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Besteman SB, Bogaert D, Bont L, Mejias A, Ramilo O, Weinberger DM, Dagan R. Interactions between respiratory syncytial virus and Streptococcus pneumoniae in the pathogenesis of childhood respiratory infections: a systematic review. THE LANCET. RESPIRATORY MEDICINE 2024:S2213-2600(24)00148-6. [PMID: 38991585 DOI: 10.1016/s2213-2600(24)00148-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/11/2024] [Accepted: 05/03/2024] [Indexed: 07/13/2024]
Abstract
Lower respiratory tract infections, commonly caused by respiratory syncytial virus (RSV) or Streptococcus pneumoniae (pneumococcus), pose a substantial global health burden, especially in children younger than 5 years of age. A deeper understanding of the relationship between RSV and pneumococcus would aid the development of health-care approaches to disease prevention and management. We completed a systematic review to identify and assess evidence pertaining to the relationship between RSV and pneumococcus in the pathogenesis of childhood respiratory infections. We found mechanistic evidence for direct pathogen-pathogen interactions and for indirect interactions involving host modulation. We found a strong seasonal epidemiological association between these two pathogens, which was recently confirmed by a parallel decrease and a subsequent resurgence of both RSV and pneumococcus-associated disease during the COVID-19 pandemic. Importantly, we found that pneumococcal vaccination was associated with reduced RSV hospitalisations in infants, further supporting the relevance of their interaction in modulating severe disease. Overall evidence supports a broad biological and clinical interaction between pneumococcus and RSV in the pathogenesis of childhood respiratory infections. We hypothesise that the implementation of next-generation pneumococcal and RSV vaccines and monoclonal antibodies targeting RSV will act synergistically to reduce global morbidity and mortality related to childhood respiratory infections.
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Affiliation(s)
- Sjanna B Besteman
- Department of Pediatrics, Onze Lieve Vrouwe Gasthuis Ziekenhuis, Amsterdam, Netherlands
| | - Debby Bogaert
- Department of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands; Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK
| | - Louis Bont
- Department of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | - Asuncion Mejias
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Octavio Ramilo
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, New Haven, CT, USA
| | - Ron Dagan
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Papadopoulos NG, Apostolidou E, Miligkos M, Xepapadaki P. Bacteria and viruses and their role in the preschool wheeze to asthma transition. Pediatr Allergy Immunol 2024; 35:e14098. [PMID: 38445451 DOI: 10.1111/pai.14098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/07/2024]
Abstract
Wheezing is the cardinal symptom of asthma; its presence early in life, mostly caused by viral infections, is a major risk factor for the establishment of persistent or recurrent disease. Early-life wheezing and asthma exacerbations are triggered by common respiratory viruses, mainly rhinoviruses (RV), and to a lesser extent, respiratory syncytial virus, parainfluenza, human metapneumovirus, coronaviruses, adenoviruses, influenza, and bocavirus. The excess presence of bacteria, several of which are part of the microbiome, has also been identified in association with wheezing and acute asthma exacerbations, including haemophilus influenza, streptococcus pneumoniae, moraxella catarrhalis, mycoplasma pneumoniae, and chlamydophila pneumonia. While it is not clear when asthma starts, its characteristics develop over time. Airway remodeling already appears between the ages of 1 and 3 years of age even prior to the presence of atopic inflammation or an asthma diagnosis. The role of genetic defect or variations hampering the airway epithelium in response to environmental stimuli and severe disease morbidity are now considered as major determinants for early structural changes. Repeated viral infections can induce and perpetuate airway hyperresponsiveness. Allergic sensitization, that often precedes infection-induced wheezing, shifts inflammation toward type-2, while common respiratory infections themselves promote type-2 inflammation. Nevertheless, most children who wheeze with viral infections during infancy and during preschool years do not develop persistent asthma. Multiple factors, including illness severity, viral etiology, allergic sensitization, and the exposome, are associated with disease persistence. Here, we summarize current knowledge and developments in infection epidemiology of asthma in children, describing the known impact of each individual agent and mechanisms of transition from recurrent wheeze to asthma.
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Affiliation(s)
- Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | | | - Michael Miligkos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
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3
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Papadopoulos NG, Akdis CA, Akdis M, Damialis A, Esposito G, Fergadiotou I, Goroncy C, Guitton P, Gotua M, Erotokritou K, Jartti T, Murray C, Nenes A, Nikoletseas S, Finotto S, Pandis SN, Ramiconi V, Simpson A, Soudunsaari A, Stårbröst A, Staiano M, Varriale A, Xepapadaki P, Zuberbier T, Annesi-Maesano I. Addressing adverse synergies between chemical and biological pollutants at schools-The 'SynAir-G' hypothesis. Allergy 2024; 79:294-301. [PMID: 37654007 DOI: 10.1111/all.15857] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/17/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023]
Abstract
While the number and types of indoor air pollutants is rising, much is suspected but little is known about the impact of their potentially synergistic interactions, upon human health. Gases, particulate matter, organic compounds but also allergens and viruses, fall within the 'pollutant' definition. Distinct populations, such as children and allergy and asthma sufferers are highly susceptible, while a low socioeconomic background is a further susceptibility factor; however, no specific guidance is available. We spend most of our time indoors; for children, the school environment is of paramount importance and potentially amenable to intervention. The interactions between some pollutant classes have been studied. However, a lot is missing with respect to understanding interactions between specific pollutants of different classes in terms of concentrations, timing and sequence, to improve targeting and upgrade standards. SynAir-G is a European Commission-funded project aiming to reveal and quantify synergistic interactions between different pollutants affecting health, from mechanisms to real life, focusing on the school setting. It will develop a comprehensive and responsive multipollutant monitoring system, advance environmentally friendly interventions, and disseminate the generated knowledge to relevant stakeholders in accessible and actionable formats. The aim of this article it to put forward the SynAir-G hypothesis, and describe its background and objectives.
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Affiliation(s)
- Nikolaos G Papadopoulos
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland, Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland, Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Athanasios Damialis
- Department of Ecology, School of Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | | | - Maia Gotua
- Center for Allergy and Immunology Research (CAIR), Tbilisi, Georgia
| | | | - Tuomas Jartti
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Pediatrics, Oulu University Hospital, Oulu, Finland
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Clare Murray
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Athanasios Nenes
- Laboratory of Atmospheric Processes and their Impacts, School of Architecture, Civil and Environmental Engineering, Swiss Institute of Technology, Lausanne, Switzerland
| | - Sotirios Nikoletseas
- Computer Engineering and Informatics Department, University of Patras, Patras, Greece
| | - Susetta Finotto
- Molecular Pneumology Department, University Hospital of Erlangen, Erlangen, Germany
| | - Spyros N Pandis
- Institute of Chemical Engineering Sciences (ICEHT), Foundation for Research and Technology Hellas (FORTH), Patras, Greece
| | - Valeria Ramiconi
- The European Federation of Allergy and Airways Diseases Patients' Association (EFA), Brussels, Belgium
| | - Angela Simpson
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
| | | | | | - Maria Staiano
- Institute of Food Science, CNR Italy, Avellino, Italy
| | - Antonio Varriale
- Institute of Food Science, CNR Italy, Avellino, Italy
- URT-ISA, CNR at Department of Biology, University of Naples Federico II, Naples, Italy
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Global Allergy & Asthma European Network of Excellence-GA2LEN, Berlin, Germany
| | - Isabella Annesi-Maesano
- Department of Allergic and Respiratory Disease, Institut Desbrest of Epidemiology and Public Health, University of Montpellier and INSERM, Montpellier University Hospital, Montpellier, France
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Goh M, Joy C, Gillespie AN, Soh QR, He F, Sung V. Asymptomatic viruses detectable in saliva in the first year of life: a narrative review. Pediatr Res 2024; 95:508-531. [PMID: 38135726 DOI: 10.1038/s41390-023-02952-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
Viral infections are common in children. Many can be asymptomatic or have delayed health consequences. In view of increasing availability of point-of-care viral detection technologies, with possible application in newborn screening, this review aimed to (1) identify potentially asymptomatic viruses detectable in infants under one year old, via saliva/nasopharyngeal swab, and (2) describe associations between viruses and long-term health conditions. We systematically searched Embase(Ovid), Medline(Ovid) and PubMed, then further searched the literature in a tiered approach. From the 143 articles included, 28 potentially asymptomatic viruses were identified. Our second search revealed associations with a range of delayed health conditions, with most related to the severity of initial symptoms. Many respiratory viruses were linked with development of recurrent wheeze or asthma. Of note, some potentially asymptomatic viruses are linked with later non-communicable diseases: adenovirus serotype 36 and obesity, Enterovirus-A71 associated Hand, Foot, Mouth Disease and Attention-Deficit Hyperactivity Disorder, Ebstein Barr Virus (EBV) and malignancy, EBV and multiple sclerosis, HHV-6 and epilepsy, HBoV-1 and lung fibrosis and Norovirus and functional gastrointestinal disorders. Our review identified many potentially asymptomatic viruses, detectable in early life with potential delayed health consequences, that could be important to screen for in the future using rapid point-of-care viral detection methods. IMPACT: Novel point-of-care viral detection technologies enable rapid detection of viruses, both old and emerging. In view of increasing capability to screen for viruses, this is the first review to explore which potentially asymptomatic viruses, that are detectable using saliva and/or nasopharyngeal swabs in infants less than one year of age, are associated with delayed adverse health conditions. Further research into detecting such viruses in early life and their delayed health outcomes may pave new ways to prevent non-communicable diseases in the future.
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Affiliation(s)
- Melody Goh
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
- Prevention Innovation, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Charissa Joy
- Prevention Innovation, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Monash Children's Hospital Clayton, Clayton, VIC, Australia
| | - Alanna N Gillespie
- Prevention Innovation, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Qi Rui Soh
- Prevention Innovation, Murdoch Children's Research Institute, Parkville, VIC, Australia
- The University of Melbourne, Faculty of Medicine Dentistry and Health Sciences Melbourne, Melbourne, VIC, Australia
| | - Fan He
- Prevention Innovation, Murdoch Children's Research Institute, Parkville, VIC, Australia
- John Richards Centre for Rural Ageing Research, La Trobe University, Wodonga, VIC, Australia
| | - Valerie Sung
- Prevention Innovation, Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Monash Children's Hospital Clayton, Clayton, VIC, Australia.
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
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Brydak L, Sikora D, Poniedziałek B, Hallmann E, Szymański K, Kondratiuk K, Rzymski P. Association between the Seroprevalence of Antibodies against Seasonal Alphacoronaviruses and SARS-CoV-2 Humoral Immune Response, COVID-19 Severity, and Influenza Vaccination. J Clin Med 2023; 12:jcm12051733. [PMID: 36902520 PMCID: PMC10003754 DOI: 10.3390/jcm12051733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/11/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
The present study assesses the seroprevalence of antibodies against seasonal human alphacoronaviruses 229E and NL63 among adult patients infected with SARS-CoV-2, and its association with the humoral response to SARS-CoV-2 infection and its severity, and influenza vaccination. A serosurvey was conducted to quantify the presence of IgG antibodies against the nucleocapsid of 229E (anti-229E-N) and NL63 (anti-NL63-N), and anti-SARS-CoV-2 IgG antibodies (against nucleocapsid, receptor-binding domain, S2 domain, envelope, and papain-like protease) for 1313 Polish patients. The seroprevalence of anti-229E-N and anti-NL63 in the studied cohort was 3.3% and 2.4%. Seropositive individuals had a higher prevalence of anti-SARS-CoV-2 IgG antibodies, higher titers of the selected anti-SARS-CoV2 antibodies, and higher odds of an asymptomatic SARS-CoV-2 infection (OR = 2.5 for 229E and OR = 2.7 for NL63). Lastly, the individuals vaccinated against influenza in the 2019/2020 epidemic season had lower odds of seropositivity to 229E (OR = 0.38). The 229E and NL63 seroprevalence was below the expected pre-pandemic levels (up to 10%), likely due to social distancing, increased hygiene, and face masking. The study also suggests that exposure to seasonal alphacoronaviruses may improve humoral responses to SARS-CoV-2 while decreasing the clinical significance of its infection. It also adds to accumulating evidence of the favorable indirect effects of influenza vaccination. However, the findings of the present study are of a correlative nature and thereby do not necessarily imply causation.
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Affiliation(s)
- Lidia Brydak
- Department of Influenza Research, National Influenza Center at the National Institute of Public Health NIH—National Research Institute in Warsaw, 00-791 Warsaw, Poland
| | - Dominika Sikora
- Department of Environmental Medicine, Poznań University of Medical Sciences, 60-806 Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Barbara Poniedziałek
- Department of Environmental Medicine, Poznań University of Medical Sciences, 60-806 Poznan, Poland
| | - Ewelina Hallmann
- Department of Influenza Research, National Influenza Center at the National Institute of Public Health NIH—National Research Institute in Warsaw, 00-791 Warsaw, Poland
| | - Karol Szymański
- Department of Influenza Research, National Influenza Center at the National Institute of Public Health NIH—National Research Institute in Warsaw, 00-791 Warsaw, Poland
| | - Katarzyna Kondratiuk
- Department of Influenza Research, National Influenza Center at the National Institute of Public Health NIH—National Research Institute in Warsaw, 00-791 Warsaw, Poland
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznań University of Medical Sciences, 60-806 Poznan, Poland
- Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), 60-806 Poznan, Poland
- Correspondence:
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Overnutrition, Nasopharyngeal Pathogenic Bacteria and Proinflammatory Cytokines in Infants with Viral Lower Respiratory Tract Infections. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148781. [PMID: 35886632 PMCID: PMC9317356 DOI: 10.3390/ijerph19148781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/28/2022]
Abstract
Background: Little is known about the interaction between the nasopharyngeal bacterial profile and the nutritional status in children. In this study, our main goal was to evaluate the associations between overnutrition and the presence of four potentially pathogenic bacteria in the nasopharynx of infants with viral lower respiratory tract infections (LRTI). In addition, we determined whether changes in the nasopharyngeal bacterial profile were associated with mucosal and serum proinflammatory cytokines and with clinical disease severity. Methods: We enrolled 116 children less than 2 years old hospitalized for viral LRTI during two consecutive respiratory seasons (May 2016 to August 2017); their nutritional status was assessed, and nasopharyngeal and blood samples were obtained. S. aureus, S. pneumoniae, H. influenzae, M. catarrhalis, and respiratory viruses were identified in nasopharyngeal samples by qPCR. Cytokine concentrations were measured in nasopharyngeal and blood samples. Disease severity was assessed by the length of hospitalization and oxygen therapy. Results: Nasopharyngeal pathogenic bacteria were identified in 96.6% of the enrolled children, and 80% of them tested positive for two or more bacteria. The presence and loads of M. catarrhalis was higher (p = 0.001 and p = 0.022, respectively) in children with overnutrition (n = 47) compared with those with normal weights (n = 69). In addition, the detection of >2 bacteria was more frequent in children with overnutrition compared to those with normal weight (p = 0.02). Multivariate regression models showed that the presence and loads of S. pneumoniae and M. catarrhalis were associated with higher concentrations of IL-6 in plasma and TNF-α in mucosal samples in children with overnutrition. Conclusions: The nasopharyngeal profile of young children with overnutrition was characterized by an over representation of pathogenic bacteria and proinflammatory cytokines.
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Refractory Mycoplasma pneumoniae Pneumonia in Children: Early Recognition and Management. J Clin Med 2022; 11:jcm11102824. [PMID: 35628949 PMCID: PMC9144103 DOI: 10.3390/jcm11102824] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Refractory Mycoplasma pneumoniae pneumonia (RMPP) is a severe state of M. pneumoniae infection that has attracted increasing universal attention in recent years. The pathogenesis of RMPP remains unknown, but the excessive host immune responses as well as macrolide resistance of M. pneumoniae might play important roles in the development of RMPP. To improve the prognosis of RMPP, it is mandatory to recognize RMPP in the early stages, and the detection of macrolide-resistant MP, clinical unresponsiveness to macrolides and elevated proinflammatory cytokines might be clues. Timely and effective anti-mycoplasmal therapy and immunomodulating therapy are the main strategies for RMPP.
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Peno C, Armitage EP, Clerc M, Balcazar Lopez C, Jagne YJ, Drammeh S, Jarju S, Sallah H, Senghore E, Lindsey BB, Camara J, Bah S, Mohammed NI, Dockrell DH, Kampmann B, Clarke E, Bogaert D, de Silva TI. The effect of live attenuated influenza vaccine on pneumococcal colonisation densities among children aged 24-59 months in The Gambia: a phase 4, open label, randomised, controlled trial. THE LANCET. MICROBE 2021; 2:e656-e665. [PMID: 34881370 PMCID: PMC8632704 DOI: 10.1016/s2666-5247(21)00179-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Influenza and other respiratory viruses promote Streptococcus pneumoniae proliferation in the upper respiratory tract. We sought to investigate for what we believe is the first time, the effect of intranasal live attenuated influenza vaccine (LAIV) on nasopharyngeal S pneumoniae density in a low-income to middle-income country population with high pneumococcal carriage rates. METHODS In an open-label, randomised, controlled trial in The Gambia, 330 healthy children aged 24-59 months were randomly assigned 2:1 to receive one trivalent LAIV dose at enrolment (day 0, intervention) or at the end of active follow-up (day 21, control). The investigator team were initially masked to block size and randomisation sequence to avoid allocation bias. Group allocation was later revealed to the investigator team. The primary outcome was PCR-quantified day 7 and 21 pneumococcal density. Asymptomatic respiratory viral infection at baseline and LAIV strain shedding were included as covariates in generalised mixed-effects models, to assess the effect of LAIV and other variables on pneumococcal densities. The study is registered at ClinicalTrials.gov, NCT02972957, and is closed to recruitment. FINDINGS Between Feb 8 and April 12, 2017, and Jan 15 and March 28, 2018, of 343 children assessed for eligibility, 213 in the intervention group and 108 in the control group completed the study and were included in the final analysis. Although no significant differences were seen in pneumococcal carriage or density at each timepoint when comparing groups, changes from baseline were observed in the LAIV group. The baseline S pneumoniae carriage prevalence was high in both LAIV and control groups (75%) and increased by day 21 in the LAIV group (85%, p=0·0037), but not in the control group (79%, p=0·44). An increase in pneumococcal density from day 0 amounts was seen in the LAIV group at day 7 (+0·207 log10 copies per μL, SE 0·105, p=0·050) and day 21 (+0·280 log10 copies per μL, SE 0·105, p=0·0082), but not in the control group. Older age was associated with lower pneumococcal density (-0·015 log10 copies per μL, SE 0·005, p=0·0030), with the presence of asymptomatic respiratory viruses at baseline (+0·259 log10 copies per μL, SE 0·097, p=0·017), and greater LAIV shedding at day 7 (+0·380 log10 copies per μL, SE 0·167, p=0·024) associated with higher pneumococcal density. A significant increase in rhinorrhoea was reported in the LAIV group compared with the control group children during the first 7 days of the study (103 [48%] of 213, compared with 25 [23%] of 108, p<0·0001), and between day 7 and 21 (108 [51%] of 213, compared with 28 [26%] of 108, p<0·0001). INTERPRETATION LAIV was associated with a modest increase in nasopharyngeal pneumococcal carriage and density in the 21 days following vaccination, with the increase in density lower in magnitude than previously described in the UK. This increase was accelerated when LAIV was administered in the presence of pre-existing asymptomatic respiratory viruses, suggesting that nasopharyngeal S pneumoniae proliferation is driven by cumulative mixed-viral co-infections. The effect of LAIV on pneumococcal density is probably similar to other respiratory viral infections in children. Our findings provide reassurance for the use of LAIV to expand influenza vaccine programmes in low-income to middle-income country populations with high pneumococcal carriage. FUNDING Wellcome Trust.
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Affiliation(s)
- Chikondi Peno
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Edwin P Armitage
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Melanie Clerc
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Carlos Balcazar Lopez
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Ya Jankey Jagne
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Sainabou Drammeh
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Sheikh Jarju
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Hadijatou Sallah
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Elina Senghore
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Benjamin B Lindsey
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- The Florey Institute & Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield, UK
| | - Janko Camara
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Sulayman Bah
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Nuredin I Mohammed
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - David H Dockrell
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- The Vaccine Centre, Faculty of Infectious and Tropical Diseases, The London School of Hygiene & Tropical Medicine, London, UK
| | - Ed Clarke
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Debby Bogaert
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thushan I de Silva
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- The Florey Institute & Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield, UK
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9
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Kohns Vasconcelos M, Loens K, Sigfrid L, Iosifidis E, Epalza C, Donà D, Matheeussen V, Papachristou S, Roilides E, Gijon M, Rojo P, Minotti C, Da Dalt L, Islam S, Jarvis J, Syggelou A, Tsolia M, Nyirenda Nyang'wa M, Keers S, Renk H, Gemmel AL, D'Amore C, Ciofi Degli Atti M, Rodríguez-Tenreiro Sánchez C, Martinón-Torres F, Burokienė S, Goetghebuer T, Spoulou V, Riordan A, Calvo C, Gkentzi D, Hufnagel M, Openshaw PJ, de Jong MD, Koopmans M, Goossens H, Ieven M, Fraaij PLA, Giaquinto C, Bielicki JA, Horby P, Sharland M. Aetiology of acute respiratory infection in preschool children requiring hospitalisation in Europe-results from the PED-MERMAIDS multicentre case-control study. BMJ Open Respir Res 2021; 8:8/1/e000887. [PMID: 34326154 PMCID: PMC8323363 DOI: 10.1136/bmjresp-2021-000887] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/05/2021] [Indexed: 12/21/2022] Open
Abstract
Background Both pathogenic bacteria and viruses are frequently detected in the nasopharynx (NP) of children in the absence of acute respiratory infection (ARI) symptoms. The aim of this study was to estimate the aetiological fractions for ARI hospitalisation in children for respiratory syncytial virus (RSV) and influenza virus and to determine whether detection of specific respiratory pathogens on NP samples was associated with ARI hospitalisation. Methods 349 children up to 5 years of age hospitalised for ARI (following a symptom-based case definition) and 306 hospital controls were prospectively enrolled in 16 centres across seven European Union countries between 2016 and 2019. Admission day NP swabs were analysed by multiplex PCR for 25 targets. Results RSV was the leading single cause of ARI hospitalisations, with an overall population attributable fraction (PAF) of 33.4% and high seasonality as well as preponderance in younger children. Detection of RSV on NP swabs was strongly associated with ARI hospitalisation (OR adjusted for age and season: 20.6, 95% CI: 9.4 to 45.3). Detection of three other viral pathogens showed strong associations with ARI hospitalisation: influenza viruses had an adjusted OR of 6.1 (95% CI: 2.5 to 14.9), parainfluenza viruses (PIVs) an adjusted OR of 4.6 (95% CI: 1.8 to 11.3) and metapneumoviruses an adjusted OR of 4.5 (95% CI: 1.3 to 16.1). Influenza viruses had a PAF of 7.9%, PIVs of 6.5% and metapneumoviruses of 3.0%. In contrast, most other pathogens were found in similar proportions in cases and controls, including Streptococcus pneumoniae, which was weakly associated with case status, and endemic coronaviruses. Conclusion RSV is the predominant cause of ARI hospitalisations in young children in Europe and its detection, as well as detection of influenza virus, PIV or metapneumovirus, on NP swabs can establish aetiology with high probability. PAFs for RSV and influenza virus are highly seasonal and age dependent.
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Affiliation(s)
- Malte Kohns Vasconcelos
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK .,Institute for Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Katherine Loens
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Louise Sigfrid
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Elias Iosifidis
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Cristina Epalza
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre and Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Veerle Matheeussen
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Savvas Papachristou
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Manuel Gijon
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre and Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Pablo Rojo
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre and Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Chiara Minotti
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Liviana Da Dalt
- Paediatric Emergency Department, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Samsul Islam
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK
| | - Jessica Jarvis
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aggeliki Syggelou
- 2nd Department of Paediatrics, National and Kapodistrian University of Athens (NKUA) School of Medicine, P. and A. Kyriakou Children's Hospital, Athens, Greece
| | - Maria Tsolia
- 2nd Department of Paediatrics, National and Kapodistrian University of Athens (NKUA) School of Medicine, P. and A. Kyriakou Children's Hospital, Athens, Greece
| | - Maggie Nyirenda Nyang'wa
- Paediatric Department, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, UK
| | - Sophie Keers
- Paediatric Department, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, UK
| | - Hanna Renk
- Department of Paediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Anna-Lena Gemmel
- Department of Paediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Carmen D'Amore
- Clinical Pathways and Epidemiology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Marta Ciofi Degli Atti
- Clinical Pathways and Epidemiology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Carmen Rodríguez-Tenreiro Sánchez
- Translational Paediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Servizo Galego de Saude, Santiago de Compostela, Spain.,Genetics, Vaccines and Infectious Diseases Research Group, Instituto de Investigación Sanitaria de Santiago, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Federico Martinón-Torres
- Translational Paediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Servizo Galego de Saude, Santiago de Compostela, Spain.,Genetics, Vaccines and Infectious Diseases Research Group, Instituto de Investigación Sanitaria de Santiago, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Sigita Burokienė
- Clinic of Children's Diseases, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Tessa Goetghebuer
- Department of Paediatrics, St-Pierre Hospital Brussels, Brussels, Belgium
| | - Vana Spoulou
- 1st Department of Paediatrics, National and Kapodistrian University of Athens (NKUA) School of Medicine, Agia Sophia Children's Hospital of Athens, Athens, Greece
| | - Andrew Riordan
- Department of Paediatric Infectious Diseases, Alder Hey Children's Hospital, Liverpool, UK
| | - Cristina Calvo
- Paediatrics and Infectious Diseases Department, La Paz University Hospital, Madrid, Spain
| | - Despoina Gkentzi
- Department of Paediatrics, University General Hospital of Patras, Patras Medical School, Patras, Greece
| | - Markus Hufnagel
- Division of Paediatric Infectious Diseases and Rheumatology, Department of Paediatrics and Adolescent Medicine, University Medical Centre, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Peter J Openshaw
- National Heart and Lung Division, Faculty of Medicine, Imperial College London, London, UK
| | - Menno D de Jong
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marion Koopmans
- Department of Viroscience, ErasmusMC, Rotterdam, The Netherlands
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Margareta Ieven
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | | | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Julia A Bielicki
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK.,Department of Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Michael Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK
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10
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Tzani-Tzanopoulou P, Skliros D, Megremis S, Xepapadaki P, Andreakos E, Chanishvili N, Flemetakis E, Kaltsas G, Taka S, Lebessi E, Doudoulakakis A, Papadopoulos NG. Interactions of Bacteriophages and Bacteria at the Airway Mucosa: New Insights Into the Pathophysiology of Asthma. FRONTIERS IN ALLERGY 2021; 1:617240. [PMID: 35386933 PMCID: PMC8974763 DOI: 10.3389/falgy.2020.617240] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022] Open
Abstract
The airway epithelium is the primary site where inhaled and resident microbiota interacts between themselves and the host, potentially playing an important role on allergic asthma development and pathophysiology. With the advent of culture independent molecular techniques and high throughput technologies, the complex composition and diversity of bacterial communities of the airways has been well-documented and the notion of the lungs' sterility definitively rejected. Recent studies indicate that the microbial composition of the asthmatic airways across the spectrum of disease severity, differ significantly compared with healthy individuals. In parallel, a growing body of evidence suggests that bacterial viruses (bacteriophages or simply phages), regulating bacterial populations, are present in almost every niche of the human body and can also interact directly with the eukaryotic cells. The triptych of airway epithelial cells, bacterial symbionts and resident phages should be considered as a functional and interdependent unit with direct implications on the respiratory and overall homeostasis. While the role of epithelial cells in asthma pathophysiology is well-established, the tripartite interactions between epithelial cells, bacteria and phages should be scrutinized, both to better understand asthma as a system disorder and to explore potential interventions.
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Affiliation(s)
- Panagiota Tzani-Tzanopoulou
- Allergy and Clinical Immunology Unit, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Skliros
- Laboratory of Molecular Biology, Department of Biotechnology, School of Food, Biotechnology and Development, Agricultural University of Athens, Athens, Greece
| | - Spyridon Megremis
- Division of Evolution and Genomic Sciences, University of Manchester, Manchester, United Kingdom
| | - Paraskevi Xepapadaki
- Allergy and Clinical Immunology Unit, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Andreakos
- Center for Clinical, Experimental Surgery and Translational Research of the Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Nina Chanishvili
- Laboratory for Genetics of Microorganisms and Bacteriophages, Eliava Institute of Bacteriophage, Microbiology & Virology, Tbilisi, GA, United States
| | - Emmanouil Flemetakis
- Laboratory of Molecular Biology, Department of Biotechnology, School of Food, Biotechnology and Development, Agricultural University of Athens, Athens, Greece
| | - Grigoris Kaltsas
- Department of Electrical and Electronic Engineering, University of West Attica, Athens, Greece
| | - Styliani Taka
- Allergy and Clinical Immunology Unit, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Lebessi
- Department of Microbiology, P. & A. Kyriakou Children's Hospital, Athens, Greece
| | | | - Nikolaos G Papadopoulos
- Allergy and Clinical Immunology Unit, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.,Division of Evolution and Genomic Sciences, University of Manchester, Manchester, United Kingdom
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11
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Ngocho JS, Minja L, van der Gaast-de Jongh CE, Rahamat-Langendoen JC, Langereis JD, Mmbaga BT, de Jonge MI. Viral-bacterial (co-)occurrence in the upper airways and the risk of childhood pneumonia in resource-limited settings. J Infect 2020; 81:213-220. [PMID: 32533999 DOI: 10.1016/j.jinf.2020.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/31/2020] [Accepted: 06/06/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the association between bacterial-viral co-occurrence in the nasopharynx and the risk of community acquired pneumonia (CAP) in young children living in resource-limited settings. METHODS A case-control study was conducted between January and December 2017 in Moshi, Tanzania. Children 2-59 months with CAP and healthy controls were enrolled. RSV and Influenza A/B were detected with a standardized polymerase chain reaction (PCR) method, and a simplified real-time quantitative PCR method, without sample pre-processing, was developed to detect bacterial pathogens in nasopharyngeal samples. RESULTS A total of 109 CAP patients and 324 healthy controls were enrolled. Co-detection of H. influenzae and S. pneumoniae in nasopharyngeal swabs was linked with higher odds of CAP (aOR=3.2, 95% CI=1.1-9.5). The majority of the H. influenzae isolated in cases and controls (95.8%) were non-typeable. Of the viruses examined, respiratory syncytial virus (RSV) was most common (n = 31, 7.2%) in cases and controls. Children with RSV had 8.4 times higher odds to develop pneumonia than healthy children (aOR=8.4, 95%CI= 3.2 - 22.1). CONCLUSIONS Co-occurence of H. influenzae and S. pneumoniae in the nasopharynx was strongly associated with CAP. The high prevalence of non-typeable H. influenzae might be a sign of replacement as a consequence of Haemophilus influenzae type b vaccination.
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Affiliation(s)
- James S Ngocho
- Kilimanjaro Christian Medical University College (KCMUCo), Box 2240, Moshi, Tanzania.
| | - Linda Minja
- Kilimanjaro Clinical Research Institute (KCRI), Box 2236, Moshi, Tanzania
| | - Christa E van der Gaast-de Jongh
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Janette C Rahamat-Langendoen
- Department of Medical Microbiology, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jeroen D Langereis
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College (KCMUCo), Box 2240, Moshi, Tanzania; Kilimanjaro Clinical Research Institute (KCRI), Box 2236, Moshi, Tanzania
| | - Marien I de Jonge
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
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12
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Jung J, Seo E, Yoo RN, Sung H, Lee J. Clinical significance of viral-bacterial codetection among young children with respiratory tract infections: Findings of RSV, influenza, adenoviral infections. Medicine (Baltimore) 2020; 99:e18504. [PMID: 31914021 PMCID: PMC6959858 DOI: 10.1097/md.0000000000018504] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We aimed to evaluate the clinical significance of bacterial coexistence and the coinfection dynamics between bacteria and respiratory viruses among young children. We retrospectively analyzed clinical data from children aged < 5 years hospitalized with a community-acquired single respiratory viral infection of influenza, adenovirus, or RSV during 2 recent consecutive influenza seasons. Remnant respiratory specimens were used for bacterial PCR targeting Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.A total of 102 children were included; median age was 0.8 years and 44.1% had underlying comorbidities. Overall, 6.8% (7/102) of cases were classified as severe diseases requiring intensive care unit admission and/or mechanical ventilation and ranged from 8.8% for a patient with RSV and 7.6% for those with adenovirus to 0% for those with influenza viruses. The overall viral-bacterial codetection rate was 59.8% (61/102); M catarrhalis was the most frequent (33.3%), followed by H influenzae (31.4%). Influenza cases showed higher bacterial codetection rates (80.0%; 8/10) compared with those with adenoviruses (69.2%; 9/13) and RSV (55.7%; 44/79). S pneumoniae and H influenzae codetections were associated with reduced severity (aOR, 0.24; 95% CI, 0.07-0.89), and reduced risk of wheezing (aOR, 0.36; 95% CI, 0.13-0.98), respectively.We observed the interactions between respiratory viruses and bacteria and the clinical significance of viral-bacterial coexistence in upper airway on disease severity. Future study will be necessary to elucidate the active interactions between different viruses and bacteria and give clues to risk stratified strategy in the management of respiratory infections among young children.
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Affiliation(s)
- Jiwon Jung
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Euri Seo
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul
- Department of Pediatrics, Dongkuk University Ilsan Hospital, Ilsan
| | - Ree Nar Yoo
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Hungseop Sung
- Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jina Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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13
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Effectiveness of the ten-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) against all respiratory tract infections in children under two years of age. Vaccine 2019; 37:2935-2941. [DOI: 10.1016/j.vaccine.2019.04.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/03/2019] [Accepted: 04/12/2019] [Indexed: 01/17/2023]
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14
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Preoperative Illnesses in Children Do Not Increase the Risk of Complications After Hypospadias Repair. Pediatr Infect Dis J 2019; 38:104-109. [PMID: 29620719 DOI: 10.1097/inf.0000000000002064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preoperative illnesses might induce immunosuppression and subsequently increase morbidity after surgery. Several studies have tried to identify risk factors for complications after hypospadias correction, but effects of illnesses in the weeks just before surgery are unknown. We aimed to determine the associations between preoperative illnesses not severe enough to postpone surgery and short-term complications after hypospadias repair in children. METHODS In this retrospective cohort study, data were collected from 681 children with anterior or middle type hypospadias that had initial 1-stage repair in the period 1983-2012 in the Radboudumc, The Netherlands. The associations between common illnesses, such as common cold, fever and ear infection, within 2 weeks before repair, and postoperative complications, such as urethrocutaneous fistula, wound dehiscence and stenosis, within 2 months and 1 year after surgery, were analyzed using multivariable logistic regression analyses. RESULTS Of the 681 boys, 22% had preoperative illnesses, most often common cold, and 14% had postoperative complications. Children with preoperative illnesses had fewer postoperative complications within 2 months (n = 13, 9%) than children without preoperative illnesses (n = 79, 16%), resulting in a 50% risk reduction (odds ratio: 0.49; 95% confidence interval: 0.26-0.93). Preoperative infections (common cold, fever and ear infection), in particular, reduced the risk of postoperative infections (wound and urinary tract infections; odds ratio: 0.37; 95% confidence interval: 0.14-0.98). Results were similar for complications within 1 year. CONCLUSIONS Common preoperative illnesses not severe enough to postpone surgery did not increase the postoperative complication risk and even seemed to have a protective effect, especially for postoperative infections. Consequently, there is no reason to alter preoperative screening.
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15
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Fukutani KF, Nascimento-Carvalho CM, Bouzas ML, Oliveira JR, Barral A, Dierckx T, Khouri R, Nakaya HI, Andrade BB, Van Weyenbergh J, de Oliveira CI. In situ Immune Signatures and Microbial Load at the Nasopharyngeal Interface in Children With Acute Respiratory Infection. Front Microbiol 2018; 9:2475. [PMID: 30473680 PMCID: PMC6238668 DOI: 10.3389/fmicb.2018.02475] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/27/2018] [Indexed: 12/13/2022] Open
Abstract
Acute respiratory infection (ARI) is the most frequent cause for hospitalization in infants and young children. Using multiplexed nCounter technology to digitally quantify 600 human mRNAs in parallel with 14 virus- and 5 bacterium-specific RNAs, we characterized viral and bacterial presence in nasopharyngeal aspirates (NPA) of 58 children with ARI and determined the corresponding in situ immune profiles. NPA contained different groups of organisms and these were classified into bacterial (n = 27), viral (n = 5), codetection [containing both viral and bacterial transcripts (n = 21), or indeterminate intermediate where microbial load is below threshold (n = 5)]. We then identified differentially expressed immune transcripts (DEITs) comparing NPAs from symptomatic children vs. healthy controls, and comparing children presenting NPAs with detectable microbial load vs. indeterminate. We observed a strong innate immune response in NPAs, due to the presence of evolutionarily conserved type I Interferon (IFN)-stimulated genes (ISG), which was correlated with total bacterial and/or viral load. In comparison with indeterminate NPAs, adaptive immunity transcripts discriminated among viral, bacterial, and codetected microbial profiles. In viral NPAs, B cell transcripts were significantly enriched among DEITs, while only type III IFN was correlated with viral load. In bacterial NPAs, myeloid cells and coinhibitory transcripts were enriched and significantly correlated with bacterial load. In conclusion, digital nCounter transcriptomics provide a microbial and immunological in situ “snapshot” of the nasopharyngeal interface in children with ARI. This enabled discrimination among viral, bacterial, codetection, and indeterminate transcripts in the samples using non-invasive sampling.
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Affiliation(s)
| | - Cristiana M Nascimento-Carvalho
- School of Medicine, Federal University of Bahia, Salvador, Brazil.,Department of Pediatrics, School of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Maiara L Bouzas
- School of Medicine, Federal University of Bahia, Salvador, Brazil
| | | | - Aldina Barral
- Instituto Gonçalo Moniz-FIOCRUZ, Salvador, Brazil.,School of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Tim Dierckx
- Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Ricardo Khouri
- Instituto Gonçalo Moniz-FIOCRUZ, Salvador, Brazil.,School of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Helder I Nakaya
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Bruno B Andrade
- Instituto Gonçalo Moniz-FIOCRUZ, Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Fundação José Silveira, Salvador, Brazil
| | - Johan Van Weyenbergh
- Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Camila I de Oliveira
- Instituto Gonçalo Moniz-FIOCRUZ, Salvador, Brazil.,School of Medicine, Federal University of Bahia, Salvador, Brazil
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16
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Bassene H, Niang EHA, Fenollar F, Dipankar B, Doucouré S, Ali E, Michelle C, Raoult D, Sokhna C, Mediannikov O. 16S Metagenomic Comparison of Plasmodium falciparum-Infected and Noninfected Anopheles gambiae and Anopheles funestus Microbiota from Senegal. Am J Trop Med Hyg 2018; 99:1489-1498. [PMID: 30350766 DOI: 10.4269/ajtmh.18-0263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
In the context of the pre-elimination of malaria, biological control may provide an alternative or additional tool to current malaria control strategies. During their various stages of development, mosquitoes undergo subsequent changes in their associated microbiota, depending on their environment and nutritional status. Although Anopheles gambiae s.l. and Anopheles funestus are the two major malaria vectors in Senegal, the composition of their microbiota is not yet well known. In this study, we explored the microbiota of mosquitoes naturally infected or not by Plasmodium falciparum (Pf) using the 16S ribosomal RNA gene-based bacterial metagenomic approach. In both vector species, the microbiota was more diverse in Pf-infected samples than in the noninfected ones, although the total number of reads appeared to be higher in noninfected mosquitoes. Overall, the microbiota was different between the two vector species. Noteworthy, the bacterial microbiota was significantly different between Pf-positive and Pf-negative groups whatever the species, but was similar between individuals of the same infection status within a species. Overall, the phylum of Proteobacteria was the most predominant in both species, with bacteria of the genus Burkholderia outweighing the others in noninfected vectors. The presence of some specific bacterial species such as Asaia bogorensis, Enterobacter cloacae, Burkholderia fungorum, and Burkholderia cepacia was also observed in Pf-free samples only. These preliminary observations pave the way for further characterization of the mosquito microbiota to select promising bacterial candidates for potential use in an innovative approach to controlling malaria and overcoming the challenges to achieving a malaria-free world.
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Affiliation(s)
- Hubert Bassene
- Aix Marseille Université, IRD, Assistance Publique-Hopitaux Marseille, Service de Santé des Armées, Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), Marseille, France.,Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), Campus International Université Cheikh Anta Diop-Institut de Recherche pour le Développement, Dakar, Sénégal
| | - El Hadji Amadou Niang
- Aix Marseille Université, IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France.,Laboratoire d'Ecologie Vectorielle et Parasitaire (LEVP), Faculté des Sciences et Techniques, Université Cheikh Anta Diop (UCAD) de Dakar, Dakar, Sénégal.,Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), Campus International Université Cheikh Anta Diop-Institut de Recherche pour le Développement, Dakar, Sénégal
| | - Florence Fenollar
- Aix Marseille Université, IRD, Assistance Publique-Hopitaux Marseille, Service de Santé des Armées, Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), Marseille, France
| | - Bachar Dipankar
- Aix Marseille Université, IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
| | - Souleymane Doucouré
- Aix Marseille Université, IRD, Assistance Publique-Hopitaux Marseille, Service de Santé des Armées, Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), Marseille, France.,Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), Campus International Université Cheikh Anta Diop-Institut de Recherche pour le Développement, Dakar, Sénégal
| | - Essoham Ali
- Laboratoire d'Études et de Recherche en Statistique et Développement (LERSTAD), Université Gaston Berger de Saint Louis, St. Louis, Sénégal
| | - Caroline Michelle
- Aix Marseille Université, IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
| | - Didier Raoult
- Aix Marseille Université, IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
| | - Cheikh Sokhna
- Aix Marseille Université, IRD, Assistance Publique-Hopitaux Marseille, Service de Santé des Armées, Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), Marseille, France.,Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), Campus International Université Cheikh Anta Diop-Institut de Recherche pour le Développement, Dakar, Sénégal
| | - Oleg Mediannikov
- Aix Marseille Université, IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
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17
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The nasopharyngeal microbiota in patients with viral respiratory tract infections is enriched in bacterial pathogens. Eur J Clin Microbiol Infect Dis 2018; 37:1725-1733. [DOI: 10.1007/s10096-018-3305-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/15/2018] [Indexed: 01/05/2023]
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18
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Guibas GV, Tsolia M, Christodoulou I, Stripeli F, Sakkou Z, Papadopoulos NG. Distinction between rhinovirus-induced acute asthma and asthma-augmented influenza infection. Clin Exp Allergy 2018; 48:536-543. [PMID: 29473978 DOI: 10.1111/cea.13124] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/24/2018] [Accepted: 01/27/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rhinovirus (RV) is an established trigger of asthma attacks, whereas such a link is less consistent for influenza virus (IFV). OBJECTIVE In the context of precision medicine, we hypothesized that IFV infection may cause a condition essentially different from RV, and we investigated this by evaluating clinical characteristics of RV/IFV-positive and -negative children with respiratory symptoms and/or fever. METHODS One thousand two hundred and seven children, 6 months to 13 years old, hospitalized for flu-like illness were recruited in this cross-sectional study. Collected information included demographics, medical history, symptoms/physical findings/diagnosis at presentation and treatment. Nasal secretions were PCR-tested for IFV/RV. Associations were evaluated with adjusted logistic regression models. RESULTS Rhinovirus positivity was associated with an asthma-like presentation, including increased wheeze/effort of breathing/diagnosis of acute asthma, and decreased fever/vomiting. Conversely, IFV+ children presented with less wheeze/effort of breathing/diagnosis of acute asthma, while they were more frequently febrile. In those with previous asthma history, both viruses induced wheeze; however, IFV was uniquely associated with a more generalised and severe presentation including fever, rales, intercostal muscle retractions and lymphadenopathy. These symptoms were not seen in RV+ asthmatics, who had fewer systemic signs and more cough. CONCLUSIONS AND CLINICAL RELEVANCE In children with respiratory symptoms and/or fever, RV but not IFV is associated with wheeze and an asthma-like presentation. In those with an asthma history, IFV causes more generalised and severe disease that may be better described as "asthma-augmented influenza" rather than an "asthma attack." Differences in the acute conditions caused by these viruses should be considered in the design of epidemiological studies.
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Affiliation(s)
- G V Guibas
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Department, Manchester University NHS Foundation Trust, Manchester, UK.,Paediatric Allergy Department, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Tsolia
- 2nd Paediatric Clinic, University of Athens, Athens, Greece
| | | | - F Stripeli
- 2nd Paediatric Clinic, University of Athens, Athens, Greece
| | - Z Sakkou
- 2nd Paediatric Clinic, University of Athens, Athens, Greece
| | - N G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Department, Manchester University NHS Foundation Trust, Manchester, UK.,Paediatric Allergy Department, Manchester University NHS Foundation Trust, Manchester, UK.,2nd Paediatric Clinic, University of Athens, Athens, Greece
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19
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Wagner K, Springer B, Imkamp F, Opota O, Greub G, Keller PM. Detection of respiratory bacterial pathogens causing atypical pneumonia by multiplex Lightmix ® RT-PCR. Int J Med Microbiol 2018; 308:317-323. [PMID: 29397298 DOI: 10.1016/j.ijmm.2018.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/15/2018] [Accepted: 01/27/2018] [Indexed: 10/18/2022] Open
Abstract
Pneumonia is a severe infectious disease. In addition to common viruses and bacterial pathogens (e.g. Streptococcus pneumoniae), fastidious respiratory pathogens like Chlamydia pneumoniae, Mycoplasma pneumoniae and Legionella spp. can cause severe atypical pneumonia. They do not respond to penicillin derivatives, which may cause failure of antibiotic empirical therapy. The same applies for infections with B. pertussis and B. parapertussis, the cause of pertussis disease, that may present atypically and need to be treated with macrolides. Moreover, these fastidious bacteria are difficult to identify by culture or serology, and therefore often remain undetected. Thus, rapid and accurate identification of bacterial pathogens causing atypical pneumonia is crucial. We performed a retrospective method evaluation study to evaluate the diagnostic performance of the new, commercially available Lightmix® multiplex RT-PCR assay that detects these fastidious bacterial pathogens causing atypical pneumonia. In this retrospective study, 368 clinical respiratory specimens, obtained from patients suffering from atypical pneumonia that have been tested negative for the presence of common agents of pneumonia by culture and viral PCR, were investigated. These clinical specimens have been previously characterized by singleplex RT-PCR assays in our diagnostic laboratory and were used to evaluate the diagnostic performance of the respiratory multiplex Lightmix® RT-PCR. The multiplex RT-PCR displayed a limit of detection between 5 and 10 DNA copies for different in-panel organisms and showed identical performance characteristics with respect to specificity and sensitivity as in-house singleplex RT-PCRs for pathogen detection. The Lightmix® multiplex RT-PCR assay represents a low-cost, time-saving and accurate diagnostic tool with high throughput potential. The time-to-result using an automated DNA extraction device for respiratory specimens followed by multiplex RT-PCR detection was below 4 h, which is expected to significantly improve diagnostics for atypical pneumonia-associated bacterial pathogens.
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Affiliation(s)
- Karoline Wagner
- Institute of Medical Microbiology, University of Zurich, Switzerland
| | - Burkard Springer
- Institute of Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety, Graz, Austria
| | - Frank Imkamp
- Institute of Medical Microbiology, University of Zurich, Switzerland
| | - Onya Opota
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland
| | - Gilbert Greub
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland; Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland
| | - Peter M Keller
- Institute of Medical Microbiology, University of Zurich, Switzerland.
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20
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Bacterial and viral pathogen spectra of acute respiratory infections in under-5 children in hospital settings in Dhaka city. PLoS One 2017; 12:e0174488. [PMID: 28346512 PMCID: PMC5367831 DOI: 10.1371/journal.pone.0174488] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/09/2017] [Indexed: 02/01/2023] Open
Abstract
The study aimed to examine for the first time the spectra of viral and bacterial pathogens along with the antibiotic susceptibility of the isolated bacteria in under-5 children with acute respiratory infections (ARIs) in hospital settings of Dhaka, Bangladesh. Nasal swabs were collected from 200 under-five children hospitalized with clinical signs of ARIs. Nasal swabs from 30 asymptomatic children were also collected. Screening of viral pathogens targeted ten respiratory viruses using RT-qPCR. Bacterial pathogens were identified by bacteriological culture methods and antimicrobial susceptibility of the isolates was determined following CLSI guidelines. About 82.5% (n = 165) of specimens were positive for pathogens. Of 165 infected cases, 3% (n = 6) had only single bacterial pathogens, whereas 43.5% (n = 87) cases had only single viral pathogens. The remaining 36% (n = 72) cases had coinfections. In symptomatic cases, human rhinovirus was detected as the predominant virus (31.5%), followed by RSV (31%), HMPV (13%), HBoV (11%), HPIV-3 (10.5%), and adenovirus (7%). Streptococcus pneumoniae was the most frequently isolated bacterial pathogen (9%), whereas Klebsiella pneumaniae, Streptococcus spp., Enterobacter agglomerans, and Haemophilus influenzae were 5.5%, 5%, 2%, and 1.5%, respectively. Of 15 multidrug-resistant bacteria, a Klebsiella pneumoniae isolate and an Enterobacter agglomerans isolate exhibited resistance against more than 10 different antibiotics. Both ARI incidence and predominant pathogen detection rates were higher during post-monsoon and winter, peaking in September. Pathogen detection rates and coinfection incidence in less than 1-year group were significantly higher (P = 0.0034 and 0.049, respectively) than in 1–5 years age group. Pathogen detection rate (43%) in asymptomatic cases was significantly lower compared to symptomatic group (P<0.0001). Human rhinovirus, HPIV-3, adenovirus, Streptococcus pneumonia, and Klebsiella pneumaniae had significant involvement in coinfections with P values of 0.0001, 0.009 and 0.0001, 0.0001 and 0.001 respectively. Further investigations are required to better understand the clinical roles of the isolated pathogens and their seasonality.
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21
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Cilveti R, Olmo M, Pérez-Jove J, Picazo JJ, Arimany JL, Mora E, Pérez-Porcuna TM, Aguilar I, Alonso A, Molina F, del Amo M, Mendez C. Epidemiology of Otitis Media with Spontaneous Perforation of the Tympanic Membrane in Young Children and Association with Bacterial Nasopharyngeal Carriage, Recurrences and Pneumococcal Vaccination in Catalonia, Spain - The Prospective HERMES Study. PLoS One 2017; 12:e0170316. [PMID: 28146590 PMCID: PMC5287464 DOI: 10.1371/journal.pone.0170316] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/03/2017] [Indexed: 01/26/2023] Open
Abstract
The Epidemiology of otitis media with spontaneous perforation of the tympanic membrane and associated nasopharyngeal carriage of bacterial otopathogens was analysed in a county in Catalonia (Spain) with pneumococcal conjugate vaccines (PCVs) not included in the immunization programme at study time. A prospective, multicentre study was performed in 10 primary care centres and 2 hospitals (June 2011-June 2014), including all otherwise healthy children ≥2 months ≤8 years with otitis media presenting spontaneous tympanic perforation within 48h. Up to 521 otitis episodes in 487 children were included, showing by culture/PCR in middle ear fluid (MEF): Haemophilus influenzae [24.2%], both Streptococcus pneumoniae and H. influenzae [24.0%], S. pneumoniae [15.9%], Streptococcus pyogenes [13.6%], and Staphylococcus aureus [6.7%]. Culture-negative/PCR-positive otitis accounted for 31.3% (S. pneumoniae), 30.2% (H. influenzae) and 89.6% (mixed S. pneumoniae/H. influenzae infections). Overall, incidence decreased over the 3-year study period, with significant decreases in otitis by S. pneumoniae and by H. influenzae, but no decreases for mixed S. pneumoniae/H. influenzae infections. Concordance between species in nasopharynx and MEF was found in 58.3% of cases, with maximal rates for S. pyogenes (71.8%), and with identical pneumococcal serotype in 40.5% of cases. Most patients (66.6%) had past episodes. PCV13 serotypes were significantly more frequent in first episodes, in otitis by S. pneumoniae as single agent, and among MEF than nasopharyngeal isolates. All non-PCV13 serotypes separately accounted for <5% in MEF. Up to 73.9% children had received ≥1 dose of PCV, with lower carriage of PCV13 serotypes than among non-vaccinated children. Pooling pneumococcal isolates from MEF and nasopharynx, 30% were multidrug resistant, primarily belonging to serotypes 19A [29.8%], 24A [14.3%], 19F [8.3%] and 15A [6.0%]. Our results suggest that increasing PCV13 vaccination would further reduce transmission of PCV13 serotypes with special benefits for youngest children (with none or uncompleted vaccine schedules), preventing first otitis episodes and subsequent recurrences.
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Affiliation(s)
- Robert Cilveti
- Department of Paediatrics, H. Universitari Mútua Terrassa, Barcelona, Spain
- * E-mail:
| | - Montserrat Olmo
- Department of Paediatrics, H. Universitari Mútua Terrassa, Barcelona, Spain
| | | | | | | | - Emiliano Mora
- Department of Paediatrics, H. Universitari Mútua Terrassa, Barcelona, Spain
| | | | - Ignacio Aguilar
- CAP Turó de Can Mates, San Cugat del Vallés, Barcelona, Spain
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22
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Smits HH, Hiemstra PS, Prazeres da Costa C, Ege M, Edwards M, Garn H, Howarth PH, Jartti T, de Jong EC, Maizels RM, Marsland BJ, McSorley HJ, Müller A, Pfefferle PI, Savelkoul H, Schwarze J, Unger WWJ, von Mutius E, Yazdanbakhsh M, Taube C. Microbes and asthma: Opportunities for intervention. J Allergy Clin Immunol 2016; 137:690-7. [PMID: 26947981 DOI: 10.1016/j.jaci.2016.01.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 01/06/2016] [Accepted: 01/19/2016] [Indexed: 02/08/2023]
Abstract
The worldwide incidence and prevalence of asthma continues to increase. Asthma is now understood as an umbrella term for different phenotypes or endotypes, which arise through different pathophysiologic pathways. Understanding the many factors contributing to development of the disease is important for the identification of novel therapeutic targets for the treatment of certain asthma phenotypes. The hygiene hypothesis has been formulated to explain the increasing prevalence of allergic disease, including asthma. This hypothesis postulates that decreased exposure at a young age to certain infectious agents as a result of improved hygiene, increased antibiotic use and vaccination, and changes in lifestyle and dietary habits is associated with changes in the immune system, which predispose subjects to allergy. Many microbes, during their coevolution with human subjects, developed mechanisms to manipulate the human immune system and to increase their chances of survival. Improving models of asthma, as well as choosing adequate end points in clinical trials, will lead to a more complete understanding of the underlying mechanisms, thus providing an opportunity to devise primary and secondary interventions at the same time as identifying new molecular targets for treatment. This article reports the discussion and conclusion of a workshop under the auspices of the Netherlands Lung Foundation to extend our understanding of how modulation of the immune system by bacterial, parasitic, and viral infections might affect the development of asthma and to map out future lines of investigation.
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Affiliation(s)
- Hermelijn H Smits
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Clarissa Prazeres da Costa
- Institute of Medical Microbiology, Immunology and Hygiene, Technische Universät München, Munich, Germany
| | - Markus Ege
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität of Munich, Munich, Germany
| | - Michael Edwards
- Department of Respiratory Medicine & Wright-Fleming Institute of Infection and Immunity, Imperial College London, London, United Kingdom
| | - Holger Garn
- Institute for Laboratory Medicine and Pathobiochemistry, Philipps University of Marburg, Marburg, Germany
| | - Peter H Howarth
- Academic Unit of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, University Hospital Southampton, Southampton, United Kingdom
| | - Tuomas Jartti
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Esther C de Jong
- Department of Cell Biology and Histology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Rick M Maizels
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Ben J Marsland
- Faculty of Biology and Medicine, University of Lausanne, Service de Pneumologie, CHUV, Epalinges, Switzerland
| | - Henry J McSorley
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Anne Müller
- Institute of Molecular Cancer Research, University of Zurich, Zurich, Switzerland
| | - Petra I Pfefferle
- Comprehensive Biomaterial Bank Marburg (CBBMR), Philipps University Marburg, Marburg, Germany
| | - Huub Savelkoul
- Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands
| | - Jürgen Schwarze
- MRC-Centre for Inflammation Research, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Wendy W J Unger
- Department of Paediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Erika von Mutius
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität of Munich, Munich, Germany
| | - Maria Yazdanbakhsh
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Christian Taube
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
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23
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Diaz MH, Cross KE, Benitez AJ, Hicks LA, Kutty P, Bramley AM, Chappell JD, Hymas W, Patel A, Qi C, Williams DJ, Arnold SR, Ampofo K, Self WH, Grijalva CG, Anderson EJ, McCullers JA, Pavia AT, Wunderink RG, Edwards KM, Jain S, Winchell JM. Identification of Bacterial and Viral Codetections With Mycoplasma pneumoniae Using the TaqMan Array Card in Patients Hospitalized With Community-Acquired Pneumonia. Open Forum Infect Dis 2016; 3:ofw071. [PMID: 27191004 PMCID: PMC4867659 DOI: 10.1093/ofid/ofw071] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/28/2016] [Indexed: 12/13/2022] Open
Abstract
Mycoplasma pneumoniae was detected in a number of patients with community-acquired pneumonia in a recent prospective study. To assess whether other pathogens were also detected in these patients, TaqMan Array Cards were used to test 216 M pneumoniae-positive respiratory specimens for 25 additional viral and bacterial respiratory pathogens. It is interesting to note that 1 or more codetections, predominantly bacterial, were identified in approximately 60% of specimens, with codetections being more common in children.
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Affiliation(s)
| | | | | | | | | | - Anna M Bramley
- Influenza Division , Centers for Disease Control, and Prevention , Atlanta, Georgia
| | | | - Weston Hymas
- University of Utah Health Sciences Center , Salt Lake City
| | - Anami Patel
- Le Bonheur Children's Hospital, Memphis, Tennessee; University of Tennessee Health Science Center, Memphis
| | - Chao Qi
- Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Derek J Williams
- Vanderbilt University School of Medicine, Nashville, Tennessee; Vanderbilt Vaccine Research Program, Nashville, Tennessee
| | - Sandra R Arnold
- Le Bonheur Children's Hospital, Memphis, Tennessee; University of Tennessee Health Science Center, Memphis
| | - Krow Ampofo
- University of Utah Health Sciences Center , Salt Lake City
| | - Wesley H Self
- Vanderbilt University School of Medicine , Nashville, Tennessee
| | | | | | - Jonathan A McCullers
- Le Bonheur Children's Hospital, Memphis, Tennessee; University of Tennessee Health Science Center, Memphis; St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Andrew T Pavia
- University of Utah Health Sciences Center , Salt Lake City
| | | | - Kathryn M Edwards
- Vanderbilt University School of Medicine, Nashville, Tennessee; Vanderbilt Vaccine Research Program, Nashville, Tennessee
| | - Seema Jain
- Influenza Division , Centers for Disease Control, and Prevention , Atlanta, Georgia
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24
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Diaz MH, Winchell JM. The Evolution of Advanced Molecular Diagnostics for the Detection and Characterization of Mycoplasma pneumoniae. Front Microbiol 2016; 7:232. [PMID: 27014191 PMCID: PMC4781879 DOI: 10.3389/fmicb.2016.00232] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 02/15/2016] [Indexed: 12/12/2022] Open
Abstract
Over the past decade there have been significant advancements in the methods used for detecting and characterizing Mycoplasma pneumoniae, a common cause of respiratory illness and community-acquired pneumonia worldwide. The repertoire of available molecular diagnostics has greatly expanded from nucleic acid amplification techniques (NAATs) that encompass a variety of chemistries used for detection, to more sophisticated characterizing methods such as multi-locus variable-number tandem-repeat analysis (MLVA), Multi-locus sequence typing (MLST), matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS), single nucleotide polymorphism typing, and numerous macrolide susceptibility profiling methods, among others. These many molecular-based approaches have been developed and employed to continually increase the level of discrimination and characterization in order to better understand the epidemiology and biology of M. pneumoniae. This review will summarize recent molecular techniques and procedures and lend perspective to how each has enhanced the current understanding of this organism and will emphasize how Next Generation Sequencing may serve as a resource for researchers to gain a more comprehensive understanding of the genomic complexities of this insidious pathogen.
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Affiliation(s)
| | - Jonas M. Winchell
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, AtlantaGA, USA
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