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Barros PBD, Xavier LF, Herter EDC, Fernandes MFGM, Ferreira ICS, Pinto LA. Atypical bacterial respiratory infections in children. J Bras Pneumol 2024; 50:e20240126. [PMID: 38808838 PMCID: PMC11185144 DOI: 10.36416/1806-3756/e20240126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Affiliation(s)
- Paula Barros de Barros
- . Centro Infant, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Luiza Fernandes Xavier
- . Centro Infant, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Eduardo da Costa Herter
- . Centro Infant, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | | | - Isabel Cristina Schütz Ferreira
- . Programa de Pós-Graduação em Medicina - Pediatria, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Leonardo Araujo Pinto
- . Programa de Pós-Graduação em Medicina - Pediatria, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
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Tagini F, Opota O, Greub G. Chlamydia pneumoniae Upsurge at Tertiary Hospital, Lausanne, Switzerland. Emerg Infect Dis 2024; 30:810-812. [PMID: 38413241 PMCID: PMC10977832 DOI: 10.3201/eid3004.231610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Chlamydia pneumoniae infection cases have usually accounted for <1.5% of community-acquired respiratory tract infections. Currently, Lausanne, Switzerland is experiencing a notable upsurge in cases, with 28 reported within a span of a few months. This upsurge in cases highlights the need for heightened awareness among clinicians.
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Han HY, Moon JU, Rhim JW, Kang HM, Lee SJ, Yang EA. Surge of Chlamydia pneumoniae pneumonia in children hospitalized with community-acquired pneumonia at a single center in korea in 2016. J Infect Chemother 2023; 29:453-457. [PMID: 36738859 DOI: 10.1016/j.jiac.2023.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/02/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Hye Young Han
- Departments of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Department of Pediatrics, The Catholic University of Korea Daejeon St. Mary's Hospital, Daejeon, South Korea
| | - Ja Un Moon
- Departments of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jung Woo Rhim
- Departments of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Department of Pediatrics, The Catholic University of Korea Daejeon St. Mary's Hospital, Daejeon, South Korea
| | - Hyun Mi Kang
- Departments of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Soo Jin Lee
- Department of Pediatrics, College of Medicine, Eulji University, Daejeon, South Korea
| | - Eun-Ae Yang
- Departments of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Department of Pediatrics, The Catholic University of Korea Daejeon St. Mary's Hospital, Daejeon, South Korea.
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Garin N, Marti C, Skali Lami A, Prendki V. Atypical Pathogens in Adult Community-Acquired Pneumonia and Implications for Empiric Antibiotic Treatment: A Narrative Review. Microorganisms 2022; 10:microorganisms10122326. [PMID: 36557579 PMCID: PMC9783917 DOI: 10.3390/microorganisms10122326] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
Atypical pathogens are intracellular bacteria causing community-acquired pneumonia (CAP) in a significant minority of patients. Legionella spp., Chlamydia pneumoniae and psittaci, Mycoplasma pneumoniae, and Coxiella burnetii are commonly included in this category. M. pneumoniae is present in 5-8% of CAP, being the second most frequent pathogen after Streptococcus pneumoniae. Legionella pneumophila is found in 3-5% of inpatients. Chlamydia spp. and Coxiella burnetii are present in less than 1% of patients. Legionella longbeachae is relatively frequent in New Zealand and Australia and might also be present in other parts of the world. Uncertainty remains on the prevalence of atypical pathogens, due to limitations in diagnostic means and methodological issues in epidemiological studies. Despite differences between CAP caused by typical and atypical pathogens, the clinical presentation alone does not allow accurate discrimination. Hence, antibiotics active against atypical pathogens (macrolides, tetracyclines and fluoroquinolones) should be included in the empiric antibiotic treatment of all patients with severe CAP. For patients with milder disease, evidence is lacking and recommendations differ between guidelines. Use of clinical prediction rules to identify patients most likely to be infected with atypical pathogens, and strategies of narrowing the antibiotic spectrum according to initial microbiologic investigations, should be the focus of future investigations.
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Affiliation(s)
- Nicolas Garin
- Division of Internal Medicine, Riviera Chablais Hospital, 1847 Rennaz, Switzerland
- Division of General Internal Medicine, Geneva University Hospital, 1211 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Correspondence: ; Tel.: +41-79-900-54-74
| | - Christophe Marti
- Division of General Internal Medicine, Geneva University Hospital, 1211 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Aicha Skali Lami
- Division of Internal Medicine, Riviera Chablais Hospital, 1847 Rennaz, Switzerland
| | - Virginie Prendki
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Division of Infectious Disease, Geneva University Hospital, 1211 Geneva, Switzerland
- Division of Internal Medicine for the Aged, Geneva University Hospital, 1211 Geneva, Switzerland
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Reliable and Sensitive Nested PCR for the Detection of Chlamydia in Sputum. Microorganisms 2021; 9:microorganisms9050935. [PMID: 33925646 PMCID: PMC8145989 DOI: 10.3390/microorganisms9050935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/25/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022] Open
Abstract
Chlamydia are Gram-negative, intracellular pathogens colonizing epithelial mucosa. They cause primarily atypical pneumonia and have recently been associated with chronic diseases. Diagnostics relies almost exclusively on serological methods; PCR tests are used rarely because in patients with positive ELISA, it is nearly impossible to identify chlamydial DNA. This paradox is associated with DNA degradation in sputum samples, low abundance, and low sensitivity of PCR systems. In a newly designed and validated “nested” PCR (NPCR) assay, it was possible to amplify DNA of Chlamydia known to infect humans in 31% samples. The reliability of the assay was confirmed by DNA sequencing, and all PCR products belonged exclusively to the Chlamydiales, mainly recognized as Chlamydia pneumoniae. Three samples were related to Ca. Rhabdochlamydia porcellionis and Ca. Renichlamydia lutjani, which infect arthropods. In one case, samples were taken from sick individual, indicating the potential as a human pathogen.
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Chen JR, Zhou XF. A retrospective survey of Chlamydia pneumoniae infection rates in paediatric patients from a single centre in Wuxi, China. J Int Med Res 2020; 48:300060520961720. [PMID: 33115294 PMCID: PMC7645430 DOI: 10.1177/0300060520961720] [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: 11/23/2022] Open
Abstract
Objective To provide some epidemiological data on Chlamydia pneumoniae infection rates in paediatric patients at a single centre in Wuxi, China. Methods This was a retrospective analysis of serum samples from paediatric patients (<12 years) with a respiratory tract infection (RTI) and who had been admitted to the Department of Paediatrics, Wuxi No.2 People’s Hospital, China, from 01 January 2015 to 31 December 2016. C. pneumoniae IgM antibodies had been analysed using enzyme-linked immunosorbent assay (ELISA). Results Of the 3866 children (2073 boys, 1793 girls) with a RTI that provided serum samples, 19% were positive for C. pneumoniae IgM antibodies. Among these children, 56% were positive for other infections. Conclusions Children over 6 years of age with a RTI had a higher C.pneumoniae infection rate than younger children and the infection rate was more common in winter months compared with other times of the year.
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Affiliation(s)
- Jie-Ru Chen
- Department of Pediatrics, Wuxi No.2 People's Hospital, Wuxi, China
| | - Xiao-Fei Zhou
- Department of Pediatrics, Wuxi No.2 People's Hospital, Wuxi, China
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Low prevalence of Chlamydia pneumoniae infections during the Mycoplasma pneumoniae epidemic season: Results of nationwide surveillance in Japan. J Infect Chemother 2020; 26:1116-1121. [PMID: 32800484 DOI: 10.1016/j.jiac.2020.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Chlamydia pneumoniae and Mycoplasma pneumoniae are both common causes of atypical pneumonia. We conducted an annual national survey of Japanese children to screen them for C. pneumoniae infections during the M. pneumoniae epidemic season. METHODS Nasopharyngeal swab specimens were collected from children aged 0-15 years with suspected acute lower respiratory tract infection due to atypical pathogens, at 85 medical facilities in Japan from June 2008 to March 2018. Specimens were tested for infection using real-time polymerase chain reaction assays. RESULTS Of 5002 specimens tested, 1822 (36.5%) were positive for M. pneumoniae alone, 42 (0.8%) were positive for C. pneumoniae alone, and 20 (0.4%) were positive for both organisms. In children with C. pneumoniae infection, the median C. pneumoniae DNA copy number was higher in those with single infections than in those with M. pneumoniae coinfection (p = 0.08); however it did not differ significantly according to whether the children had received antibiotics prior to sample collection (p = 0.34). CONCLUSIONS The prevalence of C. pneumoniae infection was substantially lower than that of M. pneumoniae infection during the study period. The change in prevalence of C. pneumoniae was not influenced by that of M. pneumoniae. Children with single C. pneumoniae infection are likely to have had C. pneumoniae infection, while those with coinfection are likely to have been C. pneumoniae carriers.
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Al-Hajaya TS, Al-Zereini WA, Al-Younes HM. Chlamydia pneumoniae infection in patients hospitalised for community-acquired pneumonia in Southern Jordan. Indian J Med Microbiol 2020; 38:338-343. [PMID: 33154244 DOI: 10.4103/ijmm.ijmm_20_63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose Chlamydia pneumoniae is associated with human respiratory diseases. Few reports examined the involvement of this bacterium in community-acquired pneumonia (CAP) in Jordan. This study investigates for the first time the role of C. pneumoniae in the establishment of CAP among nationals residing the southern part of Jordan. Materials and Methods Nasopharyngeal and sera samples were collected from 70 hospitalised CAP patients and 63 healthy controls from Al-Karak Governorate and examined using the microimmunofluorescence and polymerase chain reaction techniques. The overall prevalence of C. pneumoniae infection was estimated by detecting the chlamydial immunoglobulin G (IgG) antibodies at a titre of 1:16. Rate of acute infection was estimated by detecting chlamydial DNA in nasopharyngeal samples and IgG and IgM at titres of 1:512 and 1:16, respectively. Results A higher overall seroprevalence of C. pneumoniae IgG was detected in CAP patients than controls (44.3% vs. 30.2%). The rate of acute infection in the entire CAP patients, based on IgG titre of 1:512, was 7.14% compared to 1.58% in the controls. Approximately, three-fold increase in the rate of acute infection was observed in CAP cases, seropositive at IgG titre of 1:16, compared to seropositive controls (16.1% vs. 5.3%). Interestingly, chlamydial IgM antibodies were detectable in 27.1% compared to only 3.2% of the controls. The presence of chlamydial nucleic acids was confirmed in 40% of CAP patients and in 7.9% of controls. Conclusions The present findings clearly suggest a role of C. pneumoniae in the aetiology of CAP in Southern Jordan. However, coinfections with other respiratory pathogens should not be excluded.
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Affiliation(s)
| | - Wael Ali Al-Zereini
- Department of Biological Sciences, Faculty of Science, Mutah University, Al-Karak, Jordan
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Hagemann JB, Simnacher U, Marschall MT, Maile J, Soutschek E, Wellinghausen N, Essig A. Analysis of humoral immune responses to recombinant Chlamydia pneumoniae antigens. Int J Infect Dis 2019; 91:232-239. [PMID: 31841725 DOI: 10.1016/j.ijid.2019.12.007] [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: 09/20/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Chlamydia pneumoniae is a difficult to diagnose respiratory pathogen. This study was performed to systematically characterize humoral immune responses to selected C. pneumoniae antigens in order to provide novel serodiagnostic perspectives for clinical and epidemiological issues. METHODS Based on a literature search, gene library screening, and serological proteome analysis, 15 immunogenic surface-associated, virulence-associated, and hypothetical C. pneumoniae antigens were selected, recombinantly expressed, and lined on a nitrocellulose strip. Specific IgM and IgG reactivity was measured in a total of 172 PCR- and micro-immunofluorescence testing (MIF)-characterized serum samples from patients with respiratory infections. A theoretical model was conceived to approximate a putative course of C. pneumoniae antigen expression and assess the potential of early and late antigens. RESULTS While surface antigens performed poorly, the virulence-associated TARP was a reliable antigen for IgM detection, with a sensitivity of 80.0% and a diagnostic specificity of 90.2%. The hypothetical protein YwbM proved powerful for IgG detection with MIF-correlative sensitivities of up to 94.4% and a diagnostic specificity of 95.1%. CONCLUSIONS This study provides new insights into antibody profiles to immunogenic proteins in C. pneumoniae infection. The study findings offer antigen candidates for more reliable and standardized serological investigations of C. pneumoniae infections, including studies on seroprevalence and epidemiology.
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Affiliation(s)
- Jürgen Benjamin Hagemann
- Institute of Medical Microbiology and Hygiene, University Hospital of Ulm, Albert-Einstein-Allee 23, D-89081 Ulm, Germany.
| | - Ulrike Simnacher
- Institute of Medical Microbiology and Hygiene, University Hospital of Ulm, Albert-Einstein-Allee 23, D-89081 Ulm, Germany
| | - Miriam Theresia Marschall
- Institute of Medical Microbiology and Hygiene, University Hospital of Ulm, Albert-Einstein-Allee 23, D-89081 Ulm, Germany
| | - Julia Maile
- Mikrogen Diagnostik, Floriansbogen 2, D-82061 Neuried, Germany
| | - Erwin Soutschek
- Mikrogen Diagnostik, Floriansbogen 2, D-82061 Neuried, Germany
| | | | - Andreas Essig
- Institute of Medical Microbiology and Hygiene, University Hospital of Ulm, Albert-Einstein-Allee 23, D-89081 Ulm, Germany
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Rahman KS, Kaltenboeck B. Multi-peptide ELISAs overcome cross-reactivity and inadequate sensitivity of conventional Chlamydia pneumoniae serology. Sci Rep 2019; 9:15078. [PMID: 31636331 PMCID: PMC6803651 DOI: 10.1038/s41598-019-51501-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022] Open
Abstract
Cross-reactivity of classical chlamydial antigens compromises Chlamydia (C.) pneumoniae serology. By testing with 185 human antisera, we expanded 18 previously discovered C. pneumoniae-specific B-cell epitopes to 48 peptide antigens from 12 C. pneumoniae immunodominant proteins. For specific detection of antibodies against C. pneumoniae, we developed novel ELISAs with strongly reactive individual peptide antigens and mixtures of these peptides. By comparison to a composite reference standard (CRS) for anti-C. pneumoniae antibody status of human sera, the top-performing CpnMixF12 peptide assay showed 91% sensitivity at 95% specificity, significantly higher than 4 commercial anti-C. pneumoniae IgG ELISAs (36-12% sensitivity at 95% specificity). Human C. pneumoniae (Cpn) and C. trachomatis (Ctr) seroreactivity was 54% biased towards co-positivity in commercial Cpn and Ctr ELISAs, but unbiased in Cpn and Ctr peptide antibody assays, suggesting severe cross-reactivity of commercial ELISAs. Using hyperimmune mouse sera against each of 11 Chlamydia spp., we confirm that commercial Cpn and Ctr ELISA antigens are cross-reactive among all Chlamydia spp., but Cpn and Ctr peptide antigens react only with antisera against the cognate chlamydial species. With simultaneously high specificity and sensitivity, and convenient use for non-specialized laboratories, these ELISAs have the potential to improve serodiagnosis of C. pneumoniae infection.
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Affiliation(s)
- Kh Shamsur Rahman
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA.
| | - Bernhard Kaltenboeck
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
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Wen S, Lv F, Chen X, Zhu L, Li H, Lin L, Zhang H. Application of a nucleic acid-based multiplex kit to identify viral and atypical bacterial aetiology of lower respiratory tract infection in hospitalized children. J Med Microbiol 2019; 68:1211-1218. [PMID: 31225788 DOI: 10.1099/jmm.0.001006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Shunhang Wen
- Department of Children's Respiration Disease, Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, PR China
| | - Fangfang Lv
- Department of Children's Respiration Disease, Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, PR China
| | - Xiaofang Chen
- Department of Children's Respiration Disease, Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, PR China
| | - Lili Zhu
- Department of Children's Respiration Disease, Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, PR China
| | - Haiyan Li
- Department of Children's Respiration Disease, Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, PR China
| | - Li Lin
- Department of Children's Respiration Disease, Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, PR China
| | - Hailin Zhang
- Department of Children's Respiration Disease, Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, PR China
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Atypical and Typical Bacteria in Children with Community Acquired Pneumonia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019. [PMID: 31016635 DOI: 10.1007/5584_2019_377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2023]
Abstract
This study seeks to determine the pathogens in respiratory specimens and blood serum obtained from children who present with community acquired pneumonia (CAP) diagnosed on the basis of clinical and radiological evidence. The study group consisted of 46 hospitalized children aged 1-11 years. The material for research consisted of pharyngeal swabs and samples of blood serum. One hundred and thirty eight pharyngeal swabs were examined for the presence of C. pneumoniae antigen, C. pneumoniae DNA, and for typical pathogens. C. pneumoniae DNA was detected in pharyngeal swabs with nested PCR. Classical microbiological culture was used for detection of typical bacteria. ELISA test were used for detection anti-C. pneumoniae and anti-M. pneumoniae antibodies in the serum. C. pneumoniae DNA was identified in 10.9% of children. Positive culture for typical pathogens was observed in 8.7% of children. Specific anti-C. pneumoniae IgM antibodies were found in 8.7% of children, and IgG and IgA antibodies in 1 child each. Specific anti-M. pneumoniae IgG antibodies were found in 13.1% of children and IgM antibodies in 1 child. We conclude that the underlying bacterial etiology of CAP is rather rarely conclusively confirmed in children. Nonetheless, determining the etiology of CAP is essential for the choice of treatment to optimize the use and effectiveness of antimicrobials and to avoid adverse effect. Due to considerable variations in the power of detection of the type of atypical bacteria causing CAP, the search for the optimum diagnostic methods continues.
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The use of multiplex PCR for the detection of atypical pathogens in Egyptian children with CAP: a high rate of Bordetella pertussis in early infancy. J Egypt Public Health Assoc 2019; 94:5. [PMID: 30713347 PMCID: PMC6338716 DOI: 10.1186/s42506-018-0003-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/20/2018] [Indexed: 01/30/2023]
Abstract
Background Atypical pathogen infections played an important role in community-acquired pneumonia (CAP) in children. Pathogen-specific clinical symptoms are often lacking, and it is difficult to detect atypical pathogens by culture methods. The use of multiplex polymerase chain reaction (PCR) methods enables testing for many pathogens simultaneously in a single analysis. Aim To determine the role of atypical pathogens in children hospitalized with CAP. Patients and methods This cross-sectional study was conducted throughout a 2-year period from August 2015 to September 2017. It included 400 Egyptian children hospitalized with clinical diagnosis of CAP at a tertiary hospital in Cairo, Egypt. Sputum samples were collected from lower respiratory tract of all enrolled patients by mucus trap catheter for identification of Bordetella pertussis, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophilia by using multiplex real-time PCR. Results Among the 400 CAP patients enrolled in this study, atypical pathogens were detected in 12/400 (3%) patients. Bordetella pertussis was detected in 2% of cases, and it was responsible for CAP in 8/104 (7.69%) infants in the age stratum ≤ 4 months; compared with pertussis-negative cases, pertussis-positive cases were younger and incompletely vaccinated (P values were 0.001 and 0.007, respectively). Mycoplasma pneumoniae was detected in 1% of cases, all were among the age stratum > 4 months ≤ 59 months in 4/272 (1.47%) children. Conclusion In early infancy, Bordetella pertussis causes a significant proportion of hospitalized CAP cases; all were ≤ 4 months old and incompletely vaccinated. This finding could suggest the role of maternal immunization in developing countries.
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Chlamydia pneumoniae sero-prevalence in Moroccan patients with cardiovascular diseases. Infect Dis Health 2018; 24:67-74. [PMID: 30541691 DOI: 10.1016/j.idh.2018.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/18/2018] [Accepted: 10/22/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chlamydia pneumoniae is a pathogen associated with human respiratory tract infection, its viable presence in atherosclerotic plaques is also assumed to play significant function in cardiac diseases. Our study's main objective is to evaluate Chlamydia pneumoniae sero-prevalence in Moroccan patients with cardiovascular diseases using and comparing two serological methods. METHODS Two hundred eighteen patients were enrolled; serums were tested by microimmunofluorescence to explore the sero-prevalence. Simultaneously 74 serums were analyzed by both immunoblot and micro-immunofluorescence to evaluate recombinant proteins diagnosis value. RESULTS MIF results revealed 81% male and 84.5% female positive cases. The comparative study among 74 patients showed 78% men and 89% women positive cases by immunoblot, whereas MIF showed respectively 80% and 72%, a significant concordance between these methods was revealed. However, this comparison showed also two types of discrepancies, which may be related to difficulties in antigens detection by micro-immunofluorescence resulting from their structure complexity, or the antibodies reactivity with species' common antigens. CONCLUSIONS The study revealed a high sero-prevalence of Chlamydia pneumoniae in the studied population, a big interest of recombinant protein was also revealed in the diagnosis accuracy. We suggest therefore using immunoblot for diagnosis confirmation because it provides additional useful information.
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Transmission Electron Microscopy Improves the Diagnostic Sensitivity in Nonbacterial Etiology of Severe Pneumonia: A Retrospective Study. Am J Med Sci 2018; 357:289-295. [PMID: 30638601 PMCID: PMC7093854 DOI: 10.1016/j.amjms.2018.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/30/2018] [Accepted: 11/27/2018] [Indexed: 12/31/2022]
Abstract
Background Severe pneumonia is responsible for great mortality and morbidity worldwide, and early-applied effective anti-infective therapy can improve the prognosis of patients. However, identification of infectious agents in severe pneumonia remains a major challenge so far. In this study, the potential utility of transmission electron microscopy (TEM) in detecting nonbacterial pathogens in patients with severe pneumonia was retrospectively evaluated. Materials and Methods A total of 106 patients diagnosed with severe pneumonia at our hospital from September 2015 to December 2017 were included, and their baseline clinical characteristics were collected. Nonbacterial infectious agents detected by TEM in bronchoalveolar lavage fluid (BALF) and serological tests were summarized. The detection rates were further compared between TEM and serological tests. Results BALF examination under the transmission electron microscope revealed 24 viruses, 16 mycoplasmas, 18 chlamydia, 2 fungi and 74 bacteria in 99 samples, among which 61 samples were mixed infections. The combined use of serological tests and TEM significantly improved the detection rate of nonbacterial infectious agents in patients with severe pneumonia. Conclusions Our data support that implementation of TEM could improve the sensitivity for detecting viruses, atypical pathogens and mixed infections in BALF from patient of severe pneumonia. Therefore, TEM may be used as an auxiliary diagnostic method of other microbiological tests in severe pneumonia.
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Jung CY, Choe YH, Lee SY, Kim WJ, Lee JD, Ra SW, Choi EG, Lee JS, Park MJ, Na JO. Use of serology and polymerase chain reaction to detect atypical respiratory pathogens during acute exacerbation of chronic obstructive pulmonary disease. Korean J Intern Med 2018; 33:941-951. [PMID: 29929350 PMCID: PMC6129643 DOI: 10.3904/kjim.2017.279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/02/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS To use serological and multiplex polymerase chain reaction (PCR) assays to examine sputum samples from patients experiencing acute exacerbation of chronic obstructive pulmonary disease (AECOPD) for the presence of atypical pathogens, including Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila. METHODS From September 2012 to February 2014, 341 patients with AECOPD attending outpatient clinics were enrolled as part of a randomized, double-blind, multicenter study. A commercial enzyme-linked immunosorbent assay was used to measure serum immunoglobulin M (IgM) and IgG antibody titers on the first day of the study and at 36 days post-enrollment. Multiplex PCR was used to test sputum samples for the presence of atypical pathogens. A urinary antigen test for L. pneumophila was performed on the first day. RESULTS Nineteen patients (5.6%) showed serological evidence of acute infection with M. pneumoniae. Also, one and seven patients (2%) showed serological evidence of acute infection with C. pneumoniae and L. pneumophila, respectively. All DNA samples were negative for M. pneumoniae, C. pneumoniae, and L. pneumophila according to PCR. Only one urine sample was positive for L. pneumophila antigen, but serologic evidence was lacking. CONCLUSION Serological testing suggested that infection by atypical pathogens during AECOPD was relatively uncommon. In addition, PCR provided no direct evidence of infection by atypical pathogens. Thus, atypical pathogens may not be a major cause of AECOPD in South Korea.
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Affiliation(s)
- Chi Young Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Yeoung Hun Choe
- Division of Pulmonology and Allergology, Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Sang Yeub Lee
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Woo Jin Kim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jong Deog Lee
- Division of Pulmonology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Seung Won Ra
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Eu Gene Choi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Daejeon Hankook Hospital, Daejeon, Korea
| | - Jae Seung Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung Jae Park
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Ju Ock Na
- Division of Pulmonology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
- Correspondence to Ju Ock Na, M.D. Division of Pulmonology, Department of Internal Medicine, Soonchunhyang University College of Medicine, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea Tel: +82-41-570-3891 Fax: +82-41-574-5762 E-mail:
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Contemporary Situation of Community-acquired Pneumonia in China: A Systematic Review. J Transl Int Med 2018; 6:26-31. [PMID: 29607301 DOI: 10.2478/jtim-2018-0006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The prevalence and microbial pattern reported for Community-acquired pneumonia (CAP) differ considerably and contemporary situation remains changing over time. We therefore searched both international and domestic databases for relevant references and pooled incidence of CAP and etiological distribution were estimated separately between children and adults groups. The results showed that CAP remained a major public health issue in China, with a relatively higher incidence than that reported in Western countries. Although pathogens were not detected in nearly half of patients, Mycoplasma pneumoniae remained to be the most frequently detected agent across age groups, the detection yield of which was lower than that reported from other countries. Notably, the incidence of influenza virus A in adults was almost four times higher than that in children while the prevalence of respiratory syncytial virus was much less common in adults than that in children. Despite some limitations, the value of this review, approaching to systematically review grey published data, is to sketch out the contemporary epidemiological and etiological situation of CAP in our country, which could be useful to help policymakers and clinicians make informed choices and to inspire future studies and surveillance.
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Sahu R, Verma R, Dixit S, Igietseme JU, Black CM, Duncan S, Singh SR, Dennis VA. Future of human Chlamydia vaccine: potential of self-adjuvanting biodegradable nanoparticles as safe vaccine delivery vehicles. Expert Rev Vaccines 2018; 17:217-227. [PMID: 29382248 PMCID: PMC6330895 DOI: 10.1080/14760584.2018.1435279] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/29/2018] [Indexed: 01/12/2023]
Abstract
INTRODUCTION There is a persisting global burden and considerable public health challenge by the plethora of ocular, genital and respiratory diseases caused by members of the Gram-negative bacteria of the genus Chlamydia. The major diseases are conjunctivitis and blinding trachoma, non-gonococcal urethritis, cervicitis, pelvic inflammatory disease, ectopic pregnancy, tubal factor infertility, and interstitial pneumonia. The failures in screening and other prevention programs led to the current medical opinion that an efficacious prophylactic vaccine is the best approach to protect humans from chlamydial infections. Unfortunately, there is no human Chlamydia vaccine despite successful veterinary vaccines. A major challenge has been the effective delivery of vaccine antigens to induce safe and effective immune effectors to confer long-term protective immunity. The dawn of the era of biodegradable polymeric nanoparticles and the adjuvanted derivatives may accelerate the realization of the dream of human vaccine in the foreseeable future. AREAS COVERED This review focuses on the current status of human chlamydial vaccine research, specifically the potential of biodegradable polymeric nanovaccines to provide efficacious Chlamydia vaccines in the near future. EXPERT COMMENTARY The safety of biodegradable polymeric nanoparticles-based experimental vaccines with or without adjuvants and the array of available chlamydial vaccine candidates would suggest that clinical trials in humans may be imminent. Also, the promising results from vaccine testing in animal models could lead to human vaccines against trachoma and reproductive diseases simultaneously.
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Affiliation(s)
- Rajnish Sahu
- Department of Biological Sciences, Alabama State University, Montgomery, AL, USA
| | - Richa Verma
- Department of Biological Sciences, Alabama State University, Montgomery, AL, USA
| | - Saurabh Dixit
- Department of Biological Sciences, Alabama State University, Montgomery, AL, USA
| | - Joseph U. Igietseme
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control & Prevention (CDC), Atlanta, GA, USA
| | - Carolyn M Black
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control & Prevention (CDC), Atlanta, GA, USA
| | - Skyla Duncan
- Department of Biological Sciences, Alabama State University, Montgomery, AL, USA
| | - Shree R Singh
- Department of Biological Sciences, Alabama State University, Montgomery, AL, USA
| | - Vida A Dennis
- Department of Biological Sciences, Alabama State University, Montgomery, AL, USA
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Messous S, Grissa MH, Beltaief K, Boukef R, Nouira S, Mastouri M. [Bacteriology of acute exacerbations of chronic obstructive pulmonary disease in Tunisia]. Rev Mal Respir 2018; 35:36-47. [PMID: 29395563 DOI: 10.1016/j.rmr.2017.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/17/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The role of bacteria, including atypical organisms, in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has been assessed in various ways in Tunisia. METHODS This was a descriptive and analytical study of patients with a mean age of 68.3±10.5 years hospitalized for AECOPD. Bacteriological examination included a cytological sputum exam and serology for atypical organisms including Mycoplasma pneumoniae, Coxiella burnetii, Chlamydophila pneumoniae and Legionella pneumophila using standard techniques. RESULTS Of the 240 patients enrolled, 175 sputum cultures (73%) were considered significant. Twenty-nine cultures were positive (16.5%) and 31 microorganisms were isolated of which the most frequent were P. aeruginosa (25.8%), K. pneumoniae (16.2%), H. influenzae (13%) and S. pneumoniae (9.7%). The prevalence of C. pneumoniae, M. pneumoniae and C. burnetii was 8.4%, 9% and 6.6%, respectively. No L. pneumophila infection was found. The Anthonisen criteria were associated with a positive culture (P=0.04). Almost half (40.9%) of the isolates were resistant to conventional first line antibiotics (43.7% to amoxicillin-clavulanic acid). CONCLUSIONS Awareness of the low positivity of quantitative sputum bacteriology and the large percentage of resistant strains with a predominance of exclusively multi-resistant Pseudomonas should help in the management of patients with AECOPD.
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Affiliation(s)
- S Messous
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Laboratoire de microbiologie, hôpital universitaire Fattouma Bourguiba de Monastir, Monastir, Tunisie.
| | - M H Grissa
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Services des urgences, hôpital universitaire Fattouma Bourguiba de Monastir, Monastir, Tunisie
| | - K Beltaief
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Services des urgences, hôpital universitaire Fattouma Bourguiba de Monastir, Monastir, Tunisie
| | - R Boukef
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Services des urgences, hôpital universitaire Sahloul de Sousse, Sousse, Tunisie
| | - S Nouira
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Services des urgences, hôpital universitaire Fattouma Bourguiba de Monastir, Monastir, Tunisie
| | - M Mastouri
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Laboratoire de microbiologie, hôpital universitaire Fattouma Bourguiba de Monastir, Monastir, Tunisie
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20
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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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21
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Rane V, Khailin K, Williams J, Francis M, Kotsanas D, Korman TM, Graham M. Underdiagnosis of Chlamydia trachomatis and Chlamydia psittaci revealed by introduction of respiratory multiplex PCR assay with Chlamydiaceae family primers. Diagn Microbiol Infect Dis 2017; 90:163-166. [PMID: 29258707 DOI: 10.1016/j.diagmicrobio.2017.11.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/11/2017] [Accepted: 11/20/2017] [Indexed: 02/08/2023]
Abstract
We describe unanticipated detection of respiratory infection with Chlamydia trachomatis and Chlamydia psittaci after introduction of respiratory multiplex polymerase chain reaction assay that includes Chlamydiaceae family primers. We detected cases of pediatric C. trachomatis and of adult C. psittaci infection in patients with previously unrecognized risk factors. Directed testing for C. trachomatis and C. psittaci based on clinical features and risk factors alone is likely to miss the majority of infected cases.
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Affiliation(s)
- Vinita Rane
- Monash Infectious Diseases, Monash University, Monash Health, Clayton, Australia.
| | - Kong Khailin
- Monash Infectious Diseases, Monash University, Monash Health, Clayton, Australia
| | - Jackie Williams
- Department of Microbiology, Monash Pathology, Clayton, Australia
| | - Michelle Francis
- Department of Microbiology, Monash Pathology, Clayton, Australia
| | - Despina Kotsanas
- Monash Infectious Diseases, Monash University, Monash Health, Clayton, Australia
| | - Tony M Korman
- Monash Infectious Diseases, Monash University, Monash Health, Clayton, Australia; Department of Microbiology, Monash Pathology, Clayton, Australia
| | - Maryza Graham
- Monash Infectious Diseases, Monash University, Monash Health, Clayton, Australia; Department of Microbiology, Monash Pathology, Clayton, Australia.
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22
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Paplińska-Goryca M, Rubinsztajn R, Nejman-Gryz P, Przybyłowski T, Krenke R, Chazan R. The association between serological features of chronic Chlamydia pneumoniae infection and markers of systemic inflammation and nutrition in COPD patients. Scandinavian Journal of Clinical and Laboratory Investigation 2017; 77:644-650. [PMID: 29069917 DOI: 10.1080/00365513.2017.1393694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Chlamydia pneumoniae is an obligatory human pathogen involved in lower and upper airway infections, including pneumonia, bronchitis. Asymptomatic C. pneumoniae carriage is also relatively common. The association of C. pneumoniae infections with the chronic obstructive pulmonary disease (COPD) course is unclear. OBJECTIVES The aim of the study was to investigate the association between chronic C. pneumoniae infection and clinical features of COPD, markers of inflammation and metabolic dysfunction. PATIENTS AND METHODS The study included 59 patients with stable COPD who had no, or had ≥2 acute exacerbations during last year. The level of IgA and IgG antibody against C. pneumoniae, IL-6, IL-8, resistin, insulin, adiponectin and acyl ghrelin was measured in serum by enzyme-linked immunosorbent assay (ELISA). RESULTS No differences in clinical and functional data were observed between COPD patients without serological features of C. pneumoniae infection and chronic C. pneumoniae infection. The level of anti C. pneumoniae IgA significantly correlated with IL-8, IL-6, resistin concentration in group of frequent exacerbators. IgG level correlated negatively with acetyl ghrelin and body mass index (BMI) in patients without frequent exacerbations, in contrast to frequent COPD exacerbation group where significant correlations between IgG level and BMI was demonstrated. Serum IL-6 correlated positively with resistin and insulin and negatively with adiponectin in group of patients with serological features of chronic C. pneumoniae infection only. CONCLUSIONS Our study showed that chronic C. pneumoniae infection does not influence the clinical course of COPD in the both study groups. Chronic C. pneumoniae infections might be associated with a distinct COPD phenotype that affects metabolic dysfunction.
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Affiliation(s)
- Magdalena Paplińska-Goryca
- a Department of Internal Medicine, Pulmonary Diseases and Allergy , Medical University of Warsaw , Warsaw , Poland
| | - Renata Rubinsztajn
- a Department of Internal Medicine, Pulmonary Diseases and Allergy , Medical University of Warsaw , Warsaw , Poland
| | - Patrycja Nejman-Gryz
- a Department of Internal Medicine, Pulmonary Diseases and Allergy , Medical University of Warsaw , Warsaw , Poland
| | - Tadeusz Przybyłowski
- a Department of Internal Medicine, Pulmonary Diseases and Allergy , Medical University of Warsaw , Warsaw , Poland
| | - Rafał Krenke
- a Department of Internal Medicine, Pulmonary Diseases and Allergy , Medical University of Warsaw , Warsaw , Poland
| | - Ryszarda Chazan
- a Department of Internal Medicine, Pulmonary Diseases and Allergy , Medical University of Warsaw , Warsaw , Poland
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Cao B, Huang Y, She DY, Cheng QJ, Fan H, Tian XL, Xu JF, Zhang J, Chen Y, Shen N, Wang H, Jiang M, Zhang XY, Shi Y, He B, He LX, Liu YN, Qu JM. Diagnosis and treatment of community-acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association. CLINICAL RESPIRATORY JOURNAL 2017; 12:1320-1360. [PMID: 28756639 PMCID: PMC7162259 DOI: 10.1111/crj.12674] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/25/2017] [Indexed: 02/05/2023]
Abstract
Community‐acquired pneumonia (CAP) in adults is an infectious disease with high morbidity in China and the rest of the world. With the changing pattern in the etiological profile of CAP and advances in medical techniques in diagnosis and treatment over time, Chinese Thoracic Society of Chinese Medical Association updated its CAP guideline in 2016 to address the standard management of CAP in Chinese adults. Extensive and comprehensive literature search was made to collect the data and evidence for experts to review and evaluate the level of evidence. Corresponding recommendations are provided appropriately based on the level of evidence. This updated guideline covers comprehensive topics on CAP, including aetiology, antimicrobial resistance profile, diagnosis, empirical and targeted treatments, adjunctive and supportive therapies, as well as prophylaxis. The recommendations may help clinicians manage CAP patients more effectively and efficiently. CAP in pediatric patients and immunocompromised adults is beyond the scope of this guideline. This guideline is only applicable for the immunocompetent CAP patients aged 18 years and older. The recommendations on selection of antimicrobial agents and the dosing regimens are not mandatory. The clinicians are recommended to prescribe and adjust antimicrobial therapies primarily based on their local etiological profile and results of susceptibility testing, with reference to this guideline.
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Affiliation(s)
- Bin Cao
- National Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship Hospital, Capital Medical University, Beijing 100029, China
| | - Yi Huang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China
| | - Dan-Yang She
- Department of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100853, China
| | - Qi-Jian Cheng
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
| | - Hong Fan
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan 610041, China
| | - Xin-Lun Tian
- Department of Pulmonary Medicine, Peking Union Medical College Hospital, Beijing 100730, China
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jing Zhang
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yu Chen
- Department of Respiratory and Critical Care Medicine, Shengjing Hospital, China Medical University, Shenyang 110004, China
| | - Ning Shen
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Hui Wang
- Department of Laboratory Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Mei Jiang
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xiang-Yan Zhang
- Department of Respiratory and Critical Care Medicine, Guizhou Provincial People's Hospital, Guizhou 550002, China
| | - Yi Shi
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing 210002, China
| | - Bei He
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Li-Xian He
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - You-Ning Liu
- Department of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100853, China
| | - Jie-Ming Qu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
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Zhao MC, Li GX, Zhang D, Zhou HY, Wang H, Yang S, Wang L, Feng ZS, Ma XJ. Clinical evaluation of a new single-tube multiplex reverse transcription PCR assay for simultaneous detection of 11 respiratory viruses, Mycoplasma pneumoniae and Chlamydia in hospitalized children with acute respiratory infections. Diagn Microbiol Infect Dis 2017; 88:115-119. [PMID: 28365060 PMCID: PMC7132751 DOI: 10.1016/j.diagmicrobio.2017.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/13/2017] [Accepted: 03/16/2017] [Indexed: 12/09/2022]
Abstract
Respiratory Pathogen 13 Detection Kit (13× kit) is able to simultaneously detect 11 respiratory viruses, Mycoplasma pneumoniae (MP) and Chlamydia in a single reaction. Using 572 Nasopharyngeal aspirates collected from hospitalized children, the clinical performance of 13× kit for detecting 11 respiratory viruses was evaluated in comparison with a routinely used 2-tube multiplex reverse transcription PCR assay (2-tube assay) at provincial Centers for Disease Control and Prevention in China. The clinical performance of 13× kit for detecting MP and Chlamydia was evaluated by commercial real-time quantitative PCR (qPCR) kits or sequencing. For tested viruses, the assay concordance was 95.98% and the kappa coefficient was 0.89. All the MP and Chlamydia positive samples detected by 13× kit were confirmed as true positives. The utilization of the 13× kit in clinical settings will be helpful for doctors to assess clinical outcome according to virus type or multiple infections, and to limit the use of antibiotics. A 13× kit allowed for simultaneous detection of 11 respiratory viruses, MP and Ch. The detection rate of 13× kit was comparable to that of 2-tube assay (kappa >0.75). A 13× kit has high sensitivity (97.41%) and specificity (91.89%). MP and Chlamydia detected by 13× kit were verified by qPCR/sequencing as true positives.
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Affiliation(s)
- Meng-Chuan Zhao
- Pediatric Research Institute, Children's Hospital of Hebei Province, Shijiazhuang, 050031, Hebei Province, China; Key Laboratory for Medical Virology, National Health and Family Planning Commission, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206,China.
| | - Gui-Xia Li
- Pediatric Research Institute, Children's Hospital of Hebei Province, Shijiazhuang, 050031, Hebei Province, China.
| | - Dan Zhang
- Key Laboratory for Medical Virology, National Health and Family Planning Commission, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206,China.
| | - Hang-Yu Zhou
- Key Laboratory for Medical Virology, National Health and Family Planning Commission, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206,China.
| | - Hao Wang
- Key Laboratory for Medical Virology, National Health and Family Planning Commission, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206,China; Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 41345, Sweden.
| | - Shuo Yang
- Pediatric Research Institute, Children's Hospital of Hebei Province, Shijiazhuang, 050031, Hebei Province, China.
| | - Le Wang
- Pediatric Research Institute, Children's Hospital of Hebei Province, Shijiazhuang, 050031, Hebei Province, China.
| | - Zhi-Shan Feng
- Pediatric Research Institute, Children's Hospital of Hebei Province, Shijiazhuang, 050031, Hebei Province, China.
| | - Xue-Jun Ma
- Key Laboratory for Medical Virology, National Health and Family Planning Commission, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206,China.
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del Valle-Mendoza J, Orellana-Peralta F, Marcelo-Rodríguez A, Verne E, Esquivel-Vizcarra M, Silva-Caso W, Aguilar-Luis MA, Weilg P, Casabona-Oré V, Ugarte C, del Valle LJ. High Prevalence of Mycoplasma pneumoniae and Chlamydia pneumoniae in Children with Acute Respiratory Infections from Lima, Peru. PLoS One 2017; 12:e0170787. [PMID: 28129377 PMCID: PMC5271412 DOI: 10.1371/journal.pone.0170787] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 01/11/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Mycoplasma pneumoniae and Chlamydia pneumoniae are atypical pathogens responsible for pneumonia and a leading cause of morbidity and mortality in low income countries. The study objective is to determine the prevalence of this pathogens in Peruvian children with acute respiratory infections. METHODS A consecutive cross-sectional study was conducted in Lima, Peru from May 2009 to September 2010. A total of 675 children admitted with clinical diagnoses of acute respiratory infections were tested for Mycoplasma pneumoniae and Chlamydia pneumoniae detection by polymerase chain reaction (PCR), and clinical symptoms were registered by the attending physician. RESULTS Mycoplasma pneumonia was detected in 25.19% (170/675) of nasopharyngeal samples and Chlamydia pneumonia in 10.52% (71/675). The most common symptoms in patients with these atypical pathogens were rhinorrhea, cough and fever. A higher prevalence of Mycoplasma pneumoniae cases were registered in summer, between December 2009 and March 2010. CONCLUSIONS Mycoplasma pneumoniae and Chlamydia pneumonia are a significant cause of morbidity in Peruvian children with acute respiratory infections (ARI). Further studies should evaluate the use of reliable techniques such as PCR in Peru in order to avoid underdiagnoses of these atypical pathogens.
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Affiliation(s)
- Juana del Valle-Mendoza
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences. Universidad Peruana de Ciencias Aplicadas-UPC, Lima, Peru
- Instituto de Investigación Nutricional, Lima, Peru
| | - Fiorella Orellana-Peralta
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences. Universidad Peruana de Ciencias Aplicadas-UPC, Lima, Peru
- Instituto de Investigación Nutricional, Lima, Peru
| | | | | | | | - Wilmer Silva-Caso
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences. Universidad Peruana de Ciencias Aplicadas-UPC, Lima, Peru
| | - Miguel Angel Aguilar-Luis
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences. Universidad Peruana de Ciencias Aplicadas-UPC, Lima, Peru
- Instituto de Investigación Nutricional, Lima, Peru
| | - Pablo Weilg
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences. Universidad Peruana de Ciencias Aplicadas-UPC, Lima, Peru
| | - Verónica Casabona-Oré
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences. Universidad Peruana de Ciencias Aplicadas-UPC, Lima, Peru
- Instituto de Investigación Nutricional, Lima, Peru
| | | | - Luis J. del Valle
- Centre de Biotecnologia Molecular (CEBIM), Departament d’Enginyeria Química, ETSEIB, Universitat Politècnica de Catalunya (UPC) Barcelona Tech, Barcelona, Spain
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Inostroza E, Pinto R. NEUMONÍA POR AGENTES ATÍPICOS EN NIÑOS. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sasaoka Y, Yoto Y, Tatsumi M, Iida K, Tsutsumi H. Neonatal apnea with Chlamydia pneumoniae infection. Pediatr Int 2017; 59:111-112. [PMID: 28102626 DOI: 10.1111/ped.13145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 08/12/2016] [Accepted: 08/24/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Yuta Sasaoka
- Department of Pediatrics, Otaru-Kyokai Hospital, Otaru, Hokkaido, Japan
| | - Yuko Yoto
- Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Masatoshi Tatsumi
- Department of Pediatrics, Otaru-Kyokai Hospital, Otaru, Hokkaido, Japan
| | - Kazuki Iida
- Department of Pediatrics, Otaru-Kyokai Hospital, Otaru, Hokkaido, Japan
| | - Hiroyuki Tsutsumi
- Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Identification of Dietzia spp. from Cardiac Tissue by 16S rRNA PCR in a Patient with Culture-Negative Device-Associated Endocarditis: A Case Report and Review of the Literature. Case Rep Infect Dis 2016; 2016:8935052. [PMID: 28101387 PMCID: PMC5215629 DOI: 10.1155/2016/8935052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 10/25/2016] [Accepted: 12/05/2016] [Indexed: 11/18/2022] Open
Abstract
The genus Dietzia was recently distinguished from other actinomycetes such as Rhodococcus. While these organisms are known to be distributed widely in the environment, over the past decade several novel species have been described and isolated from human clinical specimens. Here we describe the identification of Dietzia natronolimnaea/D. cercidiphylli by PCR amplification and sequencing of the 16S rRNA encoding gene from cardiac tissue in a patient with culture-negative device-associated endocarditis.
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Shaik-Dasthagirisaheb YB, Mekasha S, He X, Gibson FC, Ingalls RR. Signaling events in pathogen-induced macrophage foam cell formation. Pathog Dis 2016; 74:ftw074. [PMID: 27481727 DOI: 10.1093/femspd/ftw074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2016] [Indexed: 12/31/2022] Open
Abstract
Macrophage foam cell formation is a key event in atherosclerosis. Several triggers induce low-density lipoprotein (LDL) uptake by macrophages to create foam cells, including infections with Porphyromonas gingivalis and Chlamydia pneumoniae, two pathogens that have been linked to atherosclerosis. While gene regulation during foam cell formation has been examined, comparative investigations to identify shared and specific pathogen-elicited molecular events relevant to foam cell formation are not well documented. We infected mouse bone marrow-derived macrophages with P. gingivalis or C. pneumoniae in the presence of LDL to induce foam cell formation, and examined gene expression using an atherosclerosis pathway targeted plate array. We found over 30 genes were significantly induced in response to both pathogens, including PPAR family members that are broadly important in atherosclerosis and matrix remodeling genes that may play a role in plaque development and stability. Six genes mainly involved in lipid transport were significantly downregulated. The response overall was remarkably similar and few genes were regulated in a pathogen-specific manner. Despite very divergent lifestyles, P. gingivalis and C. pneumoniae activate similar gene expression profiles during foam cell formation that may ultimately serve as targets for modulating infection-elicited foam cell burden, and progression of atherosclerosis.
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Affiliation(s)
- Yazdani B Shaik-Dasthagirisaheb
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA
| | - Samrawit Mekasha
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA
| | - Xianbao He
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA
| | - Frank C Gibson
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA
| | - Robin R Ingalls
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA
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Hanski L, Ausbacher D, Tiirola TM, Strøm MB, Vuorela PM. Amphipathic β2,2-Amino Acid Derivatives Suppress Infectivity and Disrupt the Intracellular Replication Cycle of Chlamydia pneumoniae. PLoS One 2016; 11:e0157306. [PMID: 27280777 PMCID: PMC4900588 DOI: 10.1371/journal.pone.0157306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/29/2016] [Indexed: 12/27/2022] Open
Abstract
We demonstrate in the current work that small cationic antimicrobial β2,2-amino acid derivatives (Mw < 500 Da) are highly potent against Chlamydia pneumoniae at clinical relevant concentrations (< 5 μM, i.e. < 3.4 μg/mL). C. pneumoniae is an atypical respiratory pathogen associated with frequent treatment failures and persistent infections. This gram-negative bacterium has a biphasic life cycle as infectious elementary bodies and proliferating reticulate bodies, and efficient treatment is challenging because of its long and obligate intracellular replication cycle within specialized inclusion vacuoles. Chlamydicidal effect of the β2,2-amino acid derivatives in infected human epithelial cells was confirmed by transmission electron microscopy. Images of infected host cells treated with our lead derivative A2 revealed affected chlamydial inclusion vacuoles 24 hours post infection. Only remnants of elementary and reticulate bodies were detected at later time points. Neither the EM studies nor resazurin-based cell viability assays showed toxic effects on uninfected host cells or cell organelles after A2 treatment. Besides the effects on early intracellular inclusion vacuoles, the ability of these β2,2-amino acid derivatives to suppress Chlamydia pneumoniae infectivity upon treatment of elementary bodies suggested also a direct interaction with bacterial membranes. Synthetic β2,2-amino acid derivatives that target C. pneumoniae represent promising lead molecules for development of antimicrobial agents against this hard-to-treat intracellular pathogen.
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Affiliation(s)
- Leena Hanski
- Pharmaceutical Design and Discovery Research Group, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki (UHEL), Helsinki, Finland
| | - Dominik Ausbacher
- Natural Products and Medicinal Chemistry Research Group, Department of Pharmacy, Faculty of Health Sciences, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Terttu M. Tiirola
- Pharmaceutical Design and Discovery Research Group, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki (UHEL), Helsinki, Finland
| | - Morten B. Strøm
- Natural Products and Medicinal Chemistry Research Group, Department of Pharmacy, Faculty of Health Sciences, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Pia M. Vuorela
- Pharmaceutical Design and Discovery Research Group, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki (UHEL), Helsinki, Finland
- * E-mail:
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Using Nucleic Acid Amplification Techniques in a Syndrome-Oriented Approach: Detection of Respiratory Agents. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, Reed C, Grijalva CG, Anderson EJ, Courtney DM, Chappell JD, Qi C, Hart EM, Carroll F, Trabue C, Donnelly HK, Williams DJ, Zhu Y, Arnold SR, Ampofo K, Waterer GW, Levine M, Lindstrom S, Winchell JM, Katz JM, Erdman D, Schneider E, Hicks LA, McCullers JA, Pavia AT, Edwards KM, Finelli L. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med 2015; 373:415-27. [PMID: 26172429 PMCID: PMC4728150 DOI: 10.1056/nejmoa1500245] [Citation(s) in RCA: 1546] [Impact Index Per Article: 171.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. Incidence estimates of pneumonia confirmed radiographically and with the use of current laboratory diagnostic tests are needed. METHODS We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among adults 18 years of age or older in five hospitals in Chicago and Nashville. Patients with recent hospitalization or severe immunosuppression were excluded. Blood, urine, and respiratory specimens were systematically collected for culture, serologic testing, antigen detection, and molecular diagnostic testing. Study radiologists independently reviewed chest radiographs. We calculated population-based incidence rates of community-acquired pneumonia requiring hospitalization according to age and pathogen. RESULTS From January 2010 through June 2012, we enrolled 2488 of 3634 eligible adults (68%). Among 2320 adults with radiographic evidence of pneumonia (93%), the median age of the patients was 57 years (interquartile range, 46 to 71); 498 patients (21%) required intensive care, and 52 (2%) died. Among 2259 patients who had radiographic evidence of pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 853 (38%): one or more viruses in 530 (23%), bacteria in 247 (11%), bacterial and viral pathogens in 59 (3%), and a fungal or mycobacterial pathogen in 17 (1%). The most common pathogens were human rhinovirus (in 9% of patients), influenza virus (in 6%), and Streptococcus pneumoniae (in 5%). The annual incidence of pneumonia was 24.8 cases (95% confidence interval, 23.5 to 26.1) per 10,000 adults, with the highest rates among adults 65 to 79 years of age (63.0 cases per 10,000 adults) and those 80 years of age or older (164.3 cases per 10,000 adults). For each pathogen, the incidence increased with age. CONCLUSIONS The incidence of community-acquired pneumonia requiring hospitalization was highest among the oldest adults. Despite current diagnostic tests, no pathogen was detected in the majority of patients. Respiratory viruses were detected more frequently than bacteria. (Funded by the Influenza Division of the National Center for Immunizations and Respiratory Diseases.).
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Affiliation(s)
- Seema Jain
- From the Centers for Disease Control and Prevention, Atlanta (S.J., A.M.B., C.R., M.L., S.L., J.M.W., J.M.K., D.E., E.S., L.A.H., L.F.); Vanderbilt University School of Medicine (W.H.S., C.G.G., J.D.C., F.C., D.J.W., Y.Z., K.M.E.) and University of Tennessee Health Science Center-Saint Thomas Health (C.T.), Nashville, and Le Bonheur Children's Hospital (S.R.A., J.A.M.), University of Tennessee Health Science Center (S.R.A., J.A.M.), and St. Jude Children's Research Hospital (J.A.M.), Memphis - all in Tennessee; Northwestern University Feinberg School of Medicine (R.G.W., E.J.A., D.M.C., C.Q., E.M.H., H.K.D., G.W.W.), John H. Stroger, Jr., Hospital of Cook County (S.F.), and Rush University Medical Center (R.B.) - all in Chicago; University of Utah Health Sciences Center, Salt Lake City (K.A., A.T.P.); and University of Western Australia, Perth (G.W.W.)
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Kumar S, Smith-Norowitz TA, Kohlhoff S, Apfalter P, Roblin P, Kutlin A, Harkema J, Ng SP, Doherty-Lyons S, Zelikoff JT, Hammerschlag MR. Exposure to cigarette smoke and Chlamydia pneumoniae infection in mice: Effect on infectious burden, systemic dissemination and cytokine responses: A pilot study. J Immunotoxicol 2015; 13:77-83. [PMID: 25640695 DOI: 10.3109/1547691x.2015.1006346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Cigarette smoke exposure has been considered a risk factor for infection with Chlamydia pneumoniae. C. pneumoniae infection is associated with respiratory tract infection and chronic respiratory disease, which is a serious public health concern. To determine whether prior exposure to cigarette smoke worsens C. pneumoniae infection (specifically, increases infectious burden and systemic dissemination) as well as alters cytokine responses in mice, adult female C57BL/6 mice were exposed to either filtered air (FA) or mainstream cigarette smoke (MCS) (15 mg/m(3), total suspended particulates) for 5 days/week for 2 weeks and then infected with C. pneumoniae (10(5) IFU) via intratracheal instillation. Mice were euthanized on Days 7, 14 or 26 post-infection (p.i.). Chlamydial burdens in the lungs and spleen were quantified by quantitative PCR (qPCR) and histologic analyses were performed; cytokine levels (TNFα, IL-4, IFNγ) in bronchoalveolar lavage fluid and serum were assayed by enzyme-linked immunosorbent assay (ELISA). The results indicated that: (1) mice exposed to either FA or MCS had similar chlamydial burdens in the lungs and spleen on Days 14 and 26 p.i.; (2) proximal and distal airway inflammation was observed on Day 14 p.i. in both FA and MCS mice, but persisted in MCS mice until Day 26 p.i.; FA exposed mice demonstrated resolution of distal airway inflammation; and (3) MCS mice displayed higher serum levels of IFNγ and IL-4 on Day 26 p.i. These findings indicate that exposure of mice to MCS (at a concentration equivalent to smoking < 1 pack cigarettes/day) led to greater C. pneumoniae-induced inflammation, as indicated by prolonged inflammatory changes.
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Affiliation(s)
- Swati Kumar
- a Department of Pediatrics , State University of New York Downstate Medical Center , Brooklyn , NY , USA
| | - Tamar A Smith-Norowitz
- a Department of Pediatrics , State University of New York Downstate Medical Center , Brooklyn , NY , USA
| | - Stephan Kohlhoff
- a Department of Pediatrics , State University of New York Downstate Medical Center , Brooklyn , NY , USA
| | - Petra Apfalter
- a Department of Pediatrics , State University of New York Downstate Medical Center , Brooklyn , NY , USA
| | - Patricia Roblin
- a Department of Pediatrics , State University of New York Downstate Medical Center , Brooklyn , NY , USA
| | - Andrei Kutlin
- a Department of Pediatrics , State University of New York Downstate Medical Center , Brooklyn , NY , USA
| | - Jack Harkema
- b Center for Integrative Toxicology, Michigan State University , East Lansing , MI , USA
| | - Sheung P Ng
- c DuPont Stine Haskell Research Center , Newark , DE , USA , and
| | - Shannon Doherty-Lyons
- d Department of Environmental Medicine , New York University School of Medicine , Tuxedo , NY , USA
| | - Judith T Zelikoff
- d Department of Environmental Medicine , New York University School of Medicine , Tuxedo , NY , USA
| | - Margaret R Hammerschlag
- a Department of Pediatrics , State University of New York Downstate Medical Center , Brooklyn , NY , USA
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Abstract
PURPOSE OF REVIEW We present the key advances in the infections that clinicians conventionally associate with atypical pneumonia: legionellosis, Mycoplasma pneumonia, Chlamydophila species pneumonia and Q fever. RECENT FINDINGS There have been significant developments in molecular diagnosis to include Mycoplasma pneumoniae and Chlamydophila pneumoniae in multiplex PCR of respiratory specimens. There are diagnostic challenges in distinguishing carriage from infection, which is recognized in C. pneumoniae and now also evident in M. pneumoniae. Macrolide-resistant M. pneumoniae has emerged in Asia. There are new antimicrobials on the horizon in the ketolide class with activity against typical and atypical pathogens and useful empirical agents. SUMMARY There are few advances in our knowledge of the epidemiology of atypical pathogens or the effectiveness of antimicrobial therapy--empirical or pathogen specific. However, if molecular testing becomes widely implemented, there will be an increased understanding of the epidemiology and presentation of atypical pneumonia and a shift to more targeted antimicrobial therapy.
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Hammerschlag MR, Kohlhoff SA, Gaydos CA. Chlamydia pneumoniae. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7173483 DOI: 10.1016/b978-1-4557-4801-3.00184-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nakou A, Papaparaskevas J, Diamantea F, Skarmoutsou N, Polychronopoulos V, Tsakris A. A prospective study on bacterial and atypical etiology of acute exacerbation in chronic obstructive pulmonary disease. Future Microbiol 2014; 9:1251-60. [DOI: 10.2217/fmb.14.90] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
ABSTRACT Aim: The bacterial and atypical etiology of acute exacerbations of chronic obstructive pulmonary disease was investigated and the diagnostic techniques used were compared among 92 hospitalized patients. Materials & methods: Sputum specimens were investigated using culture and PCR, serological status evaluation was performed and the inflammatory profile was associated with the microbiological results. Results & conclusion: The majority of the patients (65.2%) had very severe airway obstruction. The most common bacteria were Haemophilus influenzae and Pseudomonas aeruginosa (23.9 and 14.1%, respectively). Acinetobacter baumannii- and P. aeruginosa-positive cultures were associated with prolonged hospitalization and severe airway obstruction (p = 0.03 and 0.031, respectively). Chlamydia pneumoniae or Mycoplasma pneumoniae infection was diagnosed in four and two patients, respectively. Discrepant results were detected between PCR and serology, especially regarding C. pneumoniae.
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Affiliation(s)
- Alexandra Nakou
- Department of Microbiology, Medical School, University of Athens, 11527, Athens, Greece
- Third Pulmonary Department, Sismanoglio District General Hospital, 15126, Maroussi, Greece
| | - Joseph Papaparaskevas
- Department of Microbiology, Medical School, University of Athens, 11527, Athens, Greece
| | - Filia Diamantea
- Third Pulmonary Department, Sismanoglio District General Hospital, 15126, Maroussi, Greece
| | - Nikoletta Skarmoutsou
- Department of Microbiology, Sismanoglio District General Hospital, 15126, Maroussi, Greece
| | | | - Athanassios Tsakris
- Department of Microbiology, Medical School, University of Athens, 11527, Athens, Greece
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Leonard CA, Borel N. Chronic Chlamydial Diseases: From Atherosclerosis to Urogenital Infections. CURRENT CLINICAL MICROBIOLOGY REPORTS 2014. [DOI: 10.1007/s40588-014-0005-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Javadi Nia S, Zarabi V, Noorbakhsh S, Farhadi M, Ghavidel Darestani S. Chlamydophila pneumoniae Infection Assessment in Children With Adenoid Hypertrophy Concomitant With Rhino Sinusitis. Jundishapur J Microbiol 2014; 7:e11134. [PMID: 25485049 PMCID: PMC4255211 DOI: 10.5812/jjm.11134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 06/16/2013] [Accepted: 07/15/2013] [Indexed: 11/16/2022] Open
Abstract
Background: Since adenoids may act as a reservoir for bacteria, they can cause ear infection, recurrent otitis and recurrent adenotonsillitis. Therefore, adenotonsillectomy is an efficient method for reducing the number and severity of subsequent infections. Objectives: This study aimed to determine the Chlamydophila pneumonia infection by serological tests and performing PCR in the adenoid tissue, in children undergoing adenoid surgery and compare the results with normal children. Patients and Methods: This case control study was conducted in the ENT and pediatric wards of Rasoul Akram Hospital in Tehran (2008-2011). We studied 53 patients who had undergone the adenoid surgery (adenoid hypertrophy concomitant with rhino sinusitis) and 31 other patients undergoing elective surgeries in the general surgery ward (like orthopedic surgeries, hernia, etc.) without any infection (like rhinosinusitis), as the control groups. We searched for C. pneumoniae by PCR kits (Chemicon, Germany) in resected adenoid tissues and nasopharyngeal swabs of controls (ethics restrictions in controls). We also looked for specific IgM & IgG antibodies (ELISA, Biochem Immuno Systems, Italy) and compared them between the two groups. A P value < 0.05 was considered statistically significant. Results: Positive PCR results were observed in 13.5% of cases and none of the controls. The condition prevalence was higher in warm seasons (P = 0.05). No correlation was found between positive PCR results and patients' gender. IgM presence was observed in 11% (6.51) of cases and 6.5% (2.31) of controls (P = 0.7). IgG results were not positive in any of the cases (0.51), whereas positive results were seen in 13.3% of the controls (P = 0.007). IgM results showed no significant difference with PCR results (P = 0.7) but IgG results did (P = 0.05). Conclusions: The results of the study showed a positive correlation between PCR and serology (IgM) results in the case group. Recent C. pneumoniae infection was proved to exist by PCR and serology (IgM) in patients who had undergone adenoidectomy. In contrast to the controls, none of the patients in the study group showed previous immunity. Findings indicate the probable role of C. pneumoniae infection, in inducing adenoid hypertrophy in nearly 13% of cases.
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Affiliation(s)
- Shima Javadi Nia
- Research Center of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran, IR Iran
| | - Vida Zarabi
- Research Center of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran, IR Iran
| | - Samileh Noorbakhsh
- Research Center of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Samileh Noorbakhsh, Research Center of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran. Tel: +98-2166525328, Fax: +98-2166516049, E-mail:
| | - Mohammad Farhadi
- ENT Head and Neck Surgery Research Center, Iran University of Medical Sciences, Tehran, IR Iran
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Peto L, Nadjm B, Horby P, Ngan TTD, van Doorn R, Van Kinh N, Wertheim HFL. The bacterial aetiology of adult community-acquired pneumonia in Asia: a systematic review. Trans R Soc Trop Med Hyg 2014; 108:326-37. [PMID: 24781376 PMCID: PMC4023908 DOI: 10.1093/trstmh/tru058] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a major cause of adult mortality in Asia. Appropriate empirical treatment depends on knowledge of the pathogens commonly responsible. However, assessing the aetiological significance of identified organisms is often difficult, particularly with sputum isolates that might represent contamination with oropharyngeal flora. METHODS A systematic review of all adult CAP aetiology studies from Asia, excluding the Middle East, published in English between 1 January 1990 and 1 March 2012 was conducted. Forty-eight studies reporting on 10 423 patients were included, representing data from China, India, Indonesia, Japan, Malaysia, The Philippines, Singapore, South Korea, Taiwan, Thailand and Vietnam. Data from large parts of Asia were unavailable and there was substantial heterogeneity in methodology. RESULTS As in western studies, Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella spp. and Haemophilus influenzae were all significant pathogens. However, compared with western studies, S. pneumoniae was of less relative importance. Gram-negative bacilli and Mycobacterium tuberculosis were more important, and in northeast Thailand Burkholderia pseudomallei was a major pathogen. CONCLUSION These data have major implications for diagnostic strategies and empirical treatment. Narrow-spectrum antibiotics targeting S. pneumoniae may be inappropriate in many Asian settings, and agents active against TB may lead to partial response and delayed TB diagnosis.
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Affiliation(s)
- Leon Peto
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi and Ho Chi Minh City, Vietnam Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford OX3 7LJ, UK
| | - Behzad Nadjm
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi and Ho Chi Minh City, Vietnam Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford OX3 7LJ, UK
| | - Peter Horby
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi and Ho Chi Minh City, Vietnam Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford OX3 7LJ, UK
| | | | - Rogier van Doorn
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi and Ho Chi Minh City, Vietnam Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford OX3 7LJ, UK
| | | | - Heiman F L Wertheim
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi and Ho Chi Minh City, Vietnam Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford OX3 7LJ, UK
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Jouneau S, Desrues B. [Long-term macrolide treatment in adult chronic bronchial diseases: benefits and limits]. Presse Med 2014; 43:510-9. [PMID: 24631048 DOI: 10.1016/j.lpm.2013.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/03/2013] [Accepted: 08/19/2013] [Indexed: 10/25/2022] Open
Abstract
Decreased frequency of pulmonary exacerbations, mainly related to immunomodulatory effects of macrolide antibiotics, has been demonstrated in bronchiectasis and chronic obstructive pulmonary diseases (COPD). Due to its tolerance, azithromycin is the antibiotic of choice for maintenance therapy at the dose of 250 mg per day or 500 mg × 3 per week (for body weight >55 kg). Maintenance therapy with macrolide could be proposed in selected patients with bronchiectasis or COPD with more than 3 acute exacerbations in the previous year or decreased lung function despite compliance with optimum treatment. The risk of sudden cardiac death with azithromycin is rare and controversial. It should be avoided in patients with a high baseline risk of cardiovascular disease, QT>450 msec, pulse rate>100 bpm and potential drug interactions, particularly those known to cause QT prolongation. It is recommended to search for hearing deficit (audiometry) and sputum culture positive for mycobacteria. Patients must also be aware that it can rapidly lead to macrolide resistance in commensal or pathogenic flora. Follow-up evaluation every 3 month can be proposed with medical history (hearing deficit) and electrocardiography. After one year, the treatment should be stopped in the absence of reduction in the frequency of exacerbations.
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Affiliation(s)
- Stéphane Jouneau
- Centre hospitalier universitaire de Rennes, hôpital Pontchaillou, service de pneumologie, 35033 Rennes cedex 9, France; IRSET-UMR Inserm U1085, 35043 Rennes cedex, France
| | - Benoît Desrues
- Centre hospitalier universitaire de Rennes, hôpital Pontchaillou, service de pneumologie, 35033 Rennes cedex 9, France.
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Abstract
BACKGROUND Mycoplasma pneumoniae has been implicated in asthma exacerbations and chronic asthma. A 2-year longitudinal study has been conducted to investigate the role of M. pneumoniae infections in 168 and 20 hospitalized children and adults, respectively, with asthma exacerbation compared with outpatients (88 children and 48 adults) with chronic asthma (without an exacerbation). The prevalence of Chlamydia pneumoniae and respiratory viruses was also assessed in these 2 populations. METHODS Lung function testing, blood sampling and microbiological testing (polymerase chain reaction, culture and serology) were performed for 256 children and 68 adults followed by a 7-week, follow-up visit with repeated blood sampling for serological testing and phone interviews at 6 and 12 months later. RESULTS M. pneumoniae infection was more prevalent in children with chronic asthma (13.6%) compared with children with exacerbation (7.1%), while the reverse was true in adults (6.3 vs. 10.0%, respectively). However, these differences were not statistically significant. Acute C. pneumoniae infection was identified in 3.9% of children and 7.4% adults. Children seen for chronic asthma were significantly more likely to be infected with C. pneumoniae than children hospitalized for an asthma exacerbation. Viruses were the most prevalent microorganisms detected in children with an asthma exacerbation. No differences in the outcome parameters were identified between M. pneumoniae-infected and noninfected patients. CONCLUSIONS The present study suggests that M. pneumoniae does not play a direct role in the pathogenicity of acute or chronic asthma in most children.
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Asner SA, Jaton K, Kyprianidou S, Nowak AML, Greub G. Chlamydia pneumoniae: possible association with asthma in children. Clin Infect Dis 2014; 58:1198-9. [PMID: 24429432 DOI: 10.1093/cid/ciu034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sandra A Asner
- Unit of Pediatric Infectious Diseases and Vaccinology, Department of Paediatrics, University Hospital Center
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Lamoth F, Greub G. Fastidious intracellular bacteria as causal agents of community-acquired pneumonia. Expert Rev Anti Infect Ther 2014; 8:775-90. [DOI: 10.1586/eri.10.52] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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High seroprevalence of Mycoplasma pneumoniae IgM in acute Q fever by enzyme-linked immunosorbent assay (ELISA). PLoS One 2013; 8:e77640. [PMID: 24147043 PMCID: PMC3798658 DOI: 10.1371/journal.pone.0077640] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 09/13/2013] [Indexed: 11/23/2022] Open
Abstract
Q fever is serologically cross-reactive with other intracellular microorganisms. However, studies of the serological status of Mycoplasma pneumoniae and Chlamydophila pneumoniae during Q fever are rare. We conducted a retrospective serological study of M. pneumoniae and C. pneumoniae by enzyme-linked immunosorbent assay (ELISA), a method widely used in clinical practice, in 102 cases of acute Q fever, 39 cases of scrub typhus, and 14 cases of murine typhus. The seropositive (57.8%, 7.7%, and 0%, p<0.001) and seroconversion rates (50.6%, 8.8%, and 0%, p<0.001) of M. pneumoniae IgM, but not M. pneumoniae IgG and C. pneumoniae IgG/IgM, in acute Q fever were significantly higher than in scrub typhus and murine typhus. Another ELISA kit also revealed a high seropositivity (49.5%) and seroconversion rate (33.3%) of M. pneumoniae IgM in acute Q fever. The temporal and age distributions of patients with positive M. pneumoniae IgM were not typical of M. pneumoniae pneumonia. Comparing acute Q fever patients who were positive for M. pneumoniae IgM (59 cases) with those who were negative (43 cases), the demographic characteristics and underlying diseases were not different. In addition, the clinical manifestations associated with atypical pneumonia, including headache (71.2% vs. 81.4%, p=0.255), sore throat (8.5% vs. 16.3%, p=0.351), cough (35.6% vs. 23.3%, p=0.199), and chest x-ray suggesting pneumonia (19.3% vs. 9.5%, p=0.258), were unchanged between the two groups. Clinicians should be aware of the high seroprevalence of M. pneumoniae IgM in acute Q fever, particularly with ELISA kits, which can lead to misdiagnosis, overestimations of the prevalence of M. pneumoniae pneumonia, and underestimations of the true prevalence of Q fever pneumonia.
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Abstract
Community-acquired pneumonia (CAP) accounts for major morbidity and mortality in the United States. With improved broad-spectrum antibiotics, the implementation of diagnostic studies has declined and most patients do not have an etiologic pathogen of CAP identified. To enhance the appropriate use of antiviral agents and prevent overuse of antibiotics, the successful management of CAP requires rapid and accurate diagnosis of the etiologic agent of CAP. This article provides an overview of the new rapid molecular tests for the diagnosis of influenza, other respiratory viruses, and bacteria compared with nonmolecular tests and how their use for directed therapy can enhance and improve the management of CAP.
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Affiliation(s)
- Charlotte A Gaydos
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
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High prevalence of Chlamydia pneumoniae infection in an asymptomatic Jordanian population. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 47:412-7. [PMID: 23751768 DOI: 10.1016/j.jmii.2013.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/10/2013] [Accepted: 04/15/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND/PURPOSE The bacterium Chlamydia pneumoniae is associated with respiratory diseases and nonrespiratory illnesses like atherosclerosis. This study aims to investigate the seroprevalence of immunoglobulin G (IgG) against C. pneumoniae in an asymptomatic population in Jordan and to analyze the immunity state in relation to age and sex. METHODS Serum samples were collected from 588 apparently healthy individuals aged 2-86 years. Using the microimmunofluorescence (MIF) test, seropositivity was defined as an anti-C. pneumoniae IgG titer ≥1:16. Titers from 1:16 to 1:256 were considered indicative for a past infection, whereas 1:512 was considered diagnostic of an acute infection. RESULTS The overall prevalence of C. pneumoniae was 54.9%. The mean seropositivity in males was slightly higher than females. The seroprevalence of infection was relatively low in children aged 2-9 years, and steadily increased to reach a plateau of 66.7% at around 30-39 years of age, which remained stable in later years. Recent infection was indicated in 14.3% of study subjects. The seropositivity was highest in males, and more frequent in adults than in children and teenagers. CONCLUSION A high seroprevalence of C. pneumoniae in the asymptomatic population suggests that infection with this pathogen is common in Jordan. Higher seropositivity in males compared to females was observed. The primary infection is acquired during the first four decades of life, and in older ages high antibody levels are likely maintained by reinfection or persistent infection.
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Conklin L, Adjemian J, Loo J, Mandal S, Davis C, Parks S, Parsons T, McDonough B, Partida J, Thurman K, Diaz MH, Benitez A, Pondo T, Whitney CG, Winchell JM, Kendig N, Van Beneden C. Investigation of a Chlamydia pneumoniae outbreak in a Federal correctional facility in Texas. Clin Infect Dis 2013; 57:639-47. [PMID: 23723194 DOI: 10.1093/cid/cit357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chlamydia pneumoniae illness is poorly characterized, particularly as a sole causative pathogen. We investigated a C. pneumoniae outbreak at a federal correctional facility. METHODS We identified inmates with acute respiratory illness (ARI) from 1 November 2009 to 24 February 2010 through clinic self-referral and active case finding. We tested oropharyngeal and/or nasopharyngeal swabs for C. pneumoniae by real-time polymerase chain reaction (qPCR) and serum samples by microimmunofluorescence. Cases were inmates with ARI and radiologically confirmed pneumonia, positive qPCR, or serological evidence of recent infection. Swabs from 7 acutely ill inmates were tested for 18 respiratory pathogens using qPCR TaqMan Array Cards (TACs). Follow-up swabs from case patients were collected for up to 8 weeks. RESULTS Among 33 self-referred and 226 randomly selected inmates, 52 (20.1%) met the case definition; pneumonia was confirmed in 4 by radiology only, in 9 by qPCR only, in 17 by serology only, and in 22 by both qPCR and serology. The prison attack rate was 10.4% (95% confidence interval, 7.0%-13.8%). White inmates and residents of housing unit Y were at highest risk. TAC testing detected C. pneumoniae in 4 (57%) inmates; no other causative pathogens were identified. Among 40 inmates followed prospectively, C. pneumoniae was detected for up to 8 weeks. Thirteen (52%) of 25 inmates treated with azithromycin continued to be qPCR positive >2 weeks after treatment. CONCLUSIONS Chlamydia pneumoniae was the causative pathogen of this outbreak. Higher risk among certain groups suggests that social interaction contributed to transmission. Persistence of C. pneumoniae in the oropharynx creates challenges for outbreak control measures.
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Affiliation(s)
- Laura Conklin
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Chen Z, Ji W, Wang Y, Yan Y, Zhu H, Shao X, Xu J. Epidemiology and associations with climatic conditions of Mycoplasma pneumoniae and Chlamydophila pneumoniae infections among Chinese children hospitalized with acute respiratory infections. Ital J Pediatr 2013; 39:34. [PMID: 23705964 PMCID: PMC3691665 DOI: 10.1186/1824-7288-39-34] [Citation(s) in RCA: 30] [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: 11/04/2012] [Accepted: 05/20/2013] [Indexed: 11/10/2022] Open
Abstract
Background The incidence of severe acute respiratory tract infections in children caused by Mycoplasma pneumoniae (syn. Schizoplasma pneumoniae) and Chlamydophila pneumoniae (formerly Chlamydia pneumoniae) varies greatly from year to year and place to place around the world. This study investigated the epidemiology of M. pneumoniae and C. pneumoniae infections among children hospitalized with acute respiratory infections in Suzhou, China in the year 2006, and associations between incidence rates and climatic conditions. Methods Nasopharyngeal aspirates obtained from 1598 patients (aged 26.4 ± 28.3 months; range, 1 month to 13 years) were analyzed with real-time PCR and ELISA. Meteorological data were obtained from the weather bureau. Results About 18.5% of patients were infected with M. pneumoniae and, C. pneumoniae, or both. Isolated M. pneumoniae infection was positively correlated with increasing age (χ2 = 34.76, P < 0.0001). Incidence of M. pneumoniae infection was seasonal with a peak in summer (P < 0.0001) and minimum in winter (P = 0.0001), whereas C. pneumoniae infection was low only in autumn (P = 0.02). Monthly mean temperature was strongly correlated with the incidence of M. pneumoniae infection (r = 0.825, P = 0.001). Conclusions M. pneumoniae and C. pneumoniae are important infectious agents in hospitalized children with acute respiratory tract infections. M. pneumoniae infection showed a strong direct correlation with environmental temperature.
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Affiliation(s)
- Zhengrong Chen
- Department of Respiratory Disease, Children's Hospital Affiliated to Soochow University, No. 303 JingDe Road, Suzhou, Jiangsu Province 215003, China.
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Atanu FO, Oviedo-Orta E, Watson KA. A novel transport mechanism for MOMP in Chlamydophila pneumoniae and its putative role in immune-therapy. PLoS One 2013; 8:e61139. [PMID: 23637791 PMCID: PMC3634821 DOI: 10.1371/journal.pone.0061139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 03/05/2013] [Indexed: 01/31/2023] Open
Abstract
Major outer membrane proteins (MOMPs) of Gram negative bacteria are one of the most intensively studied membrane proteins. MOMPs are essential for maintaining the structural integrity of bacterial outer membranes and in adaptation of parasites to their hosts. There is evidence to suggest a role for purified MOMP from Chlamydophila pneumoniae and corresponding MOMP-derived peptides in immune-modulation, leading to a reduced atherosclerotic phenotype in apoE(-/-) mice via a characteristic dampening of MHC class II activity. The work reported herein tests this hypothesis by employing a combination of homology modelling and docking to examine the detailed molecular interactions that may be responsible. A three-dimensional homology model of the C. pneumoniae MOMP was constructed based on the 14 transmembrane β-barrel crystal structure of the fatty acid transporter from Escherichia coli, which provides a plausible transport mechanism for MOMP. Ligand docking experiments were used to provide details of the possible molecular interactions driving the binding of MOMP-derived peptides to MHC class II alleles known to be strongly associated with inflammation. The docking experiments were corroborated by predictions from conventional immuno-informatic algorithms. This work supports further the use of MOMP in C. pneumoniae as a possible vaccine target and the role of MOMP-derived peptides as vaccine candidates for immune-therapy in chronic inflammation that can result in cardiovascular events.
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Affiliation(s)
- Francis O. Atanu
- School of Biological Sciences, Whiteknights Campus, University of Reading, Reading, Berkshire, United Kingdom
| | - Ernesto Oviedo-Orta
- University of Surrey, Faculty of Health and Medical Sciences, Guildford, United Kingdom
| | - Kimberly A. Watson
- School of Biological Sciences, Whiteknights Campus, University of Reading, Reading, Berkshire, United Kingdom
- * E-mail:
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Abstract
In recent years, quantitative real-time PCR tests have been extensively developed in clinical microbiology laboratories for routine diagnosis of infectious diseases, particularly bacterial diseases. This molecular tool is well-suited for the rapid detection of bacteria directly in clinical specimens, allowing early, sensitive and specific laboratory confirmation of related diseases. It is particularly suitable for the diagnosis of infections caused by fastidious growth species, and the number of these pathogens has increased recently. This method also allows a rapid assessment of the presence of antibiotic resistance genes or gene mutations. Although this genetic approach is not always predictive of phenotypic resistances, in specific situations it may help to optimize the therapeutic management of patients. Finally, an approach combining the detection of pathogens, their mechanisms of antibiotic resistance, their virulence factors and bacterial load in clinical samples could lead to profound changes in the care of these infected patients.
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Affiliation(s)
- Max Maurin
- Laboratoire de Bactériologie, Département des Agents Infectieux, Institut de Biologie et Pathologie, CHU de Grenoble, Université Joseph Fourier Grenoble 1, France.
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