. Serology finds application in the diagnostic work-up of suspected chronic CT infection but is inappropriate to diagnose acute infections.
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Affiliation(s)
- Thomas Meyer
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg 20246, Germany.
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Abstract
BACKGROUND Sexually transmitted infections (STIs) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) can lead to adverse pregnancy and neonatal outcomes. The prevalence of STIs and its association with HIV mother-to-child transmission (MTCT) were evaluated in a substudy analysis from a randomized, multicenter clinical trial. METHODOLOGY Urine samples from HIV-infected pregnant women collected at the time of labor and delivery were tested using polymerase chain reaction testing for the detection of CT and NG (Xpert CT/NG; Cepheid, Sunnyvale, CA). Infant HIV infection was determined by HIV DNA polymerase chain reaction at 3 months. RESULTS Of the 1373 urine specimens, 249 (18.1%) were positive for CT and 63 (4.6%) for NG; 35 (2.5%) had both CT and NG detected. Among 117 cases of HIV MTCT (8.5% transmission), the lowest transmission rate occurred among infants born to CT- and NG-uninfected mothers (8.1%) as compared with those infected with only CT (10.7%) and both CT and NG (14.3%; P = 0.04). Infants born to CT-infected mothers had almost a 1.5-fold increased risk for HIV acquisition (odds ratio, 1.47; 95% confidence interval, 0.9-2.3; P = 0.09). CONCLUSIONS This cohort of HIV-infected pregnant women is at high risk for infection with CT and NG. Analysis suggests that STIs may predispose to an increased HIV MTCT risk in this high-risk cohort of HIV-infected women.
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47
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Nguyen M, Cabeza J, Segura E, García PJ, Klausner JD. High Rate of Partner Treatment Among Chlamydia trachomatis-Infected Pregnant Women in Lima, Peru. Sex Transm Dis 2016; 43:296-8. [PMID: 27100765 PMCID: PMC4840465 DOI: 10.1097/olq.0000000000000436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This was a substudy of 60 Chlamydia trachomatis-infected women from a larger study of pregnant women in Lima, Peru. Participants were encouraged to bring their partners in for concurrent patient-partner treatment. The alternative partner treatment was expedited partner therapy. Partner treatment uptake was 91.7%. Twenty-one partners (38.2%) received treatment through concurrent patient-partner treatment, and 34 (61.8%) through expedited partner therapy. Living with the partner was significantly associated with having the partner treated (P=0.0028).
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Affiliation(s)
- Minh Nguyen
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Jeanne Cabeza
- Department of Medicine/Division of Infectious Diseases, UCLA Geffen School of Medicine, Los Angeles, California, USA
| | - Eddy Segura
- Department of Medicine/Division of Infectious Diseases, UCLA Geffen School of Medicine, Los Angeles, California, USA
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Patricia J García
- Unit of Epidemiology, STD and HIV, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Department of Medicine/Division of Infectious Diseases, UCLA Geffen School of Medicine, Los Angeles, California, USA
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Adachi K, Nielsen-Saines K, Klausner JD. Chlamydia trachomatis Infection in Pregnancy: The Global Challenge of Preventing Adverse Pregnancy and Infant Outcomes in Sub-Saharan Africa and Asia. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9315757. [PMID: 27144177 PMCID: PMC4837252 DOI: 10.1155/2016/9315757] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/09/2016] [Indexed: 12/28/2022]
Abstract
Screening and treatment of sexually transmitted infections (STIs) in pregnancy represents an overlooked opportunity to improve the health outcomes of women and infants worldwide. Although Chlamydia trachomatis is the most common treatable bacterial STI, few countries have routine pregnancy screening and treatment programs. We reviewed the current literature surrounding Chlamydia trachomatis in pregnancy, particularly focusing on countries in sub-Saharan Africa and Asia. We discuss possible chlamydial adverse pregnancy and infant health outcomes (miscarriage, stillbirth, ectopic pregnancy, preterm birth, neonatal conjunctivitis, neonatal pneumonia, and other potential effects including HIV perinatal transmission) and review studies of chlamydial screening and treatment in pregnancy, while simultaneously highlighting research from resource-limited countries in sub-Saharan Africa and Asia.
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Affiliation(s)
- Kristina Adachi
- Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90024, USA
| | - Karin Nielsen-Saines
- Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA 90024, USA
| | - Jeffrey D. Klausner
- Department of Medicine, Division of Infectious Diseases: Global Health, David Geffen School of Medicine, UCLA, Los Angeles, CA 90024, USA
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, UCLA, Los Angeles, CA 90024, USA
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49
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Can We Use Antibodies to Chlamydia trachomatis as a Surveillance Tool for National Trachoma Control Programs? Results from a District Survey. PLoS Negl Trop Dis 2016; 10:e0004352. [PMID: 26771906 PMCID: PMC4714879 DOI: 10.1371/journal.pntd.0004352] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 12/11/2015] [Indexed: 11/29/2022] Open
Abstract
Background Trachoma is targeted for elimination by 2020. World Health Organization advises districts to undertake surveillance when follicular trachoma (TF) <5% in children 1–9 years and mass antibiotic administration has ceased. There is a question if other tools could be used for surveillance as well. We report data from a test for antibodies to C. trachomatis antigen pgp3 as a possible tool. Methodology We randomly sampled 30 hamlets in Kilosa district, Tanzania, and randomly selected 50 children ages 1–9 per hamlet. The tarsal conjunctivae were graded for trachoma (TF), tested for C. trachomatis infection (Aptima Combo2 assay: Hologic, San Diego, CA), and a dried blood spot processed for antibodies to C. trachomatis pgp3 using a multiplex bead assay on a Luminex 100 platform. Principal findings The prevalence of trachoma (TF) was 0.4%, well below the <5% indicator for re-starting a program. Infection was also low, 1.1%. Of the 30 hamlets, 22 had neither infection nor TF. Antibody positivity overall was low, 7.5% and increased with age from 5.2% in 1–3 year olds, to 9.3% in 7–9 year olds (p = 0.015). In 16 of the 30 hamlets, no children ages 1–3 years had antibodies to pgp3. Conclusions The antibody status of the 1–3 year olds indicates low cumulative exposure to infection during the surveillance period. Four years post MDA, there is no evidence for re-emergence of follicular trachoma. Trachoma, the leading infectious cause of blindness world-wide, is targeted for elimination by 2020. The World Health Organization advises districts to undertake surveillance for trachoma when follicular trachoma (TF) is less than 5% in children 1–9 years. In a trachoma-endemic district that stopped its program four years ago, we undertook a surveillance survey, adding to the assessment of TF a test for C. trachomatis infection, and a dried blood spot which was processed for antibodies to C. trachomatis antigen pgp3; antibody status may indicate cumulative past exposure to infection. The prevalence of TF was 0.4%, below the 5% cut-off indicating that trachoma elimination had been achieved with no re-emergence. The antibody positivity overall was low, 7.5%, and increased with age from 5.2% in 1–3 year olds, to 9.3% in 7–9 year olds (p = 0.015). In 16 of the 30 hamlets, no children ages 1–3 years had antibodies to pgp3. The antibody status of the 1–3 year olds indicated low cumulative exposure to infection during the surveillance period. In summary, four years post -program, there is no evidence for re-emergence of trachoma using any indicator sufficient to cause re-emergence.
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50
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López-Hurtado M, Arteaga-Troncoso G, Sosa-González IE, de Haro-Cruz MDJ, Flores-Salazar VR, Guerra-Infante FM. Eosinophilia in Preterm Born Infants Infected with Chlamydia trachomatis. Fetal Pediatr Pathol 2016; 35:149-58. [PMID: 27064841 DOI: 10.3109/15513815.2016.1153175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A higher than 350 eosinophils/mm(3) is strongly associated with Chlamydia trachomatis in term born babies coursing with respiratory distress. However, in preterm newborns infected with this pathogen, the levels of eosinophils are unknown. Forty newborn infants with clinical data of respiratory problems and/or sepsis were analyzed. DNA of leukocytes from peripheral blood was used to identify C. trachomatis. Detection of chlamydial infection was performed by amplifying the ompA gene by an in-house PCR, and eosinophil levels were evaluated in an XT-2000-hematology analyzer. Eighteen infants showed chlamydial infection and 14 of them showed pneumonia (RR = 2.6; CI95% 1.03-6.5; p =.027). Their eosinophil levels were 719 ± 614 cells/mm(3). A significant association between eosinophilia ≥1250 cells/mm(3) and gestational age of less than 29 weeks (RR = 5.8; 1.35; CI95% [1.4-24.5], p <.008) was observed. The preterm infants with chlamydial infection did not show higher eosinophil levels than uninfected infants.
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Affiliation(s)
- Marcela López-Hurtado
- a National Institute of Perinatology, Infectology , Montes Urales 800, Col Lomas Virreyes, Mexico City , 11000 Mexico
| | - Gabriel Arteaga-Troncoso
- a National Institute of Perinatology, Infectology , Montes Urales 800, Col Lomas Virreyes, Mexico City , 11000 Mexico
| | - Irma E Sosa-González
- a National Institute of Perinatology, Infectology , Montes Urales 800, Col Lomas Virreyes, Mexico City , 11000 Mexico
| | - Maria de Jesus de Haro-Cruz
- b National School of Biological Sciences, Microbiology, Prol. de Carpio y Plan de Ayala , Mexico City , 11340 Mexico
| | - Veronica R Flores-Salazar
- a National Institute of Perinatology, Infectology , Montes Urales 800, Col Lomas Virreyes, Mexico City , 11000 Mexico
| | - Fernando Martín Guerra-Infante
- a National Institute of Perinatology, Infectology , Montes Urales 800, Col Lomas Virreyes, Mexico City , 11000 Mexico.,b National School of Biological Sciences, Microbiology, Prol. de Carpio y Plan de Ayala , Mexico City , 11340 Mexico
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