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Olwagen CP, Jeche TR, Van Der Merwe L, Nunes MC, Madhi SA, Baillie VL. Nanofluidic qPCR unable to detect and serotype Streptococcus pneumoniae in urine samples of hospitalized South African patients with community-acquired pneumonia. Sci Rep 2023; 13:21332. [PMID: 38049501 PMCID: PMC10695952 DOI: 10.1038/s41598-023-48045-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023] Open
Abstract
Pneumonia is a major cause of death among adults living with HIV in South Africa, but the etiology of many cases remains unknown. This study evaluated the utility of a nanofluidic qPCR assay to detect and serotype Streptococcus pneumoniae in urine samples from patients hospitalized with community-acquired pneumonia (CAP). The nanofluidic qPCR assay was optimized to target 13 pneumococcal serotypes and 4 reference genes. Archived urine samples collected from patients > 15 years of age hospitalized with pneumonia between April 2018 and August 2019 were retrospectively tested using the nanofluidic qPCR assay, BinaxNOW urine antigen test, and standard LytA qPCR. Blood culture was undertaken on a subset of the samples at the discretion of the attending physician. Cohens' Kappa statistics were used to determine the concordance between the methods. Of the 828 adults hospitalized for CAP, urine samples were available in 53% (n = 439). Of those, a random subset of 96 (22%) samples underwent testing. Of the participants included in the final analysis, the mean age was 45.8 years (SD 16.2), 49% (n = 47) were female, 98% (n = 94) were black, and 66% (n = 63) were living with HIV infection. The nanofluidic qPCR method was able to detect PCV13 vaccine strains spiked into urine samples; however, the method failed to detect any pneumococcus in clinical samples. In comparison, 19% of the pneumonia cases were attributed to S. pneumoniae using urine antigen testing. Nanofluidic qPCR is unable to detect and serotype Streptococcus pneumoniae in urine samples of South Africans hospitalized with CAP.
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Affiliation(s)
- Courtney P Olwagen
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Science National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.
| | - Tariro R Jeche
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Lara Van Der Merwe
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Marta C Nunes
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
- Centre of Excellence in Respiratory Pathogens, Hospices Civils de Lyon, and Centre International de Recherche en Infectiologie (CIRI), Inserm, Université Claude Bernard Lyon 1, CNRS, UMR5308, U1111, Lyon, France
| | - Shabir A Madhi
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
- Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Vicky L Baillie
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
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Alibayov B, Scasny A, Khan F, Creel A, Smith P, Vidal AGJ, Fitisemanu FM, Padilla-Benavides T, Weiser JN, Vidal JE. Oxidative Reactions Catalyzed by Hydrogen Peroxide Produced by Streptococcus pneumoniae and Other Streptococci Cause the Release and Degradation of Heme from Hemoglobin. Infect Immun 2022; 90:e0047122. [PMID: 36409115 PMCID: PMC9753736 DOI: 10.1128/iai.00471-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022] Open
Abstract
Streptococcus pneumoniae (Spn) strains cause pneumonia that kills millions every year worldwide. Spn produces Ply, a hemolysin that lyses erythrocytes releasing hemoglobin, and also produces the pro-oxidant hydrogen peroxide (Spn-H2O2) during growth. The hallmark of the pathophysiology of hemolytic diseases is the oxidation of hemoglobin, but oxidative reactions catalyzed by Spn-H2O2 have been poorly studied. We characterized the oxidation of hemoglobin by Spn-H2O2. We prepared a series of single-mutant (ΔspxB or ΔlctO), double-mutant (ΔspxB ΔlctO), and complemented strains in TIGR4, D39, and EF3030. We then utilized an in vitro model with oxyhemoglobin to demonstrate that oxyhemoglobin was oxidized rapidly, within 30 min of incubation, by Spn-H2O2 to methemoglobin and that the main source of Spn-H2O2 was pyruvate oxidase (SpxB). Moreover, extended incubation caused the release and the degradation of heme. We then assessed oxidation of hemoglobin and heme degradation by other bacterial inhabitants of the respiratory tract. All hydrogen peroxide-producing streptococci tested caused the oxidation of hemoglobin and heme degradation, whereas bacterial species that produce <1 μM H2O2 neither oxidized hemoglobin nor degraded heme. An ex vivo bacteremia model confirmed that oxidation of hemoglobin and heme degradation occurred concurrently with hemoglobin that was released from erythrocytes by Ply. Finally, gene expression studies demonstrated that heme, but not red blood cells or hemoglobin, induced upregulated transcription of the spxB gene. Oxidation of hemoglobin may be important for pathogenesis and for the symbiosis of hydrogen peroxide-producing bacteria with other species by providing nutrients such as iron.
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Affiliation(s)
- Babek Alibayov
- Department of Cell and Molecular Biology, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Anna Scasny
- Department of Cell and Molecular Biology, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Faidad Khan
- Department of Cell and Molecular Biology, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Aidan Creel
- Department of Cell and Molecular Biology, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Summer Undergraduate Research Experience Program, School of Graduate Studies in the Health Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Perriann Smith
- Department of Cell and Molecular Biology, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Mississippi INBRE program, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Ana G. Jop Vidal
- Department of Cell and Molecular Biology, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | | | - Jeffrey N. Weiser
- Department of Microbiology, NYU Langone Health, New York, New York, USA
| | - Jorge E. Vidal
- Department of Cell and Molecular Biology, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Boix-Palop L, Obradors M, Xercavins M, Picó-Plana E, Canales L, Dietl B, Pérez J, Garau J, Calbo E. Improvement of pneumococcal pneumonia diagnosis using quantitative real-time PCR targeting lytA in adult patients: a prospective cohort study. Clin Microbiol Infect 2021; 28:138.e1-138.e7. [PMID: 34116202 DOI: 10.1016/j.cmi.2021.05.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The aim of the study was to assess the performance of real-time PCR targeting the lytA gene (rtPCR-lytA) in plasma, urine and nasopharyngeal (NP) samples for the diagnosis of pneumococcal community-acquired pneumonia (P-CAP). METHODS Prospective observational study including all consecutive adults with CAP from November 2015 to May 2017. P-CAP was defined if pneumococcus was identified using conventional methods (CM) and/or a positive rtPCR-lytA was detected in blood, urine or NP samples (NP cut-off ≥8000 copies/mL). Diagnostic performance of each test was calculated. RESULTS A total of 133 individuals with CAP were included. Of these, P-CAP was diagnosed in 62 (46.6%). The proportion of P-CAP diagnosed by rtPCR-lytA methods was significantly higher than that diagnosed by CM (87.1% versus 59.7%, p 0.005). The rtPCR-lytA identified Streptococcus pneumoniae in 25 patients (40.3% of all individuals with P-CAP) whose diagnosis would have been missed by CM. NP-rtPCR-lytA allowed diagnosis of 62.3% of P-CAP. A nasopharyngeal colonization density ≥2351 copies/mL predicted P-CAP diagnosis (area under the curve = 0.82, sensitivity 83.3%, specificity 80.9%). There was a positive correlation between increasing bacterial load in blood and CURB-65 score (Spearman correlation coefficient r = 0.4, p 0.001), pneumonia severity index (r = 0.3, p 0.02) and time to clinical stability (r = 0.33, p 0.01). Median bacterial load in blood was higher in P-CAP patients with bacteraemia (0.65 × 103 versus 0 × 103 copies/mL, p 0.002), intensive care unit admission (0.68 × 103 versus 0 × 103 copies/mL, p 0.04) or mechanical ventilation (7.45 × 103 versus 0 × 103 copies/mL, p 0.04). CONCLUSIONS The use of rtPCR-lytA methods significantly increased the diagnosis of P-CAP compared with CM. Nasopharyngeal swabs rtPCR-lytA detection, with an accurate cut-off value, was the most promising among molecular methods for the diagnosis of P-CAP.
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Affiliation(s)
- Lucía Boix-Palop
- Infectious Diseases Unit, Hospital Universitari Mútua de Terrassa, Barcelona, Spain; Universitat Internacional de Catalunya, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Meritxell Obradors
- Infectious Diseases Unit, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | | | | | - Lydia Canales
- Radiology Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Beatriz Dietl
- Infectious Diseases Unit, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Josefa Pérez
- Microbiology Department, CatLab, Barcelona, Spain
| | - Javier Garau
- Infectious Diseases Unit, Hospital Universitari Mútua de Terrassa, Barcelona, Spain; Service of Internal Medicine, Clínica Rotger, Palma de Mallorca, Spain
| | - Esther Calbo
- Infectious Diseases Unit, Hospital Universitari Mútua de Terrassa, Barcelona, Spain; Universitat Internacional de Catalunya, Barcelona, Spain.
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Prevalence and Antimicrobial Susceptibility of Streptococcus pneumoniae Isolated from Clinical Samples in the Past 8 Years in Korea. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6615334. [PMID: 33997025 PMCID: PMC8099532 DOI: 10.1155/2021/6615334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/10/2021] [Accepted: 04/17/2021] [Indexed: 11/18/2022]
Abstract
Pneumococcal infection is the main causative agent of pneumonia, meningitis, and sepsis in immunocompromised and elderly people. The samples in this study were collected from subjects in an 800-bed hospital in Chungnam province, Korea, over the past 8 years. Of the 473,230 samples obtained for microbial culture from 2012 to 2019, Streptococcus pneumoniae was isolated from 714 samples collected from 702 patients, with a pneumococcal-positive rate of 0.15%. We investigated the temporal, demographic, and specimen-specific distributions, as well as the antibiotic susceptibility pattern for S. pneumonia. The age of patients ranged from 0 days to 98 years, with an average age of 64.7 years. The distribution among the sexes was 2.4 : 1 (male : female), with more samples isolated from male patients. We observed that spring was the predominant season in which the infection occurred, accounting for 37.6% of the cases. Pneumococci were most frequently isolated from sputum (608 cases, 85.2%). Invasive infections were detected at a rate of 66% (in blood cultures), and noninvasive infections were detected at a rate of 91% (in sputum cultures). Antimicrobial resistance to ceftriaxone, cefotaxime, erythromycin, tetracycline, clindamycin, cotrimoxazole, levofloxacin, and penicillin, based on noninvasive infections, was observed in 21.6%, 27.2%, 79.2%, 73.2%, 68.0%, 51.3%, 9.8%, and 18.1% of cases, respectively. Additionally, on average, 66.9% of multidrug-resistant bacteria showed resistance to three or more antimicrobial agents, and 2.8% showed resistance to all other antibacterial agents except vancomycin. These results might facilitate the administration of appropriate empirical antibacterial therapy for pneumococcal infections.
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Kalina WV, Souza V, Wu K, Giardina P, McKeen A, Jiang Q, Tan C, French R, Ren Y, Belanger K, McElhiney S, Unnithan M, Cheng H, Mininni T, Giordano-Schmidt D, Gessner BD, Jansen KU, Pride MW. Qualification and Clinical Validation of an Immunodiagnostic Assay for Detecting 11 Additional Streptococcus pneumoniae Serotype-specific Polysaccharides in Human Urine. Clin Infect Dis 2021; 71:e430-e438. [PMID: 32072165 PMCID: PMC7713672 DOI: 10.1093/cid/ciaa158] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/18/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Identifying Streptococcus pneumoniae serotypes by urinary antigen detection (UAD) assay is the most sensitive way to evaluate the epidemiology of nonbacteremic community-acquired pneumonia (CAP). We first described a UAD assay to detect the S. pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F, covered by the licensed 13-valent S. pneumoniae conjugate vaccine. To assess the substantial remaining pneumococcal disease burden after introduction of several pneumococcal vaccines, a UAD-2 assay was developed to detect 11 additional serotypes (2, 8, 9N, 10A, 11A, 12F, 15B, 17F, 20, 22F, and 33F) in individuals with radiographically confirmed CAP. METHODS The specificity of the UAD-2 assay was achieved by capturing pneumococcal polysaccharides with serotype-specific monoclonal antibodies, using Luminex technology. Assay qualification was used to assess accuracy, precision, and sample linearity. Serotype positivity was based on cutoffs determined by nonparametric statistical evaluation of urine samples from individuals without pneumococcal disease. The sensitivity and specificity of the positivity cutoffs were assessed in a clinical validation, using urine samples obtained from a large study that measured the proportion of radiographically confirmed CAP caused by S. pneumoniae serotypes in hospitalized US adults. RESULTS The UAD-2 assay was shown to be specific and reproducible. Clinical validation demonstrated assay sensitivity and specificity of 92.2% and 95.9% against a reference standard of bacteremic pneumonia. In addition, the UAD-2 assay identified a S. pneumoniae serotype in 3.72% of nonbacteremic CAP cases obtained from hospitalized US adults. When combined with bacteremic CAP cases, the proportion of pneumonias with a UAD-2 serotype was 4.33%. CONCLUSIONS The qualified/clinically validated UAD-2 method has applicability in understanding the epidemiology of nonbacteremic S. pneumoniae CAP and for assessing the efficacy of future pneumococcal conjugate vaccines that are under development.
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Affiliation(s)
- Warren V Kalina
- Vaccine Research and Development,Pfizer Research, Pearl River, New York, USA
| | - Victor Souza
- Vaccine Research and Development,Pfizer Research, Pearl River, New York, USA
| | - Kangjian Wu
- Vaccine Research and Development,Pfizer Research, Pearl River, New York, USA
| | - Peter Giardina
- Vaccine Research and Development,Pfizer Research, Pearl River, New York, USA
| | - Andrew McKeen
- Early Clinical Development, Pfizer Research, Pearl River, New York, USA
| | - Qin Jiang
- Global Clinical Affairs, Pfizer, Collegeville, Pennsylvania, USA
| | - Charles Tan
- Early Clinical Development, Pfizer Research, Pearl River, New York, USA
| | - Roger French
- Early Clinical Development, Pfizer Research, Pearl River, New York, USA
| | - Yanhua Ren
- Vaccine Research and Development,Pfizer Research, Pearl River, New York, USA
| | - Kelly Belanger
- Vaccine Research and Development,Pfizer Research, Pearl River, New York, USA
| | - Susan McElhiney
- Vaccine Research and Development,Pfizer Research, Pearl River, New York, USA
| | - Manu Unnithan
- Vaccine Research and Development,Pfizer Research, Pearl River, New York, USA
| | - Huiming Cheng
- Vaccine Research and Development,Pfizer Research, Pearl River, New York, USA
| | - Terri Mininni
- Vaccine Research and Development,Pfizer Research, Pearl River, New York, USA
| | | | | | - Kathrin U Jansen
- Vaccine Research and Development,Pfizer Research, Pearl River, New York, USA
| | - Michael W Pride
- Vaccine Research and Development,Pfizer Research, Pearl River, New York, USA
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6
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Bedeley E, Gori A, Yeboah-Manu D, Diallo K. Control of Streptococcal Infections: Is a Common Vaccine Target Achievable Against Streptococcus agalactiae and Streptococcus pneumoniae. Front Microbiol 2021; 12:658824. [PMID: 33967998 PMCID: PMC8103614 DOI: 10.3389/fmicb.2021.658824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/30/2021] [Indexed: 12/21/2022] Open
Abstract
Both Streptococcus agalactiae [group B streptococcus (GBS)] and Streptococcus pneumoniae (pneumococcus) remain significant pathogens as they cause life threatening infections mostly in children and the elderly. The control of diseases caused by these pathogens is dependent on antibiotics use and appropriate vaccination. The introduction of the pneumococcal conjugate vaccines (PCVs) against some serotypes has led to reduction in pneumococcal infections, however, the subsequent serotype switching, and replacement has been a serious challenge. On the other hand, no vaccine is yet licensed for use in the control of GBS diseases. In this review, we provide an overview of the history and global disease burden, disease pathophysiology and management, vaccines update, and the biology of both pathogens. Furthermore, we address recent findings regarding structural similarities that could be explored for vaccine targets across both mucosal pathogens. Finally, we conclude by proposing future genomic sequence comparison using the wealth of available sequences from both species and the possibility of identifying more related structural components that could be exploited for pan-pathogen vaccine development.
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Affiliation(s)
- Edmund Bedeley
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Andrea Gori
- NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Dorothy Yeboah-Manu
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Kanny Diallo
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
- Centre Suisse de Recherche Scientifique de Côte d’Ivoire, Abidjan, Côte d’Ivoire
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7
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Akhter F, Womack E, Vidal JE, Le Breton Y, McIver KS, Pawar S, Eichenbaum Z. Hemoglobin stimulates vigorous growth of Streptococcus pneumoniae and shapes the pathogen's global transcriptome. Sci Rep 2020; 10:15202. [PMID: 32938947 PMCID: PMC7494912 DOI: 10.1038/s41598-020-71910-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/20/2020] [Indexed: 12/14/2022] Open
Abstract
Streptococcus pneumoniae (Spn) must acquire iron from the host to establish infection. We examined the impact of hemoglobin, the largest iron reservoir in the body, on pneumococcal physiology. Supplementation with hemoglobin allowed Spn to resume growth in an iron-deplete medium. Pneumococcal growth with hemoglobin was unusually robust, exhibiting a prolonged logarithmic growth, higher biomass, and extended viability in both iron-deplete and standard medium. We observed the hemoglobin-dependent response in multiple serotypes, but not with other host proteins, free iron, or heme. Remarkably, hemoglobin induced a sizable transcriptome remodeling, effecting virulence and metabolism in particular genes facilitating host glycoconjugates use. Accordingly, Spn was more adapted to grow on the human α − 1 acid glycoprotein as a sugar source with hemoglobin. A mutant in the hemoglobin/heme-binding protein Spbhp-37 was impaired for growth on heme and hemoglobin iron. The mutant exhibited reduced growth and iron content when grown in THYB and hemoglobin. In summary, the data show that hemoglobin is highly beneficial for Spn cultivation in vitro and suggest that hemoglobin might drive the pathogen adaptation in vivo. The hemoglobin receptor, Spbhp-37, plays a role in mediating the positive influence of hemoglobin. These novel findings provide intriguing insights into pneumococcal interactions with its obligate human host.
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Affiliation(s)
- Fahmina Akhter
- Department of Biology, Georgia State University, Atlanta, GA, USA
| | - Edroyal Womack
- Department of Biology, Georgia State University, Atlanta, GA, USA
| | - Jorge E Vidal
- Department of Microbiology and Immunology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Yoann Le Breton
- Department of Cell Biology and Molecular Genetics, Maryland Pathogen Research Institute, University of Maryland, College Park (UMCP), College Park, MD, USA.,Wound Infections Department, Bacterial Diseases Branch, The Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Kevin S McIver
- Department of Cell Biology and Molecular Genetics, Maryland Pathogen Research Institute, University of Maryland, College Park (UMCP), College Park, MD, USA
| | - Shrikant Pawar
- Department of Biology, Georgia State University, Atlanta, GA, USA.,Yale Center for Genome Analysis, Yale University, New Haven, CT, USA
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Ouldali N, Cohen R. Reducing the burden of paediatric pneumonia in the most affected populations. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:408-409. [PMID: 32450118 DOI: 10.1016/s2352-4642(20)30107-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Naïm Ouldali
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil 94000, France; Groupe de Pathologie Infectieuse Pédiatrique, Paris, France; Clinical Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, ECEVE INSERM UMR 1123, Paris, France; Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France.
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil 94000, France; Groupe de Pathologie Infectieuse Pédiatrique, Paris, France; Université Paris Est, IMRB-GRC GEMINI, Créteil, France; Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France; Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, France
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9
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Albrich WC, Rassouli F, Waldeck F, Berger C, Baty F. Influence of Older Age and Other Risk Factors on Pneumonia Hospitalization in Switzerland in the Pneumococcal Vaccine Era. Front Med (Lausanne) 2019; 6:286. [PMID: 31867337 PMCID: PMC6906144 DOI: 10.3389/fmed.2019.00286] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/21/2019] [Indexed: 01/04/2023] Open
Abstract
Background: Pneumococcal pneumonia is a disease of the extremes of age. However, as other traditional risk factors for pneumococcal pneumonia also increase with older age, it is unclear if older age itself should be an indication for pneumococcal vaccination. Therefore, we assessed the effect of age on risk for hospitalization for pneumonia and for pneumococcal pneumonia. Methods: Using a national hospitalization dataset, all patients ≥16 years hospitalized in a Swiss hospital with a diagnosis of pneumonia or pneumococcal pneumonia between 2002 and 2015 were included. Multivariable logistic regression analysis was used to test the association between age (≥50 or ≥65 years) and hospitalization for pneumonia or pneumococcal pneumonia after adjusting for pneumococcal vaccine indications. Similar analyses were performed for effect of age on length of stay (LOS) and mortality. Results: Among a total of 17,619,016 hospitalizations a diagnosis of pneumonia was present in 421,760 (2.4%) and a diagnosis of pneumococcal pneumonia in 21,610 (0.12%). Age ≥50 years (OR: 3.52 and 2.12, respectively; p for both <0.001) and age ≥65 years (OR: 2.98 and 1.80, respectively; p for both <0.001) as well as most Swiss pneumococcal vaccine indications were independent predictors of hospitalization with a pneumonia and pneumococcal pneumonia diagnosis, respectively. Older age with both age cut-offs were associated with increased LOS (≥50 years: aRR: 1.19 and 1.24, respectively; age ≥65 years: aRR: 1.60 and 1.20, respectively; p < 0.001 for all) and mortality (≥50 years: aOR: 4.73 and 2.84, respectively; age ≥65 years: aOR: 2.38 and 2.69, respectively, p < 0.001 for all) in patients with a pneumonia and pneumococcal pneumonia diagnosis, respectively. The effects of pneumococcal vaccine indications decreased with older age. The incidences of hospitalizations with a pneumonia diagnosis and a pneumococcal pneumonia diagnosis increased significantly from the pre-vaccine era to the PCV7 era and the PCV13 era (p for trend for both analyses <0.001). Conclusion: This study confirms the Swiss indications for pneumococcal vaccination as independent risk factors for pneumonia hospitalizations. Older age itself should be considered as an additional vaccine indication. Pneumonia and pneumococcal pneumonia in adults have increased despite pneumococcal vaccination in children.
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Affiliation(s)
- Werner C. Albrich
- Division Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Frank Rassouli
- Department of Pulmonary and Sleep Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Frederike Waldeck
- Division Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zürich, Zurich, Switzerland
| | - Florent Baty
- Department of Pulmonary and Sleep Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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10
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Lu Y, Joseph L, Bélisle P, Sawatwong P, Jatapai A, Whistler T, Thamthitiwat S, Paveenkittiporn W, Khemla S, Van Beneden CA, Baggett HC, Gregory CJ. Pneumococcal pneumonia prevalence among adults with severe acute respiratory illness in Thailand - comparison of Bayesian latent class modeling and conventional analysis. BMC Infect Dis 2019; 19:423. [PMID: 31092207 PMCID: PMC6521483 DOI: 10.1186/s12879-019-4067-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 05/07/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Determining the etiology of pneumonia is essential to guide public health interventions. Diagnostic test results, including from polymerase chain reaction (PCR) assays of upper respiratory tract specimens, have been used to estimate prevalence of pneumococcal pneumonia. However limitations in test sensitivity and specificity and the specimen types available make establishing a definitive diagnosis challenging. Prevalence estimates for pneumococcal pneumonia could be biased in the absence of a true gold standard reference test for detecting Streptococcus pneumoniae. METHODS We conducted a case control study to identify etiologies of community acquired pneumonia (CAP) from April 2014 through August 2015 in Thailand. We estimated the prevalence of pneumococcal pneumonia among adults hospitalized for CAP using Bayesian latent class models (BLCMs) incorporating results of real-time polymerase chain reaction (qPCR) testing of upper respiratory tract specimens and a urine antigen test (UAT) from cases and controls. We compared the prevalence estimate to conventional analyses using only UAT as a reference test. RESULTS The estimated prevalence of pneumococcal pneumonia was 8% (95% CI: 5-11%) by conventional analyses. By BLCM, we estimated the prevalence to be 10% (95% CrI: 7-16%) using binary qPCR and UAT results, and 11% (95% CrI: 7-17%) using binary UAT results and qPCR cycle threshold (Ct) values. CONCLUSIONS BLCM suggests a > 25% higher prevalence of pneumococcal pneumonia than estimated by a conventional approach assuming UAT as a gold standard reference test. Higher quantities of pneumococcal DNA in the upper respiratory tract were associated with pneumococcal pneumonia in adults but the addition of a second specific pneumococcal test was required to accurately estimate disease status and prevalence. By incorporating the inherent uncertainty of diagnostic tests, BLCM can obtain more reliable estimates of disease status and improve understanding of underlying etiology.
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Affiliation(s)
- Ying Lu
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
| | - Lawrence Joseph
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Patrick Bélisle
- Centre Hospitalier de l'Universite de Montreal,Montreal, Montreal, Canada
| | - Pongpun Sawatwong
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Anchalee Jatapai
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,Office of Public Health, Regional Development Mission for Asia, US Agency for International Development, Bangkok, Thailand
| | - Toni Whistler
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Somsak Thamthitiwat
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wantana Paveenkittiporn
- Department of Medical Sciences, Ministry of Public Health, National Institute of Health, Nonthaburi, Thailand
| | - Supphacoke Khemla
- Nakhon Phanom Provincial Hospital, Ministry of Public Health, Nakhon Phanom, Thailand
| | - Chris A Van Beneden
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Disease, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Henry C Baggett
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christopher J Gregory
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,Present affiliation: Division of Vector-Borne Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO, USA
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11
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Tomczyk S, McCracken JP, Contreras CL, Lopez MR, Bernart C, Moir JC, Escobar K, Reyes L, Arvelo W, Lindblade K, Peruski L, Bryan JP, Verani JR. Factors associated with fatal cases of acute respiratory infection (ARI) among hospitalized patients in Guatemala. BMC Public Health 2019; 19:499. [PMID: 31053069 PMCID: PMC6498661 DOI: 10.1186/s12889-019-6824-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 04/15/2019] [Indexed: 01/08/2023] Open
Abstract
Background Acute respiratory infection (ARI) is an important cause of mortality in children and adults. However, studies assessing risk factors for ARI-related deaths in low- and middle-income settings are limited. We describe ARI-related death and associated factors among children aged < 2 years and adults aged ≥18 years hospitalized with ARI in Guatemala. Methods We used respiratory illness surveillance data in Guatemala from 2007 to 2013. ARI was defined as evidence of acute infection and ≥ 1 sign/symptom of respiratory disease in hospitalized patients. Clinical, sociodemographic, and follow-up data were gathered. Nasopharyngeal/oropharyngeal swabs were collected from patients with ARI and tested for 6 respiratory viruses; urine was collected only from adults with ARI and tested for pneumococcal antigen. Blood cultures and chest radiographs were performed at the physician’s discretion. Radiographs were interpreted per World Health Organization guidelines to classify endpoint pneumonia (i.e. suggestive of bacterial pneumonia). Multivariable logistic regression was used to compare characteristics of patients with fatal cases, including those who died in-hospital or were discharged in a moribund state, with those of patients with non-fatal cases. Results Among 4109 ARI cases identified in hospitalized children < 2 years old, 174 (4%) were fatal. Median age at admission was 4 and 6 months for children with fatal and non-fatal cases, respectively. Factors associated with fatality included low weight-for-age, low family income, heart disease, and endpoint pneumonia; breastfeeding and respiratory syncytial virus (RSV) detection were negatively associated with fatality. Among 1517 ARI cases identified in hospitalized adults ≥18 years, 181 (12%) episodes were fatal. Median age at admission was 57 years for adults with fatal and non-fatal cases. Low body mass index, male sex, kidney disease, and endpoint pneumonia were significantly more common among patients with fatal versus non-fatal cases. Conclusions Our findings highlight some of the factors that must be addressed in order to reduce ARI-related mortality, including promotion of good nutrition, breastfeeding, management and prevention of chronic comorbidities, and poverty reduction. Although no specific pathogen increased risk for death, endpoint pneumonia was significantly associated with fatality, suggesting that the pneumococcal conjugate vaccine could contribute to future reductions in ARI-related mortality.
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Affiliation(s)
- Sara Tomczyk
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
| | - John P McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
| | - Carmen Lucia Contreras
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Maria Renee Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Chris Bernart
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Juan Carlos Moir
- Quetzaltenango Health Area, Ministry of Public Health and Social Welfare, Quetzaltenango, Guatemala
| | - Kenneth Escobar
- Western Regional Hospital San Juan de Dios, Ministry of Public Health and Social Welfare, Quetzaltenango, Guatemala
| | - Lisette Reyes
- Santa Rosa Health Area, Ministry of Public Health and Social Welfare, Cuilapa, Guatemala
| | - Wences Arvelo
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
| | - Kim Lindblade
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
| | - Leonard Peruski
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
| | - Joe P Bryan
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
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12
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Regev-Yochay G, Chowers M, Chazan B, Gonzalez E, Gray S, Zhang Z, Pride M. Distribution of 13-Valent pneumococcal conjugate vaccine serotype streptococcus pneumoniae in adults 50 Years and Older presenting with community-acquired pneumonia in Israel. Hum Vaccin Immunother 2018; 14:2527-2532. [PMID: 30188760 PMCID: PMC6284513 DOI: 10.1080/21645515.2018.1475811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Community acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide, and is a leading cause of hospitalization in previously healthy individuals without predisposing risk factors or comorbidities. In this study we determined PCV13 serotype distribution in adults aged ≥50 years with radiographically confirmed CAP in Israel. METHODS Subjects aged ≥50 years were enrolled from one of three hospitals (Emek Medical Center, Meir Medical Center and Sheba Medical Center) from March 2014 to July 2015. Information was collected on subject demographics, comorbidities, risk factors, and pneumococcal vaccine immunization status. Subjects presented with suspected CAP supported by radiographic evidence, and provided a urine sample and informed consent. Subjects without radiographic confirmation of CAP or who received PPSV23 within 30 days of study enrollment were excluded from the final analysis. Serotype distribution was performed using the urinary antigen detection (UAD) assay and/or microbiological culture. RESULTS Overall, 498 subjects with radiographically confirmed CAP were enrolled in the study. Eighty subjects (16.1%) were positive for any S. pneumoniae serotype by ≥1 assay, and 38 (7.6%) were positive for PCV13 serotypes via the UAD. The overall 30-day mortality rate was 1.2%, though S. pneumoniae was not isolated from any case leading to death. CONCLUSION Despite six years of high pneumococcal immunization coverage in children in Israel, we have shown that 7.6% of CAP cases among adults in Israel remain related to PCV13 serotypes; and that the burden of PCV13 may be as high as 47% of observed pneumococcal CAP.
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Affiliation(s)
- Gili Regev-Yochay
- a Sheba Medical Center, Ramat Gan, affiliated to the Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
| | - Michal Chowers
- b Meir Medical Center, Kfar Saba, Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Bibiana Chazan
- c Ha'Emek Medical Center, Afula, Rappaport Faculty of Medicine , Technion , Haifa
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13
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Kersting S, Rausch V, Bier FF, von Nickisch-Rosenegk M. A recombinase polymerase amplification assay for the diagnosis of atypical pneumonia. Anal Biochem 2018; 550:54-60. [DOI: 10.1016/j.ab.2018.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 12/15/2022]
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14
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Sakai F, Sonaty G, Watson D, Klugman KP, Vidal JE. Development and characterization of a synthetic DNA, NUversa, to be used as a standard in quantitative polymerase chain reactions for molecular pneumococcal serotyping. FEMS Microbiol Lett 2018; 364:4082726. [PMID: 28903467 PMCID: PMC5812490 DOI: 10.1093/femsle/fnx173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 08/04/2017] [Indexed: 01/18/2023] Open
Abstract
Identification of Streptococcus pneumoniae and its more than 90 serotypes is routinely conducted by culture and Quellung reactions. Quantitative polymerase chain reactions (qPCRs) have been developed for molecular detection, including a pan-pneumococcus lytA assay, and assays targeting 79 serotypes. Reactions require genomic DNA from every target to prepare standards, which can be time consuming. In this study, we have developed a synthetic DNA molecule as a surrogate for genomic DNA and present new single-plex qPCR reactions to increase molecular detection to 94 pneumococcal serotypes. Specificity of these new reactions was confirmed with a limit of detection between 2 and 20 genome equivalents/reaction. A synthetic DNA (NUversa, ∼8.2 kb) was then engineered to contain all available qPCR targets for serotyping and lytA. NUversa was cloned into pUC57-Amp-modified to generate pNUversa (∼10.2 kb). Standards prepared from pNUversa and NUversa were compared against standards made out of genomic DNA. Linearity [NUversa (R2 > 0.982); pNUversa (R2 > 0.991)] and efficiency of qPCR reactions were similar to those utilizing chromosomal DNA (R2 > 0.981). Quantification with plasmid pNUversa was affected, however, whereas quantification with synthetic NUversa was comparable to that of genomic DNA. Therefore, NUversa may be utilized as DNA standard in single-plex assays of the currently known 94 pneumococcal serotypes.
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Affiliation(s)
- Fuminori Sakai
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE Room 6007, Atlanta, GA 30322, USA
| | - Griffin Sonaty
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE Room 6007, Atlanta, GA 30322, USA
| | - David Watson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE Room 6007, Atlanta, GA 30322, USA
| | - Keith P Klugman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE Room 6007, Atlanta, GA 30322, USA.,Bill and Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA 98109, USA
| | - Jorge E Vidal
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE Room 6007, Atlanta, GA 30322, USA
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15
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Baggett HC, Watson NL, Deloria Knoll M, Brooks WA, Feikin DR, Hammitt LL, Howie SRC, Kotloff KL, Levine OS, Madhi SA, Murdoch DR, Scott JAG, Thea DM, Antonio M, Awori JO, Baillie VL, DeLuca AN, Driscoll AJ, Duncan J, Ebruke BE, Goswami D, Higdon MM, Karron RA, Moore DP, Morpeth SC, Mulindwa JM, Park DE, Paveenkittiporn W, Piralam B, Prosperi C, Sow SO, Tapia MD, Zaman K, Zeger SL, O'Brien KL. Density of Upper Respiratory Colonization With Streptococcus pneumoniae and Its Role in the Diagnosis of Pneumococcal Pneumonia Among Children Aged <5 Years in the PERCH Study. Clin Infect Dis 2018; 64:S317-S327. [PMID: 28575365 PMCID: PMC5850437 DOI: 10.1093/cid/cix100] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Previous studies suggested an association between upper airway pneumococcal colonization density and pneumococcal pneumonia, but data in children are limited. Using data from the Pneumonia Etiology Research for Child Health (PERCH) study, we assessed this potential association. Methods PERCH is a case-control study in 7 countries: Bangladesh, The Gambia, Kenya, Mali, South Africa, Thailand, and Zambia. Cases were children aged 1–59 months hospitalized with World Health Organization–defined severe or very severe pneumonia. Controls were randomly selected from the community. Microbiologically confirmed pneumococcal pneumonia (MCPP) was confirmed by detection of pneumococcus in a relevant normally sterile body fluid. Colonization density was calculated with quantitative polymerase chain reaction analysis of nasopharyngeal/oropharyngeal specimens. Results Median colonization density among 56 cases with MCPP (MCPP cases; 17.28 × 106 copies/mL) exceeded that of cases without MCPP (non-MCPP cases; 0.75 × 106) and controls (0.60 × 106) (each P < .001). The optimal density for discriminating MCPP cases from controls using the Youden index was >6.9 log10 copies/mL; overall, the sensitivity was 64% and the specificity 92%, with variable performance by site. The threshold was lower (≥4.4 log10 copies/mL) when MCPP cases were distinguished from controls who received antibiotics before specimen collection. Among the 4035 non-MCPP cases, 500 (12%) had pneumococcal colonization density >6.9 log10 copies/mL; above this cutoff was associated with alveolar consolidation at chest radiography, very severe pneumonia, oxygen saturation <92%, C-reactive protein ≥40 mg/L, and lack of antibiotic pretreatment (all P< .001). Conclusions Pneumococcal colonization density >6.9 log10 copies/mL was strongly associated with MCPP and could be used to improve estimates of pneumococcal pneumonia prevalence in childhood pneumonia studies. Our findings do not support its use for individual diagnosis in a clinical setting.
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Affiliation(s)
- Henry C Baggett
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi.,Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - W Abdullah Brooks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab
| | - Daniel R Feikin
- International Vaccine Access Center, and.,Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laura L Hammitt
- International Vaccine Access Center, and.,Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Stephen R C Howie
- Medical Research Council Unit, Basse, The Gambia.,Department of Paediatrics University of Auckland, and.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Karen L Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development, Institute of Global Health, University of Maryland School of Medicine, Baltimore
| | - Orin S Levine
- International Vaccine Access Center, and.,Bill & Melinda Gates Foundation, Seattle, Washington
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - David R Murdoch
- Department of Pathology, University of Otago, and.,Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - J Anthony G Scott
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Donald M Thea
- Center for Global Health and Development, Boston University School of Public Health, Massachusetts
| | - Martin Antonio
- Medical Research Council Unit, Basse, The Gambia.,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, and.,Department of Pathogen Molecular Biology, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Juliet O Awori
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Vicky L Baillie
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrea N DeLuca
- International Vaccine Access Center, and.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | - Doli Goswami
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab
| | | | - Ruth A Karron
- Department of International Health, Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David P Moore
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics & Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, South Africa
| | - Susan C Morpeth
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom.,Microbiology Laboratory, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | | | - Daniel E Park
- International Vaccine Access Center, and.,Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, District Columbia
| | | | | | | | - Samba O Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali; and
| | - Milagritos D Tapia
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development, Institute of Global Health, University of Maryland School of Medicine, Baltimore
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab
| | - Scott L Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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16
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AlBarrak A, Alotaibi B, Yassin Y, Mushi A, Maashi F, Seedahmed Y, Alshaer M, Altaweel A, Elshiekh H, Turkistani A, Petigara T, Grabenstein J, Yezli S. Proportion of adult community-acquired pneumonia cases attributable to Streptococcus pneumoniae among Hajj pilgrims in 2016. Int J Infect Dis 2018; 69:68-74. [PMID: 29474989 PMCID: PMC7110457 DOI: 10.1016/j.ijid.2018.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 01/18/2023] Open
Abstract
The study evaluated the burden of pneumococcal community-acquired pneumonia (CAP) during Hajj 2016. The majority of CAP cases (70.6%) were admitted to hospitals in Mecca, and 53% were admitted after Hajj. A large proportion of cases were older adult males and 45.4% of cases were treated in the intensive care unit (ICU). The overall case-fatality rate was 10.1%, but was higher among those treated in the ICU and in those with invasive disease. The proportion of CAP cases positive for Streptococcus pneumoniae was 18.0%.
Background The Hajj mass gathering is a risk for pneumococcal disease. This study was performed to evaluate the proportion of adult community-acquired pneumonia (CAP) cases attributable to Streptococcus pneumoniae among Hajj pilgrims in 2016. To add sensitivity to etiological attribution, a urine antigen test was used in addition to culture-based methods. Methods Adult subjects hospitalized with X-ray-confirmed CAP were enrolled prospectively from all general hospitals designated to treat Hajj pilgrims in the holy cities of Mecca and Medina. Patients were treated according to local standard of care and administered the BinaxNow S. pneumoniae urine antigen test. Results From August 23 to September 23, 2016, a total of 266 patients with CAP were enrolled in the study, 70.6% of whom were admitted to hospitals in Mecca; 53% of the cases were admitted after the peak of Hajj. Patients originated from 43 countries. Their mean age was 65.3 years and the male to female ratio was 2:1. Just over 36% of the cases had diabetes, 10% declared that they were smokers, and 45.4% of cases were treated in the intensive care unit (ICU). The overall case-fatality rate was 10.1%, but was higher among those treated in the ICU and in those with invasive disease. The proportion of CAP cases positive for S. pneumoniae, based on culture or urine antigen test, was 18.0% (95% confidence interval 13.9–23.1%). Conclusions CAP during Hajj has an important clinical impact. A proportion of CAP cases among Hajj pilgrims were attributable to S. pneumoniae, a pathogen for which vaccines are available. Additional studies to determine the serotypes causing pneumococcal disease could further inform vaccine policy for Hajj pilgrims.
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Affiliation(s)
- Ali AlBarrak
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Badriah Alotaibi
- Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Yara Yassin
- Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdulaziz Mushi
- Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Fuad Maashi
- Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Yassein Seedahmed
- General Directorate of Health Affairs in Makkah Region, Makkah, Saudi Arabia
| | - Mohamed Alshaer
- General Directorate of Health Affairs in Makkah Region, Makkah, Saudi Arabia
| | - Abdulaziz Altaweel
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Husameddin Elshiekh
- General Directorate of Health Affairs in Medina Region, Medina, Saudi Arabia
| | | | | | | | - Saber Yezli
- Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia.
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17
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Pollock N, Dhiman R, Daifalla N, Farhat M, Campos-Neto A. Discovery of a unique Mycobacterium tuberculosis protein through proteomic analysis of urine from patients with active tuberculosis. Microbes Infect 2018; 20:228-235. [PMID: 29306028 PMCID: PMC5946903 DOI: 10.1016/j.micinf.2017.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/06/2017] [Accepted: 12/15/2017] [Indexed: 11/29/2022]
Abstract
Identification of pathogen-specific biomarkers present in patients' serum or urine samples can be a useful diagnostic approach. In efforts to discover Mycobacterium tuberculosis (Mtb) biomarkers we identified by mass spectroscopy a unique 21-mer Mtb peptide sequence (VVLGLTVPGGVELLPGVALPR) present in the urines of TB patients from Zimbabwe. This peptide has 100% sequence homology with the protein TBCG_03312 from the C strain of Mtb (a clinical isolate identified in New York, NY, USA) and 95% sequence homology with Mtb oxidoreductase (MRGA423_21210) from the clinical isolate MTB423 (identified in Kerala, India). Alignment of the genes coding for these proteins show an insertion point mutation relative to Rv3368c of the reference H37Rv strain, which generated a unique C-terminus with no sequence homology with any other described protein. Phylogenetic analysis utilizing public sequence data shows that the insertion mutation is apparently a rare event. However, sera from TB patients from distinct geographical areas of the world (Peru, Vietnam, and South Africa) contain antibodies that recognize a purified recombinant C-terminus of the protein, thus suggesting a wider distribution of isolates that produce this protein.
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Affiliation(s)
- Nira Pollock
- Boston Children's Hospital and Harvard Medical School, Boston MA, USA
| | | | | | - Maha Farhat
- Harvard Medical School, and Massachusetts General Hospital, Boston, MA, USA
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18
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Howard LM, Fan R, Zhu Y, Griffin MR, Edwards KM, Hartinger S, Williams JV, Vidal JE, Klugman KP, Gil AI, Lanata CF, Grijalva CG. Nasopharyngeal Pneumococcal Density Is Associated With Viral Activity but Not With Use of Improved Stoves Among Young Andean Children. Open Forum Infect Dis 2017; 4:ofx161. [PMID: 28929126 PMCID: PMC5601081 DOI: 10.1093/ofid/ofx161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/20/2017] [Indexed: 12/15/2022] Open
Abstract
Background Indoor smoke exposure is common in developing countries and may influence nasopharyngeal (NP) pneumococcal colonization density and risk of acute respiratory illness. We compared colonization density among Andean children living in households previously enrolled in a randomized controlled trial of a home intervention package including improved stoves to reduce smoke, kitchen sinks, and water disinfection. Methods We enrolled 260 children aged <3 years and made weekly household visits to assess for acute respiratory illness (ARI) and collect nasal swabs for respiratory virus polymerase chain reaction (PCR) testing during ARI. At monthly intervals, NP swabs were collected to determine pneumococcal colonization density through quantitative lytA PCR. We used linear quantile mixed-effects models to compare median log-transformed colonization densities among children in households randomized to the control (n = 129) versus intervention (n = 131) in sequential time points, accounting for random effects of multiple samples from individual children. Other covariates included age, sex, month, antibiotic exposure, and timing of sample collection relative to ARI with and without viral detection. Results Age and sociodemographic characteristics were similar between groups. Although no differences were observed in densities between groups, colonization density varied significantly over time in both groups, with highest densities coinciding with spring months. Time during and after virus-associated ARI was also associated with higher pneumococcal colonization density than time remote from ARIs. Conclusions A home intervention package, including improved stoves, was not associated with changes in pneumococcal densities in young Andean children. However, increasing pneumococcal density was observed with spring season and viral-associated ARIs.
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Affiliation(s)
- Leigh M Howard
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Vaccine Research Program, Nashville, Tennessee
| | | | | | - Marie R Griffin
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee
| | - Kathryn M Edwards
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Vaccine Research Program, Nashville, Tennessee
| | - Stella Hartinger
- Universidad Peruana Cayetano Heredia, Lima, Peru.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - John V Williams
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pennsylvania
| | - Jorge E Vidal
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Keith P Klugman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ana I Gil
- Instituto de Investigacion Nutricional, Lima, Peru
| | - Claudio F Lanata
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.,Instituto de Investigacion Nutricional, Lima, Peru
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee
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19
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Cocontribution of Rotavirus and Pneumococcal Conjugate Vaccines to the Reduction of Pediatric Hospital Visits in Young Children. J Pediatr 2017; 182:253-259.e2. [PMID: 27939127 DOI: 10.1016/j.jpeds.2016.11.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/10/2016] [Accepted: 11/09/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess rotavirus vaccine and pneumococcal conjugate vaccines (PCVs) cumulative impact on the pediatric emergency department visits and hospitalization rates in children <2 years of age in southern Israel between April 2006 and March 2014. STUDY DESIGN This prospective, population-based observational study calculated the rates of rotavirus gastroenteritis (RVGE), non-RVGE, community-acquired alveolar pneumonia (CAAP), nonalveolar lower respiratory tract infection, and all-cause hospital visits. PCV7, PCV13, and rotavirus vaccination programs were implemented in Israel in July 2009, November 2010, and January 2011, respectively. RESULTS From 2006-2009 to 2013-2014, the rates of hospitilizations for RVGE, non-RVGE, CAAP, and nonalveolar lower respiratory tract infection decreased by 78%, 21%, 46%, and 7%, respectively. In outpatients, the respective decreases were 80%, 16%, 67%, and 14%. All-cause outpatient pediatric emergency department visits and hospitalization rates were reduced by 12% and 11%, respectively. During the peak season (October through March), RVGE, non-RVGE, CAAP, and nonalveolar lower respiratory tract infection hospitalization rates decreased significantly by 86%, 44.6%, 23.3%, and 10.5%, respectively. In outpatients, the respective decreases were 81.7%, 73.5%, 13.8%, and 10.7%. The proportion of RVGE and CAAP (grouped) of all-cause hospitalizations and outpatient pediatric ED visits decreased from 19.9% to 12.3% and from 6.9% to 1.8%, respectively. CONCLUSIONS Rotavirus vaccine and PCV introduction cocontributed to a rapid, considerable reduction in hospital burden in children <2 years of age. Because seasonalities of both diseases overlap, this reduction is particularly helpful in relieving burdens of disease and care during the most cumbersome morbidity season.
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Blanco-Covián L, Montes-García V, Girard A, Fernández-Abedul MT, Pérez-Juste J, Pastoriza-Santos I, Faulds K, Graham D, Blanco-López MC. Au@Ag SERRS tags coupled to a lateral flow immunoassay for the sensitive detection of pneumolysin. NANOSCALE 2017; 9:2051-2058. [PMID: 28112761 DOI: 10.1039/c6nr08432j] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Establishing a definitive diagnosis of pneumonia using conventional tests is difficult and expensive. Lateral flow immunoassays (LFIAs) are an advantageous point of care (POC) test option, but they have some limitations in terms of detection and quantification. In this work we have developed a lateral flow immunoassay for the ultrasensitive detection of penumolysin employing plasmonic Surface-Enhanced Resonance Raman Scattering (SERRS) tag as labelled probe. The combination of Au@Ag core-shell nanoparticles as plasmonic platform and Rhodamine B Isothiocyanate as Raman reporter has allowed us to fabricate a SERRS tag with high efficiency and reliability. The limit of detection of the SERRS-based LFIA was 1 pg mL-1. This could be a strong foundation for a pneumonia diagnosis test based on pneumolysin detection.
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Affiliation(s)
- Lucía Blanco-Covián
- Departamento de Química Física y Analítica, Universidad de Oviedo, 33006 Oviedo, Spain.
| | | | - Alexandre Girard
- Centre for Molecular Nanometrology, Department of Pure and Applied Chemistry, WestCHEM, University of Strathclyde, Glasgow G1 1RD, UK
| | | | - Jorge Pérez-Juste
- Departamento de Química Física and CINBIO, Universidade de Vigo, 36310 Vigo, Spain.
| | | | - Karen Faulds
- Centre for Molecular Nanometrology, Department of Pure and Applied Chemistry, WestCHEM, University of Strathclyde, Glasgow G1 1RD, UK
| | - Duncan Graham
- Centre for Molecular Nanometrology, Department of Pure and Applied Chemistry, WestCHEM, University of Strathclyde, Glasgow G1 1RD, UK
| | - M Carmen Blanco-López
- Departamento de Química Física y Analítica, Universidad de Oviedo, 33006 Oviedo, Spain.
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Alcoba G, Keitel K, Maspoli V, Lacroix L, Manzano S, Gehri M, Tabin R, Gervaix A, Galetto-Lacour A. A three-step diagnosis of pediatric pneumonia at the emergency department using clinical predictors, C-reactive protein, and pneumococcal PCR. Eur J Pediatr 2017; 176:815-824. [PMID: 28474099 PMCID: PMC7087038 DOI: 10.1007/s00431-017-2913-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 04/03/2017] [Accepted: 04/18/2017] [Indexed: 12/27/2022]
Abstract
UNLABELLED Recommendations for the management of community-acquired pneumonia (CAP) advocate that, in the absence of the clinical and laboratory findings typical of bacterial CAP, antibiotics are not required. However, the true value of the clinical and laboratory predictors of pediatric CAP still needs to be assessed. This prospective cohort study in three emergency departments enrolled 142 children with radiological pneumonia. Pneumonia with lung consolidation was the primary endpoint; complicated pneumonia (bacteremia, empyema, or pleural effusion) was the secondary endpoint. We showed that three clinical signs (unilateral hypoventilation, grunting, and absence of wheezing), elevated procalcitonin (PCT), C-reactive protein (CRP), negative nasopharyngeal viral PCR, or positive blood pneumococcal PCR (P-PCR) were significantly associated with both pneumonia with consolidation and complicated pneumonia. Children with negative clinical signs and low CRP values had a low probability of having pneumonia with consolidation (13%) or complicated pneumonia (6%). Associating the three clinical signs, CRP >80 mg/L and a positive P-PCR ruled in the diagnosis of complicated pneumonia with a positive predictive value of 75%. CONCLUSION A model incorporating clinical signs and laboratory markers can effectively assess the risk of having pneumonia. Children with negative clinical signs and low CRP are at a low risk of having pneumonia. For children with positive clinical signs and high CRP, a positive blood pneumococcal PCR can more accurately confirm the diagnosis of pneumonia. What is Known: • Distinguishing between bacterial and viral pneumonia in children is challenging. • Reducing the inappropriate use of antibiotics is a priority. What is New: • Children with negative clinical signs and low C-reactive protein (CRP) values have a low probability of having pneumonia. • Children with high CRP values can be tested using a pneumococcal PCR to rule in the diagnosis of pneumonia with a high positive predictive value.
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Affiliation(s)
- Gabriel Alcoba
- Division of Pediatric Emergency Medicine, Department of Child and Adolescent Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. .,Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (Hôpitaux Universitaires de Genève, HUG), Rue Gabrielle-Perret-Gentil 4, CH-1211, Genève 14, Switzerland.
| | - Kristina Keitel
- Boston Children’s Hospital, Boston, MA USA ,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Veronica Maspoli
- Division of Pediatric Emergency Medicine, Department of Child and Adolescent Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Laurence Lacroix
- Division of Pediatric Emergency Medicine, Department of Child and Adolescent Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Sergio Manzano
- Division of Pediatric Emergency Medicine, Department of Child and Adolescent Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Mario Gehri
- Lausanne University Hospital, Lausanne, Switzerland
| | | | - Alain Gervaix
- Division of Pediatric Emergency Medicine, Department of Child and Adolescent Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Division of Pediatric Emergency Medicine, Department of Child and Adolescent Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Multiplex Urinary Antigen Detection for 13 Streptococcus pneumoniae Serotypes Improves Diagnosis of Pneumococcal Pneumonia in South African HIV-Infected Adults. J Clin Microbiol 2016; 55:302-312. [PMID: 27847374 DOI: 10.1128/jcm.01573-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/02/2016] [Indexed: 01/22/2023] Open
Abstract
A serotype-specific urinary antigen detection (UAD) assay for 13 serotypes included in the pneumococcal conjugate vaccine (PCV13) was recently reported as a useful diagnostic tool for pneumococcal pneumonia. We aimed to assess the diagnostic accuracy of the UAD in HIV-infected South African adults. Urine specimens from a well-defined cohort of HIV-infected South African adults with pneumonia were evaluated retrospectively in the UAD assay. Pneumonia was considered pneumococcal if either sputum Gram stain, sputum culture, blood culture, or the immunochromatographic (ICT) BinaxNow S. pneumoniae test (composite diagnostic) was positive. Among 235 enrolled pneumonia patients, the UAD assay was more frequently positive (104 [44.3%]) than the composite diagnostic (71 [30.2%]; P < 0.001) and increased the pneumococcal etiology from 30.2% by an additional 22.6% to 52.8%. The UAD assay detected more pneumococcal etiologies (45.0%) than the serotype-independent ICT (23.4%, P < 0.001). UAD identified 6/7 patients with PCV13 serotype bacteremia without misclassification of bacteremia episodes due to non-PCV13 serotypes. UAD was positive for 5.1% of asymptomatic HIV-infected persons, with higher rates among those with nasopharyngeal carriage. Concordance between serotypes identified by UAD and by Quellung reaction and PCR serotyping was 70/86 (81.4%). UAD identified the dominant serotype in multiple serotype carriage. This study confirms the utility of the UAD assay for HIV-infected adults comparing favorably with other diagnostic tests. A highly valent UAD may become a new standard for detection of pneumococcal pneumonia in adults. Prior to PCV introduction, at least 53% of pneumonia cases were due to pneumococci in HIV-infected South African adults.
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Sensitivity, Specificity, and Positivity Predictors of the Pneumococcal Urinary Antigen Test in Community-Acquired Pneumonia. Ann Am Thorac Soc 2016; 12:1482-9. [PMID: 26288389 DOI: 10.1513/annalsats.201505-304oc] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Detection of the C-polysaccharide of Streptococcus pneumoniae in urine by an immune-chromatographic test is increasingly used to evaluate patients with community-acquired pneumonia. OBJECTIVES We assessed the sensitivity and specificity of this test in the largest series of cases to date and used logistic regression models to determine predictors of positivity in patients hospitalized with community-acquired pneumonia. METHODS We performed a multicenter, prospective, observational study of 4,374 patients hospitalized with community-acquired pneumonia. MEASUREMENTS AND MAIN RESULTS The urinary antigen test was done in 3,874 cases. Pneumococcal infection was diagnosed in 916 cases (21%); 653 (71%) of these cases were diagnosed exclusively by the urinary antigen test. Sensitivity and specificity were 60 and 99.7%, respectively. Predictors of urinary antigen positivity were female sex; heart rate≥125 bpm, systolic blood pressure<90 mm Hg, and SaO2<90%; absence of antibiotic treatment; pleuritic chest pain; chills; pleural effusion; and blood urea nitrogen≥30 mg/dl. With at least six of all these predictors present, the probability of positivity was 52%. With only one factor present, the probability was only 12%. CONCLUSIONS The urinary antigen test is a method with good sensitivity and excellent specificity in diagnosing pneumococcal pneumonia, and its use greatly increased the recognition of community-acquired pneumonia due to S. pneumoniae. With a specificity of 99.7%, this test could be used to direct simplified antibiotic therapy, thereby avoiding excess costs and risk for bacterial resistance that result from broad-spectrum antibiotics. We also identified predictors of positivity that could increase suspicion for pneumococcal infection or avoid the unnecessary use of this test.
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Piralam B, Tomczyk SM, Rhodes JC, Thamthitiwat S, Gregory CJ, Olsen SJ, Praphasiri P, Sawatwong P, Naorat S, Chantra S, Areerat P, Hurst CP, Moore MR, Muangchana C, Baggett HC. Incidence of Pneumococcal Pneumonia Among Adults in Rural Thailand, 2006-2011: Implications for Pneumococcal Vaccine Considerations. Am J Trop Med Hyg 2015; 93:1140-1147. [PMID: 26503277 PMCID: PMC4674225 DOI: 10.4269/ajtmh.15-0429] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/20/2015] [Indexed: 11/07/2022] Open
Abstract
The incidence of pneumococcal pneumonia among adults is a key driver for the cost-effectiveness of pneumococcal conjugate vaccine used among children. We sought to obtain more accurate incidence estimates among adults by including results of pneumococcal urine antigen testing (UAT) from population-based pneumonia surveillance in two Thai provinces. Active surveillance from 2006 to 2011 identified acute lower respiratory infection (ALRI)-related hospital admissions. Adult cases of pneumococcal pneumonia were defined as hospitalized ALRI patients aged ≥ 18 years with isolation of Streptococcus pneumoniae from blood or with positive UAT. Among 39,525 adult ALRI patients, we identified 481 pneumococcal pneumonia cases (105 by blood culture, 376 by UAT only). Estimated incidence of pneumococcal pneumonia hospitalizations was 30.5 cases per 100,000 persons per year (2.2 and 28.3 cases per 100,000 persons per year by blood culture and UAT, respectively). Incidence varied between 22.7 in 2007 and 43.5 in 2010, and increased with age to over 150 per 100,000 persons per year among persons aged ≥ 70 years. Viral coinfections including influenza A/B, respiratory syncytial virus (RSV), and adenovirus occurred in 11% (44/409) of pneumococcal pneumonia cases tested. Use of UAT to identify cases of pneumococcal pneumonia among adults in rural Thailand substantially increases estimates of pneumococcal pneumonia burden, thereby informing cost-effectiveness analyses and vaccine policy decisions.
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Affiliation(s)
- Barameht Piralam
- *Address correspondence to Barameht Piralam, Nakhon Phanom Provincial Health Office, 356 Abhibanbancha Road, Muang, Nakhon Phanom 48000, Thailand. E-mail:
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Yadav MK, Go YY, Chae SW, Song JJ. The Small Molecule DAM Inhibitor, Pyrimidinedione, Disrupts Streptococcus pneumoniae Biofilm Growth In Vitro. PLoS One 2015; 10:e0139238. [PMID: 26431532 PMCID: PMC4592238 DOI: 10.1371/journal.pone.0139238] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/10/2015] [Indexed: 01/25/2023] Open
Abstract
Streptococcus pneumoniae persist in the human nasopharynx within organized biofilms. However, expansion to other tissues may cause severe infections such as pneumonia, otitis media, bacteremia, and meningitis, especially in children and the elderly. Bacteria within biofilms possess increased tolerance to antibiotics and are able to resist host defense systems. Bacteria within biofilms exhibit different physiology, metabolism, and gene expression profiles than planktonic cells. These differences underscore the need to identify alternative therapeutic targets and novel antimicrobial compounds that are effective against pneumococcal biofilms. In bacteria, DNA adenine methyltransferase (Dam) alters pathogenic gene expression and catalyzes the methylation of adenine in the DNA duplex and of macromolecules during the activated methyl cycle (AMC). In pneumococci, AMC is involved in the biosynthesis of quorum sensing molecules that regulate competence and biofilm formation. In this study, we examine the effect of a small molecule Dam inhibitor, pyrimidinedione, on Streptococcus pneumoniae biofilm formation and evaluate the changes in global gene expression within biofilms via microarray analysis. The effects of pyrimidinedione on in vitro biofilms were studied using a static microtiter plate assay, and the architecture of the biofilms was viewed using confocal and scanning electron microscopy. The cytotoxicity of pyrimidinedione was tested on a human middle ear epithelium cell line by CCK-8. In situ oligonucleotide microarray was used to compare the global gene expression of Streptococcus pneumoniae D39 within biofilms grown in the presence and absence of pyrimidinedione. Real-time RT-PCR was used to study gene expression. Pyrimidinedione inhibits pneumococcal biofilm growth in vitro in a concentration-dependent manner, but it does not inhibit planktonic cell growth. Confocal microscopy analysis revealed the absence of organized biofilms, where cell-clumps were scattered and attached to the bottom of the plate when cells were grown in the presence of pyrimidinedione. Scanning electron microscopy analysis demonstrated the absence of an extracellular polysaccharide matrix in pyrimidinedione-grown biofilms compared to control-biofilms. Pyrimidinedione also significantly inhibited MRSA, MSSA, and Staphylococcus epidermidis biofilm growth in vitro. Furthermore, pyrimidinedione does not exhibit eukaryotic cell toxicity. In a microarray analysis, 56 genes were significantly up-regulated and 204 genes were significantly down-regulated. Genes involved in galactose metabolism were exclusively up-regulated in pyrimidinedione-grown biofilms. Genes related to DNA replication, cell division and the cell cycle, pathogenesis, phosphate-specific transport, signal transduction, fatty acid biosynthesis, protein folding, homeostasis, competence, and biofilm formation were down regulated in pyrimidinedione-grown biofilms. This study demonstrated that the small molecule Dam inhibitor, pyrimidinedione, inhibits pneumococcal biofilm growth in vitro at concentrations that do not inhibit planktonic cell growth and down regulates important metabolic-, virulence-, competence-, and biofilm-related genes. The identification of a small molecule (pyrimidinedione) with S. pneumoniae biofilm-inhibiting capabilities has potential for the development of new compounds that prevent biofilm formation.
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Affiliation(s)
- Mukesh Kumar Yadav
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
- Institute for Medical Device Clinical Trials, Korea University College of Medicine, Seoul, South Korea
| | - Yoon Young Go
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Sung-Won Chae
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Jae-Jun Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
- * E-mail:
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Single-plex quantitative assays for the detection and quantification of most pneumococcal serotypes. PLoS One 2015; 10:e0121064. [PMID: 25798884 PMCID: PMC4370668 DOI: 10.1371/journal.pone.0121064] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/27/2015] [Indexed: 12/04/2022] Open
Abstract
Streptococcus pneumoniae globally kills more children than any other infectious disease every year. A prerequisite for pneumococcal disease and transmission is colonization of the nasopharynx. While the introduction of pneumococcal conjugate vaccines has reduced the burden of pneumococcal disease, understanding the impact of vaccination on nasopharyngeal colonization has been hampered by the lack of sensitive quantitative methods for the detection of >90 known S. pneumoniae serotypes. In this work, we developed 27 new quantitative (q)PCR reactions and optimized 26 for a total of 53 qPCR reactions targeting pneumococcal serotypes or serogroups, including all vaccine types. Reactions proved to be target-specific with a limit of detection of 2 genome equivalents per reaction. Given the number of probes required for these assays and their unknown shelf-life, the stability of cryopreserved reagents was evaluated. Our studies demonstrate that two-year cryopreserved probes had similar limit of detection as freshly-diluted probes. Moreover, efficiency and limit of detection of 1-month cryopreserved, ready-to-use, qPCR reaction mixtures were similar to those of freshly prepared mixtures. Using these reactions, our proof-of-concept studies utilizing nasopharyngeal samples (N=30) collected from young children detected samples containing ≥2 serotypes/serogroups. Samples colonized by multiple serotypes/serogroups always had a serotype that contributes at least 50% of the pneumococcal load. In addition, a molecular approach called S6-q(PCR)2 was developed and proven to individually detect and quantify epidemiologically-important serogroup 6 strains including 6A, 6B, 6C and 6D. This technology will be useful for epidemiological studies, diagnostic platforms and to study the pneumobiome.
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Mukae H, Yatera K, Noguchi S, Kawanami T, Yamasaki K, Tokuyama S, Inoue N, Nishida C, Kawanami Y, Ogoshi T, Orihashi T, Yoshii C, Ishimoto H. Evaluation of a rapid immunochromatographic ODK0501 assay for detecting Streptococcus pneumoniae antigens in the sputum of pneumonia patients with positive S. pneumoniae urinary antigens. J Infect Chemother 2015; 21:176-81. [DOI: 10.1016/j.jiac.2014.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/29/2014] [Accepted: 11/05/2014] [Indexed: 11/28/2022]
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Harris AM, Beekmann SE, Polgreen PM, Moore MR. Rapid urine antigen testing for Streptococcus pneumoniae in adults with community-acquired pneumonia: clinical use and barriers. Diagn Microbiol Infect Dis 2014; 79:454-7. [PMID: 24938760 DOI: 10.1016/j.diagmicrobio.2014.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/08/2014] [Accepted: 05/10/2014] [Indexed: 10/25/2022]
Abstract
Streptococcus pneumoniae (pneumococcus) is the most common bacterial etiology of community-acquired pneumonia (CAP) in adults, a leading cause of death. The majority of pneumococcal CAP is diagnosed by blood culture, which likely underestimates the burden of disease. The 2007 CAP guidelines recommend routine use of the rapid pneumococcal urinary antigen (UAg) test. To assess the how pneumococcal UAg testing is being used among hospitalized adult CAP patients and what barriers restrict its use, a Web-based survey was distributed in 2013 to 1287 infectious disease physician members of the Emerging Infectious disease Network of the Infectious Disease Society of America. Of 493 eligible responses, 65% use the pneumococcal UAg test. The primary barrier to UAg use was availability (46%). UAg users reported ordering fewer other diagnostic tests and tailoring antibiotic therapy. Increased access to UAg tests could improve pneumonia management and pneumococcal CAP surveillance.
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Affiliation(s)
- Aaron M Harris
- Respiratory Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | | | - Matthew R Moore
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
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Grijalva CG, Griffin MR, Edwards KM, Williams JV, Gil AI, Verastegui H, Hartinger SM, Vidal JE, Klugman KP, Lanata CF. The role of influenza and parainfluenza infections in nasopharyngeal pneumococcal acquisition among young children. Clin Infect Dis 2014; 58:1369-76. [PMID: 24621951 PMCID: PMC4001292 DOI: 10.1093/cid/ciu148] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Animal models suggest that influenza infection favors nasopharyngeal acquisition of pneumococci. We assessed this relationship with influenza and other respiratory viruses in young children. METHODS A case-control study was nested within a prospective cohort study of acute respiratory illness (ARI) in Andean children <3 years of age (RESPIRA-PERU study). Weekly household visits were made to identify ARI and obtain nasal swabs for viral detection using real-time reverse-transcription polymerase chain reaction. Monthly nasopharyngeal (NP) samples were obtained to assess pneumococcal colonization. We determined whether specific respiratory viral ARI episodes occurring within the interval between NP samples increased the risk of NP acquisition of new pneumococcal serotypes. RESULTS A total of 729 children contributed 2128 episodes of observation, including 681 pneumococcal acquisition episodes (new serotype, not detected in prior sample), 1029 nonacquisition episodes (no colonization or persistent colonization with the same serotype as the prior sample), and 418 indeterminate episodes. The risk of pneumococcal acquisition increased following influenza-ARI (adjusted odds ratio [AOR], 2.19; 95% confidence interval [CI], 1.02-4.69) and parainfluenza-ARI (AOR, 1.86; 95% CI, 1.15-3.01), when compared with episodes without ARI. Other viral infections (respiratory syncytial virus, human metapneumovirus, human rhinovirus, and adenovirus) were not associated with acquisition. CONCLUSIONS Influenza and parainfluenza ARIs appeared to facilitate pneumococcal acquisition among young children. As acquisition increases the risk of pneumococcal diseases, these observations are pivotal in our attempts to prevent pneumococcal disease.
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Toyokawa T, Ohnishi M, Koizumi N. Diagnosis of acute leptospirosis. Expert Rev Anti Infect Ther 2014; 9:111-21. [DOI: 10.1586/eri.10.151] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Verani JR, McCracken J, Arvelo W, Estevez A, Lopez MR, Reyes L, Moir JC, Bernart C, Moscoso F, Gray J, Olsen SJ, Lindblade KA. Surveillance for hospitalized acute respiratory infection in Guatemala. PLoS One 2013; 8:e83600. [PMID: 24391792 PMCID: PMC3877070 DOI: 10.1371/journal.pone.0083600] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 11/05/2013] [Indexed: 11/03/2022] Open
Abstract
Acute respiratory infections (ARI) are an important cause of illness and death worldwide, yet data on the etiology of ARI and the population-level burden in developing countries are limited. Surveillance for ARI was conducted at two hospitals in Guatemala. Patients admitted with at least one sign of acute infection and one sign or symptom of respiratory illness met the criteria for a case of hospitalized ARI. Nasopharyngeal/oropharyngeal swabs were collected and tested by polymerase chain reaction for adenovirus, parainfluenza virus types 1,2 and 3, respiratory syncytial virus, influenza A and B viruses, human metapneumovirus, Chlamydia pneumioniae, and Mycoplasma pneumoniae. Urine specimens were tested for Streptococcus pneumoniae antigen. Blood culture and chest radiograph were done at the discretion of the treating physician. Between November 2007 and December 2011, 3,964 case-patients were enrolled. While cases occurred among all age groups, 2,396 (60.4%) cases occurred in children <5 years old and 463 (11.7%) among adults ≥65 years old. Viruses were found in 52.6% of all case-patients and 71.8% of those aged <1 year old; the most frequently detected was respiratory syncytial virus, affecting 26.4% of case-patients. Urine antigen testing for Streptococcus pneumoniae performed for case-patients ≥15 years old was positive in 15.1% of those tested. Among 2,364 (59.6%) of case-patients with a radiograph, 907 (40.0%) had findings suggestive of bacterial pneumonia. Overall, 230 (5.9%) case-patients died during the hospitalization. Using population denominators, the observed hospitalized ARI incidence was 128 cases per 100,000, with the highest rates seen among children <1 year old (1,703 per 100,000), followed by adults ≥65 years old (292 per 100,000). These data, which demonstrate a substantial burden of hospitalized ARI in Guatemala due to a variety of pathogens, can help guide public health policies aimed at reducing the burden of illness and death due to respiratory infections.
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Affiliation(s)
- Jennifer R. Verani
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - John McCracken
- Centro de Estudios en Salud, Universidad del Valle, Guatemala City, Guatemala
| | - Wences Arvelo
- International Emerging Infections Program, Centers for Disease Control and Prevention, Regional Office for Central America and Panama, Guatemala City, Guatemala
- Division of Global Disease Detection and Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alejandra Estevez
- Centro de Estudios en Salud, Universidad del Valle, Guatemala City, Guatemala
| | - Maria Renee Lopez
- Centro de Estudios en Salud, Universidad del Valle, Guatemala City, Guatemala
| | - Lissette Reyes
- Field Epidemiology Training Program, Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala
- Área de Salud de Santa Rosa, Ministerio de Salud Pública y Asistencia Social, Cuilapa, Guatemala
| | - Juan Carlos Moir
- Área de Salud de Quetzaltenango, Ministerio de Salud Pública y Asistencia Social, Quetzaltenango, Guatemala
| | - Chris Bernart
- Centro de Estudios en Salud, Universidad del Valle, Guatemala City, Guatemala
| | - Fabiola Moscoso
- Centro de Estudios en Salud, Universidad del Valle, Guatemala City, Guatemala
| | - Jennifer Gray
- Centro de Estudios en Salud, Universidad del Valle, Guatemala City, Guatemala
| | - Sonja J. Olsen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kim A. Lindblade
- International Emerging Infections Program, Centers for Disease Control and Prevention, Regional Office for Central America and Panama, Guatemala City, Guatemala
- Division of Global Disease Detection and Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Song JY, Eun BW, Nahm MH. Diagnosis of pneumococcal pneumonia: current pitfalls and the way forward. Infect Chemother 2013; 45:351-66. [PMID: 24475349 PMCID: PMC3902818 DOI: 10.3947/ic.2013.45.4.351] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Indexed: 02/02/2023] Open
Abstract
Streptococcus pneumoniae is the most common cause of community-acquired pneumonia. However, it can also asymptomatically colonize the upper respiratory tract. Because of the need to distinguish between S. pneumoniae that is simply colonizing the upper respiratory tract and S. pneumoniae that is causing pneumonia, accurate diagnosis of pneumococcal pneumonia is a challenging issue that still needs to be solved. Sputum Gram stains and culture are the first diagnostic step for identifying pneumococcal pneumonia and provide information on antibiotic susceptibility. However, these conventional methods are relatively slow and insensitive and show limited specificity. In the past decade, new diagnostic tools have been developed, particularly antigen (teichoic acid and capsular polysaccharides) and nucleic acid (ply, lytA, and Spn9802) detection assays. Use of the pneumococcal antigen detection methods along with biomarkers (C-reactive protein and procalcitonin) may enhance the specificity of diagnosis for pneumococcal pneumonia. This article provides an overview of current methods of diagnosing pneumococcal pneumonia and discusses new and future test methods that may provide the way forward for improving its diagnosis.
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Affiliation(s)
- Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Byung Wook Eun
- Department of Pediatrics, Eulji General Hospital, Seoul, Korea
| | - Moon H Nahm
- Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. ; Department of Microbiology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Poirel L, Bonnin RA, Nordmann P. Rapid identification of antibiotic-resistant bacteria: how could new diagnostic tests halt potential endemics? Expert Rev Mol Diagn 2013; 13:409-11. [PMID: 23782246 DOI: 10.1586/erm.13.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Wolter N, Cohen C, Tempia S, Madhi SA, Venter M, Moyes J, Walaza S, Malope Kgokong B, Groome M, du Plessis M, Pretorius M, Dawood H, Kahn K, Variava E, Klugman KP, von Gottberg A. HIV and influenza virus infections are associated with increased blood pneumococcal load: a prospective, hospital-based observational study in South Africa, 2009-2011. J Infect Dis 2013; 209:56-65. [PMID: 23922370 DOI: 10.1093/infdis/jit427] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Increased pneumococcal loads are associated with severe outcomes. We determined the prevalence of pneumococcal DNA in blood specimens from patients hospitalized with acute lower respiratory tract infection and identified factors associated with invasive pneumococcal pneumonia, bacterial loads, and death. METHODS A total of 8523 patients were enrolled as part of prospective hospital-based surveillance. Blood was collected for quantitative pneumococcal (lytA) detection, and nasopharyngeal specimens were collected for detection of influenza virus and other respiratory viruses by real-time polymerase chain reaction. RESULTS Of 6396 cases (75%) with lytA results, 422 (7%) were positive for pneumococcal DNA. The prevalences of human immunodeficiency virus (HIV) and influenza virus were 51% (2965/5855) and 8% (485/6358), respectively. On multivariable analysis, HIV infection (adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.6-3.6), influenza virus coinfection (aOR, 1.4; 95% CI, 1.2-2.1), oxygen therapy during admission (aOR, 1.6; 95% CI, 1.1-2.3) and in-hospital death (aOR, 2.1; 95% CI, 1.1-4.0) were significantly associated with increased pneumococcal load. Among lytA-positive patients, after adjustment for length of hospitalization, duration of symptoms, and oxygen therapy during admission, pneumococcal loads ≥10,000 DNA copies/mL (aOR, 3.6; 95% CI, 1.8-7.2) were associated with increased risk of death. CONCLUSIONS HIV and influenza virus infections were associated with elevated pneumococcal loads, which, in turn, were associated with increased risk of death.
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Affiliation(s)
- Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service
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Huijskens EGW, van Erkel AJM, Palmen FMH, Buiting AGM, Kluytmans JAJW, Rossen JWA. Viral and bacterial aetiology of community-acquired pneumonia in adults. Influenza Other Respir Viruses 2013; 7:567-73. [PMID: 22908940 PMCID: PMC5781003 DOI: 10.1111/j.1750-2659.2012.00425.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Modern molecular techniques reveal new information on the role of respiratory viruses in community-acquired pneumonia. In this study, we tried to determine the prevalence of respiratory viruses and bacteria in patients with community-acquired pneumonia who were admitted to the hospital. METHODS Between April 2008 and April 2009, 408 adult patients (aged between 20 and 94 years) with community-acquired pneumonia were tested for the presence of respiratory pathogens using bacterial cultures, real-time PCR for viruses and bacteria, urinary antigen testing for Legionella and Pneumococci and serology for the presence of viral and bacterial pathogens. RESULTS Pathogens were identified in 263 (64·5%) of the 408 patients. The most common single organisms in these 263 patients were Streptococcus pneumoniae (22·8%), Coxiella burnetii (6·8%) and influenza A virus (3·8%). Of the 263 patients detected with pathogens, 117 (44·5%) patients were positive for one or more viral pathogens. Of these 117 patients, 52 (44·4%) had no bacterial pathogen. Multiple virus infections (≥2) were found in 16 patients. CONCLUSION In conclusion, respiratory viruses are frequently found in patients with CAP and may therefore play an important role in the aetiology of this disease.
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Affiliation(s)
- Elisabeth G W Huijskens
- Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg, The Netherlands.
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Evaluation of a WHO-validated serotype-specific serological assay for the diagnosis of pneumococcal etiology in children with community-acquired pneumonia. Pediatr Infect Dis J 2013; 32:e277-84. [PMID: 23407099 DOI: 10.1097/inf.0b013e31828c363f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The etiologic diagnosis of community-acquired pneumonia (CAP) remains challenging in children because blood cultures have low sensitivity. Novel approaches are needed to confirm the role of Streptococcus pneumoniae. METHODS In this study, pneumococcal etiology was determined by serology using a subset of blood samples collected during a prospective multicentre observational study of children <15 years of age hospitalized in Belgium with radiogram-confirmed CAP. Blood samples were collected at admission and 3-4 weeks later. Pneumococcal (P)-CAP was defined in the presence of a positive blood or pleural fluid culture. Serotyping of S. pneumoniae isolates was done with the Quellung reaction. Serological diagnosis was assessed for 9 serotypes using World Health Organization-validated IgG and IgA serotype-specific enzyme-linked immunosorbent assays (ELISAs). RESULTS Paired admission/convalescent sera from 163 children were evaluated by ELISA (35 with proven P-CAP and 128 with nonproven P-CAP). ELISA detected pneumococci in 82.8% of patients with proven P-CAP. The serotypes identified were the same as with the Quellung reaction in 82% and 59% of cases by IgG ELISA and IgA ELISA, respectively. Overall, ELISA identified a pneumococcal etiology in 55% of patients with nonproven P-CAP. Serotypes 1 (51.6%), 7F (19%) and 5 (15.7%) were the most frequent according to IgG ELISA. CONCLUSIONS In conclusion, the serological assay allows recognition of pneumococcal origin in 55% of CAP patients with negative culture. This assay should improve the diagnosis of P-CAP in children and could be a useful tool for future epidemiological studies on childhood CAP etiology.
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Expression of Streptococcus pneumoniae Virulence-Related Genes in the Nasopharynx of Healthy Children. PLoS One 2013; 8:e67147. [PMID: 23825636 PMCID: PMC3688971 DOI: 10.1371/journal.pone.0067147] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 05/13/2013] [Indexed: 11/19/2022] Open
Abstract
Colonization and persistence in the human nasopharynx are prerequisites for Streptococcus pneumoniae disease and carriage acquisition, which normally occurs during early childhood. Animal models and in vitro studies (i.e. cell adhesion and cell cytotoxicity assays) have revealed a number of colonization and virulence factors, as well as regulators, implicated in nasopharyngeal colonization and pathogenesis. Expression of genes encoding these factors has never been studied in the human nasopharynx. Therefore, this study analyzed expression of S. pneumoniae virulence-related genes in human nasopharyngeal samples. Our experiments first demonstrate that a density of ≥10(4) CFU/ml of S. pneumoniae cells in the nasopharynx provides enough DNA and RNA to amplify the lytA gene by conventional PCR and to detect the lytA message, respectively. A panel of 21 primers that amplified S. pneumoniae sequences was designed, and their specificity for S. pneumoniae sequences was analyzed in silico and validated against 20 related strains inhabitants of the human upper respiratory tract. These primers were utilized in molecular reactions to find out that all samples contained the genes ply, pavA, lytC, lytA, comD, codY, and mgrA, whereas nanA, nanB, pspA, and rrgB were present in ∼91-98% of the samples. Gene expression studies of these 11 targets revealed that lytC, lytA, pavA and comD were the most highly expressed pneumococcal genes in the nasopharynx whereas the rest showed a moderate to low level of expression. This is the first study to evaluate expression of virulence- and, colonization-related genes in the nasopharynx of healthy children and establishes the foundation for future gene expression studies during human pneumococcal disease.
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Izadnegahdar R, Cohen AL, Klugman KP, Qazi SA. Childhood pneumonia in developing countries. THE LANCET RESPIRATORY MEDICINE 2013; 1:574-84. [PMID: 24461618 DOI: 10.1016/s2213-2600(13)70075-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Pneumonia is a widespread and common infectious lung disease that causes inflammation, which can lead to reduced oxygenation, shortness of breath, and death. An estimated nearly 1.2 million children younger than 5 years died in 2011 from pneumonia. Most of these deaths occured in developing countries where access to care is limited and interventions that have improved care in developed countries are scarce. Despite substantial increases in our understanding of the clinical syndrome of pneumonia and its aetiologies, its accurate diagnosis is challenging when clinical indicators are relied on, and improves only modestly with addition of laboratory, microbiological, or radiographical tests. Prevention programmes and treatment guidelines have led to impressive reductions in disease, but children remain at risk of misdiagnosis and inadequate treatment. Research to address challenges in the aetiological diagnosis of pneumonia and widespread implementation of treatment interventions beyond vaccines and antibiotics are necessary to mitigate the burden of pneumonia and improve child survival.
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Affiliation(s)
- Rasa Izadnegahdar
- Center for Global Health and Development, Boston University, Boston, MA, USA.
| | - Adam L Cohen
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa; Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Keith P Klugman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Shamim A Qazi
- Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland
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Grijalva CG, Griffin MR, Edwards KM, Williams JV, Gil AI, Verastegui H, Hartinger SM, Vidal JE, Klugman KP, Lanata CF. Cohort profile: The study of respiratory pathogens in Andean children. Int J Epidemiol 2013; 43:1021-30. [PMID: 23771719 DOI: 10.1093/ije/dyt065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We investigated respiratory pathogens in a prospective cohort study of young children living in the Peruvian Andes. In the study we assessed viral respiratory infections among young children, and explored interactions of viruses with common respiratory bacteria, especially Streptococcus pneumoniae. Through weekly household visits, data were collected on the signs and symptoms of acute respiratory illness (ARI), nasal samples were collected to test for viruses during episodes of ARI, and nasopharyngeal samples were collected on a monthly basis to monitor bacterial colonisation. We also collected data on vaccination coverage, patterns of social mixing, geographic information, and environmental and socio-demographic variables. Understanding the interaction of respiratory viruses with bacteria and its impact on the burden and severity of ARIs in rural areas of developing countries is critical to designing strategies for preventing such infections.
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Affiliation(s)
- Carlos G Grijalva
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Marie R Griffin
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Kathryn M Edwards
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - John V Williams
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USADepartments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Ana I Gil
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Héctor Verastegui
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Stella M Hartinger
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USADepartments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Jorge E Vidal
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Keith P Klugman
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Claudio F Lanata
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
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Covington PS, Davenport JM, Andrae DA, Stryjewski ME, Turner LL, McIntyre G, Almenoff J. A Phase 2 study of the novel fluoroquinolone JNJ-Q2 in community-acquired bacterial pneumonia. J Antimicrob Chemother 2013; 68:2691-3. [PMID: 23749951 PMCID: PMC3797640 DOI: 10.1093/jac/dkt217] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Systematic review and meta-analysis of a urine-based pneumococcal antigen test for diagnosis of community-acquired pneumonia caused by Streptococcus pneumoniae. J Clin Microbiol 2013; 51:2303-10. [PMID: 23678060 DOI: 10.1128/jcm.00137-13] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Standard culture methods for diagnosis of Streptococcus pneumoniae pneumonia take at least 24 h. The BinaxNOW urine-based test for S. pneumoniae (BinaxNOW-SP) takes only 15 min to conduct, potentially enabling earlier diagnosis and targeted treatment. This study was conducted to assess whether the use of BinaxNOW-SP at the time of hospital admission would provide adequate sensitivity and specificity for diagnosis of community-acquired pneumonia (CAP) in adult patients. We searched PubMed, EMBASE/OVID, Cochrane Collaboration, Centre for Reviews and Dissemination, INAHTA, and CADTH for diagnostic or etiologic studies of hospitalized predominately adult patients with clinically defined CAP that reported the diagnostic performance of BinaxNOW-SP versus cultures. Two authors independently extracted study details and diagnostic two-by-two tables. We found that 27 studies met our inclusion criteria, and three different reference standards were used between them. A bivariate meta-analysis of 12 studies using a composite of culture tests as the reference standard estimated the sensitivity of BinaxNOW-SP as 68.5% (95% credibility interval [CrI], 62.6% to 74.2%) and specificity as 84.2% (95% CrI, 77.5% to 89.3%). A meta-analysis of all 27 studies, adjusting for the imperfect and variable nature of the reference standard, gave a higher sensitivity of 74.0% (CrI, 66.6% to 82·3%) and specificity of 97.2% (CrI, 92.7% to 99.8%). The analysis showed substantial heterogeneity across studies, which did not decrease with adjustment for covariates. We concluded that the higher pooled sensitivity (compared to culture) and high specificity of BinaxNOW-SP suggest it would be a useful addition to the diagnostic workup for community-acquired pneumonia. More research is needed regarding the impact of BinaxNOW-SP on clinical practice.
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Quorum-sensing systems LuxS/autoinducer 2 and Com regulate Streptococcus pneumoniae biofilms in a bioreactor with living cultures of human respiratory cells. Infect Immun 2013; 81:1341-53. [PMID: 23403556 DOI: 10.1128/iai.01096-12] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Streptococcus pneumoniae forms organized biofilms in the human upper respiratory tract that may play an essential role in both persistence and acute respiratory infection. However, the production and regulation of biofilms on human cells is not yet fully understood. In this work, we developed a bioreactor with living cultures of human respiratory epithelial cells (HREC) and a continuous flow of nutrients, mimicking the microenvironment of the human respiratory epithelium, to study the production and regulation of S. pneumoniae biofilms (SPB). SPB were also produced under static conditions on immobilized HREC. Our experiments demonstrated that the biomass of SPB increased significantly when grown on HREC compared to the amount on abiotic surfaces. Additionally, pneumococcal strains produced more early biofilms on lung cells than on pharyngeal cells. Utilizing the bioreactor or immobilized human cells, the production of early SPB was found to be regulated by two quorum-sensing systems, Com and LuxS/AI-2, since a mutation in either comC or luxS rendered the pneumococcus unable to produce early biofilms on HREC. Interestingly, while LuxS/autoinducer 2 (AI-2) regulated biofilms on both HREC and abiotic surfaces, Com control was specific for those structures produced on HREC. The biofilm phenotypes of strain D39-derivative ΔcomC and ΔluxS QS mutants were reversed by genetic complementation. Of note, SPB formed on immobilized HREC and incubated under static conditions were completely lysed 24 h postinoculation. Biofilm lysis was also regulated by the Com and LuxS/AI-2 quorum-sensing systems.
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Athlin S, Strålin K. The Binax NOW Streptococcus pneumoniae test applied on nasopharyngeal aspirates to support pneumococcal aetiology in community-acquired pneumonia. ACTA ACUST UNITED AC 2013; 45:425-31. [PMID: 23330980 DOI: 10.3109/00365548.2012.760843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The use of nasopharyngeal secretions to enhance diagnostic yields of pneumococcal aetiology in community-acquired pneumonia (CAP) is of interest. We evaluated the Binax NOW Streptococcus pneumoniae immunochromatographic test (ICT) on nasopharyngeal aspirates (NPA) in order to support pneumococcal aetiology in CAP. METHODS The NPA ICT was applied on 180 adult CAP patients and 64 healthy controls. The rate of pneumococcal detection in the nasopharynx was compared to rates for lytA polymerase chain reaction (PCR) and culture on NPA. RESULTS According to blood and sputum culture and urine ICT, the test sensitivity in 59 patients with a pneumococcal aetiology was 81%. The specificity was suboptimal, with 72% negative tests among CAP patients without a pneumococcal aetiology. However, the test was positive in only 11% of patients with atypical pneumonia and in 4.7% of healthy controls. The positivity rate was higher for NPA ICT compared to culture on NPA in all CAP patients, and to both PCR and culture on NPA in non-pneumococcal non-atypical CAP patients. In 113 (63%) patients with β-lactam monotherapy, cure without treatment alteration was noted more often in cases with positive compared to negative NPA ICT at admission (91% vs 69%; p < 0.01). CONCLUSIONS The high sensitivity and the low positivity rates in patients with atypical pneumonia and healthy controls, in combination with the correlation between positive test results and clinical cure with β-lactam therapy, may support a pneumococcal aetiology in CAP in populations with low pneumococcal carriage rates.
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Affiliation(s)
- Simon Athlin
- Department of Infectious Diseases , Örebro University Hospital, Örebro, Sweden.
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Abstract
We evaluated the usefulness of a rapid immunochromatographic pneumococcal urinary antigen test (UAT) for the diagnosis of pneumonia over a period of five years. The UAT was positive in 32 (2.3%) urine samples obtained from 1414 patients. In 46 of these 1414 patients results of UAT and/or sputum/pleural fluid culture and/or blood culture and/or procalcitonin levels were available and therefore the study was concentrated on these patients. A concordance between UAT positivity and the presence of Streptococcus pneumoniae in the sputum was observed in only 4 of 46 (8.7%) patients for which both urine and sputum samples were analyzed. A discordant result (UAT positive and absence of S. pneumoniae in sputum samples) was recorded in 8 of 46 (17.4 %) patients. UAT negative results with sputum culture positive for S. pneumoniae were recorded in 28.3% of patients. In 20 patients, UAT tested positive but sputum culture was not performed. A concordance between UAT positivity and the isolation of S. pneumoniae from blood was seen in 2 of 46 patients whereas a discordant result (UAT positive and blood culture negative) was seen in 12 (26.1%) patients. A concordance between the UAT and high levels (≥2ng/ml) of procalcitonin was observed in 4 out of 46 patients, whereas a positive UAT result and a procalcitonin negative result were observed in 2 patients. In our experience the UAT allows the detection of the etiological agent of pneumonia, and also when sputum and/or blood cultures are negative for S. pneumoniae, when the clinical picture is suggestive of alveolar pneumonia.
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Gupta A, Bansal N, Houston B. Metabolomics of urinary tract infection: a new uroscope in town. Expert Rev Mol Diagn 2012; 12:361-9. [PMID: 22616701 DOI: 10.1586/erm.12.27] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Urinary tract infection (UTI) is a potentially life-threatening infectious disease. For rapid directed therapy of UTIs, it is essential to determine the causative microorganism. To date, there is no single test that has been proven to reliably, rapidly and accurately identify the etiologic organism in UTI. The molecular methods for diagnosing the cause of UTI and prognostic development of clinically important metabolomic evaluations and their limitations for use in the diagnosis and monitoring of infections are discussed in this review article. The application of the emerging investigative device NMR spectroscopy as a surrogate method for the diagnosis of UTI is also addressed.
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Affiliation(s)
- Ashish Gupta
- Department of Radiology, Division of Magnetic Resonance Research, The Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
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Cohen JF, Leis A, Lecarpentier T, Raymond J, Gendrel D, Chalumeau M. Procalcitonin predicts response to beta-lactam treatment in hospitalized children with community-acquired pneumonia. PLoS One 2012; 7:e36927. [PMID: 22615848 PMCID: PMC3355171 DOI: 10.1371/journal.pone.0036927] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 04/17/2012] [Indexed: 11/19/2022] Open
Abstract
Background Antibiotic treatment of community-acquired pneumonia (CAP) in children remains mostly empirical because clinical and paraclinical findings poorly discriminate the principal causes of CAP. Fast response to beta-lactam treatment can be considered a proxy of pneumococcal aetiology. We aimed to identify the best biological predictor of response to beta-lactam therapy in children hospitalized for CAP. Methods A retrospective, single-centre cohort study included all consecutive patients 1 month to 16 years old hospitalized in a teaching hospital in Paris, France, because of CAP empirically treated with a beta-lactam alone from 2003 to 2010. Uni- and multivariate analyses were used to study the ability of routine biological parameters available in the Emergency Department to predict a favourable response to beta-lactam (defined as apyrexia within 48 hours of treatment onset). Results Among the 125 included patients, 85% (106) showed a favourable response to beta-lactam. In multivariate logistic regression, we found procalcitonin (PCT) the only independent predictor of apyrexia (p = 0.008). The adjusted odds ratio for the decadic logarithm of PCT was 4.3 (95% CI 1.5–12.7). At ≥3 ng/mL, PCT had 55.7% sensitivity (45.7–65.3), 78.9% specificity (54.4–93.9), 93.7% positive predictive value (84.5–98.2), 24.2% negative predictive value (14.2–36.7), 2.64 positive likelihood ratio (1.09–6.42) and 0.56 negative likelihood ratio (0.41–0.77). In the 4 children with a PCT level ≥3 ng/mL and who showed no response to beta-lactam treatment, secondary pleural effusion had developed in 3, and viral co-infection was documented in 1. Conclusions PCT is the best independent biologic predictor of favourable response to beta-lactam therapy in children hospitalized for CAP. Thus, a high PCT level is highly suggestive of pneumococcal aetiology. However, a 3-ng/mL cut-off does not seem compatible with daily medical practice, and additional research is needed to further define the role of PCT in managing CAP in children.
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Affiliation(s)
- Jérémie F Cohen
- Department of Pediatrics, Saint-Vincent-de-Paul and Necker-Enfants-Malades Hospital, AP-HP, Université Paris-Descartes, Paris, France.
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Tuuminen T. Urine as a specimen to diagnose infections in twenty-first century: focus on analytical accuracy. Front Immunol 2012; 3:45. [PMID: 22566927 PMCID: PMC3342332 DOI: 10.3389/fimmu.2012.00045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 02/26/2012] [Indexed: 11/29/2022] Open
Abstract
Urine as a clinical specimen to diagnose infections has been used since ancient times. Many rapid technologies to assist diagnosis of infections are currently in use. Alongside traditional enzyme immunoassays (EIA), new technologies have emerged. Molecular analysis of transrenal DNA to diagnose infections is also a rapidly growing field. The majority of EIAs utilize the detection of excreted sugar compounds of the outer microbial cell-wall shed into the bloodstream and excreted into the urine. This mini-review focuses on current knowledge on rapid urinary antigen detection tests to diagnose most common infections, and highlights their diagnostic utility. The past and the future of urinalysis are also briefly discussed. The analysis of the literature shows that some methods are not quantitative, and analytical sensitivity may remain suboptimal. In addition, the performance criteria and technical documentation of some commercial tests are insufficient. Clinical microbiologists and physicians should be alert to assay limitations.
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Affiliation(s)
- Tamara Tuuminen
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki Helsinki, Finland
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Thiem U, Heppner HJ, Pientka L. Elderly patients with community-acquired pneumonia: optimal treatment strategies. Drugs Aging 2012; 28:519-37. [PMID: 21721597 DOI: 10.2165/11591980-000000000-00000] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Community-acquired pneumonia (CAP) is a common infectious disease that still causes substantial morbidity and mortality. Elderly people are frequently affected, and several issues related to care of this condition in the elderly have to be considered. This article reviews current recommendations of guidelines with a special focus on aspects of the care of elderly patients with CAP. The most common pathogen in CAP is still Streptococcus pneumoniae, followed by other pathogens such as Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella species. Antimicrobial resistance is an increasing problem, especially with regard to macrolide-resistant S. pneumoniae and fluoroquinolone-resistant strains. With regard to β-lactam antibacterials, resistance by H. influenzae and Moraxella catarrhalis is important, as is the emergence of multidrug-resistant Staphylococcus aureus. The main management decisions should be guided by the severity of disease, which can be assessed by validated clinical risk scores such as CURB-65, a tool for measuring the severity of pneumonia based on assessment of confusion, serum urea, respiratory rate and blood pressure in patients aged ≥65 years. For the treatment of low-risk pneumonia, an aminopenicillin such as amoxicillin with or without a β-lactamase inhibitor is frequently recommended. Monotherapy with macrolides is also possible, although macrolide resistance is of concern. When predisposing factors for special pathogens are present, a β-lactam antibacterial combined with a β-lactamase inhibitor, or the combination of a β-lactam antibacterial, a β-lactamase inhibitor and a macrolide, may be warranted. If possible, patients who have undergone previous antibacterial therapy should receive drug classes not previously used. For hospitalized patients with non-severe pneumonia, a common recommendation is empirical antibacterial therapy with an aminopenicillin in combination with a β-lactamase inhibitor, or with fluoroquinolone monotherapy. With proven Legionella pneumonia, a combination of β-lactams with a fluoroquinolone or a macrolide is beneficial. In severe pneumonia, ureidopenicillins with β-lactamase inhibitors, broad-spectrum cephalosporins, macrolides and fluoroquinolones are used. A combination of a broad-spectrum β-lactam antibacterial (e.g. cefotaxime or ceftriaxone), piperacillin/tazobactam and a macrolide is mostly recommended. In patients with a predisposition for Pseudomonas aeruginosa, a combination of piperacillin/tazobactam, cefepime, imipenem or meropenem and levofloxacin or ciprofloxacin is frequently used. Treatment duration of more than 7 days is not generally recommended, except for proven infections with P. aeruginosa, for which 15 days of treatment appears to be appropriate. Further care issues in all hospitalized patients are timely administration of antibacterials, oxygen supply in case of hypoxaemia, and fluid management and dose adjustments according to kidney function. The management of elderly patients with CAP is a challenge. Shifts in antimicrobial resistance and the availability of new antibacterials will change future clinical practice. Studies investigating new methods to detect pathogens, determine the optimal antimicrobial regimen and clarify the duration of treatment may assist in further optimizing the management of elderly patients with CAP.
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Affiliation(s)
- Ulrich Thiem
- Department of Geriatrics, Marienhospital Herne, University of Bochum, Herne, Germany.
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Klugman KP. Contribution of vaccines to our understanding of pneumococcal disease. Philos Trans R Soc Lond B Biol Sci 2011; 366:2790-8. [PMID: 21893542 DOI: 10.1098/rstb.2011.0032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Pneumonia is the leading cause of mortality in children in developing countries and is also the leading infectious cause of death in adults. The most important cause of pneumonia is the Gram-positive bacterial pathogen, Streptococcus pneumoniae, also known as the pneumococcus. It has thus become the leading vaccine-preventable cause of death and is a successful and diverse human pathogen. The development of conjugate pneumococcal vaccines has made possible the prevention of pneumococcal disease in infants, but has also elucidated aspects of pneumococcal biology in a number of ways. Use of the vaccine as a probe has increased our understanding of the burden of pneumococcal disease in children globally. Vaccination has also elucidated the clinical spectrum of vaccine-preventable pneumococcal infections; the identification of a biological niche for multiple pneumococcal serotypes in carriage and the differential invasiveness of pneumococcal serotypes; the impact of pneumococcal transmission among children on disease burden in adults; the role of carriage as a precursor to pneumonia; the plasticity of a naturally transformable pathogen to respond to selective pressure through capsular switching and the accumulation of antibiotic-resistance determinants; and the role of pneumococcal infections in hospitalization and mortality associated with respiratory viral infections, including both seasonal and pandemic influenza. Finally, there has been a recent demonstration that pneumococcal pneumonia in children may be an important cause of hospitalization for those with underlying tuberculosis.
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Affiliation(s)
- Keith P Klugman
- Rollins School of Public Health, Emory University, 1518 Clifton Road, N.E.-CNR Room 6009, Atlanta, GA 30322, USA.
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