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Post-Mortem Investigations for the Diagnosis of Sepsis: A Review of Literature. Diagnostics (Basel) 2020; 10:diagnostics10100849. [PMID: 33092081 PMCID: PMC7590167 DOI: 10.3390/diagnostics10100849] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022] Open
Abstract
To date, sepsis is still one of the most important causes of death due to the difficulties concerning the achievement of a correct diagnosis. As well as in a clinical context, also in a medico-legal setting the diagnosis of sepsis can reveal challenging due to the unspecificity of the signs detected during autopsies, especially when no ante-mortem clinical data, laboratory, and cultural results are available. Thus, a systematic review of literature was performed to provide an overview of the main available and updated forensic tools for the post-mortem diagnosis of sepsis. Moreover, the aim of this review was to evaluate whether a marker or a combination of markers exist, specific enough to allow a correct and definite post-mortem diagnosis. The review was conducted searching in PubMed and Scopus databases, and using variable combinations of the keywords "post mortem sepsis diagnosis", "macroscopic signs", "morphology", "histology", "immunohistochemical markers", "biochemical markers", and "forensic microbiology". The article selection was carried out following specific inclusion and exclusion criteria. A total of 44 works was identified, providing data on morphological aspects of the organs examined, histological findings, immunohistochemical and biochemical markers, and cultural assays. The review findings suggested that the post-mortem diagnosis of sepsis can be achieved by a combination of data obtained from macroscopic and microscopic analysis and microbial investigations, associated with the increased levels of at least two of three biochemical and/or immunohistochemical markers evaluated simultaneously on blood samples.
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Grette K, Cassity S, Holliday N, Rimawi BH. Acute pyelonephritis during pregnancy: a systematic review of the aetiology, timing, and reported adverse perinatal risks during pregnancy. J OBSTET GYNAECOL 2019; 40:739-748. [PMID: 32648533 DOI: 10.1080/01443615.2019.1647524] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We performed a comprehensive systematic review of acute pyelonephritis in pregnancy using PubMed, SCOPUS, ClinicalTrials.gov, and Ovid from inception to April 2018. About 7796 references were screened for inclusion, and 52 references from 1908 to 2017 were included. One hundred seven cases of acute pyelonephritis in pregnant women were reviewed. Gestational age at diagnosis was reported as 2 (2%), 43 (40%), and 51 (52%) during the first, second, and third trimesters, respectively. Maternal complications included sepsis (49%), acute respiratory distress syndrome (47%), anaemia (33%), acute kidney injury (10%), renal abscess (6%), and death (6%). 25 preterm deliveries (23%), 6 intrauterine foetal demises (6%), 4 spontaneous abortions (4%), and 8 neonatal intensive care unit admissions (7%) were reported. Microorganisms cultured included Escherichia coli (51%), Klebsiella (8%), Proteus (5%), Staphylococcus aureus (5%), Streptococcus (4%), and Enterococcus (3%). Early diagnosis and management led to fewer complications.Impact statementWhat is already known on this subject? Acute pyelonephritis during pregnancy can lead to adverse pregnancy outcomes and in this article, we highlight the most common outcomes previously reported. Previous studies have reported maternal adverse outcomes and only very few stressed on fetal/neonatal outcomes.What do the results of this study add? The results add that not only is maternal morbidity/mortality is increased, but also increases adverse outcomes for the fetus/neonate, such as preterm delivery and fetal/neonatal demise.What are the implications of these findings for clinical practice and/or further research? The implications from this article serve to increase a medical providers knowledge on how to appropriately counsel pregnant women with acute pyelonephritis. In addition, future research can aim to understand why pregnant women are more prone to morbidity and mortality compared to nonpregnant women.
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Affiliation(s)
- Katherine Grette
- Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Canada
| | - Sarah Cassity
- Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Canada
| | - Nicolette Holliday
- Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Canada
| | - Bassam H Rimawi
- Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Canada.,Division of Maternal Fetal Medicine and Reproductive Infectious Diseases, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama, USA
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Wang S, Yao J, Zhou B, Yang J, Chaudry MT, Wang M, Xiao F, Li Y, Yin W. Bacteriostatic Effect of Quercetin as an Antibiotic Alternative In Vivo and Its Antibacterial Mechanism In Vitro. J Food Prot 2018; 81:68-78. [PMID: 29271686 DOI: 10.4315/0362-028x.jfp-17-214] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Quercetin, a ubiquitous flavonoid, is known to have antibacterial effects. The purpose of this study was to investigate the effect of quercetin on cecal microbiota of Arbor Acre (AA) broiler chickens in vivo and the bacteriostatic effect and antibacterial mechanism of quercetin in vitro. In vivo, 480 AA broilers (1 day old) were randomly allotted to four treatments (negative control and 0.2, 0.4, or 0.6 g of quercetin per kg of diet) for 42 days. Cecal microbial population and distribution were measured at the end of the experiment. The cecal microflora in these broilers included Proteobacteria, Fimicutes, Bacteroidetes, and Deferribacteres. Compared with the negative control, quercetin significantly decreased the copies of Pseudomonas aeruginosa ( P < 0.05), Salmonella enterica serotype Typhimurium ( P < 0.01), Staphylococcus aureus ( P < 0.01), and Escherichia coli ( P < 0.01) but significantly increased the copies of Lactobacillus ( P < 0.01), Bifidobacterium ( P < 0.01), and total bacteria ( P < 0.01). In vitro, we investigated the bacteriostatic effect of quercetin on four kinds of bacteria ( E. coli, P. aeruginosa, S. enterica Typhimurium, and S. aureus) and the antibacterial mechanism of quercetin in E. coli and S. aureus. The bacteriostatic effect of quercetin was stronger on gram-positive bacteria than on gram-negative bacteria. Quercetin damaged the cell walls and membranes of E. coli (at 50 × MIC) and S. aureus (at 10 × MIC). Compared with the control, the activity of the extracellular alkaline phosphatase and β-galactosidase and concentrations of soluble protein in E. coli and S. aureus were significantly increased (all P < 0.01), and the activity of ATP in S. aureus was significantly increased ( P < 0.01); however, no significant change in ATP activity in E. coli was observed ( P > 0.05). These results suggest that quercetin has potential as an alternative antibiotic feed additive in animal production.
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Affiliation(s)
- Shengan Wang
- 1 Institute of Animal Nutrition, Northeast Agricultural University, Harbin, Heilongjiang Province 150030, People's Republic of China
| | - Jiaying Yao
- 1 Institute of Animal Nutrition, Northeast Agricultural University, Harbin, Heilongjiang Province 150030, People's Republic of China
| | - Bo Zhou
- 1 Institute of Animal Nutrition, Northeast Agricultural University, Harbin, Heilongjiang Province 150030, People's Republic of China
| | - Jiaxin Yang
- 1 Institute of Animal Nutrition, Northeast Agricultural University, Harbin, Heilongjiang Province 150030, People's Republic of China
| | - Maria T Chaudry
- 1 Institute of Animal Nutrition, Northeast Agricultural University, Harbin, Heilongjiang Province 150030, People's Republic of China
| | - Mi Wang
- 1 Institute of Animal Nutrition, Northeast Agricultural University, Harbin, Heilongjiang Province 150030, People's Republic of China
| | - Fenglin Xiao
- 1 Institute of Animal Nutrition, Northeast Agricultural University, Harbin, Heilongjiang Province 150030, People's Republic of China
| | - Yao Li
- 1 Institute of Animal Nutrition, Northeast Agricultural University, Harbin, Heilongjiang Province 150030, People's Republic of China
| | - Wenzhe Yin
- 2 Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang Province 150086, People's Republic of China
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Pathogenesis of human diffusely adhering Escherichia coli expressing Afa/Dr adhesins (Afa/Dr DAEC): current insights and future challenges. Clin Microbiol Rev 2015; 27:823-69. [PMID: 25278576 DOI: 10.1128/cmr.00036-14] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The pathogenicity and clinical pertinence of diffusely adhering Escherichia coli expressing the Afa/Dr adhesins (Afa/Dr DAEC) in urinary tract infections (UTIs) and pregnancy complications are well established. In contrast, the implication of intestinal Afa/Dr DAEC in diarrhea is still under debate. These strains are age dependently involved in diarrhea in children, are apparently not involved in diarrhea in adults, and can also be asymptomatic intestinal microbiota strains in children and adult. This comprehensive review analyzes the epidemiology and diagnosis and highlights recent progress which has improved the understanding of Afa/Dr DAEC pathogenesis. Here, I summarize the roles of Afa/Dr DAEC virulence factors, including Afa/Dr adhesins, flagella, Sat toxin, and pks island products, in the development of specific mechanisms of pathogenicity. In intestinal epithelial polarized cells, the Afa/Dr adhesins trigger cell membrane receptor clustering and activation of the linked cell signaling pathways, promote structural and functional cell lesions and injuries in intestinal barrier, induce proinflammatory responses, create angiogenesis, instigate epithelial-mesenchymal transition-like events, and lead to pks-dependent DNA damage. UTI-associated Afa/Dr DAEC strains, following adhesin-membrane receptor cell interactions and activation of associated lipid raft-dependent cell signaling pathways, internalize in a microtubule-dependent manner within urinary tract epithelial cells, develop a particular intracellular lifestyle, and trigger a toxin-dependent cell detachment. In response to Afa/Dr DAEC infection, the host epithelial cells generate antibacterial defense responses. Finally, I discuss a hypothetical role of intestinal Afa/Dr DAEC strains that can act as "silent pathogens" with the capacity to emerge as "pathobionts" for the development of inflammatory bowel disease and intestinal carcinogenesis.
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Starčič Erjavec M, Žgur-Bertok D. Virulence potential for extraintestinal infections among commensal Escherichia coli isolated from healthy humans--the Trojan horse within our gut. FEMS Microbiol Lett 2015; 362:fnu061. [PMID: 25657191 DOI: 10.1093/femsle/fnu061] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Previous investigations have indicated that the reservoir of extraintestinal pathogenic Escherichia coli (ExPEC) strains is the intestinal microbiota. Nevertheless, studies focused on the prevalence of potential ExPEC strains among the bowel microbiota in healthy human individuals practically do not exist and a strong bias towards pathogenic strains among the E. coli data set is obvious. To assess the prevalence of potential ExPEC strains among E. coli from the intestinal microbiota of healthy humans, we performed a search for data on the prevalence of virulence-associated genes and pathogenicity islands among fecal E. coli found in published studies, including studies comparing isolates from patients suffering from extraintestinal E. coli infections with E. coli from feces of healthy humans. An extensive literature search, including more than 500 published papers, revealed 24 papers with data on prevalences of ≥ 5 virulence-associated genes among 21 E. coli collections including ≥ 20 fecal/rectal strains obtained from healthy individuals and 4 papers with prevalences of pathogenicity islands among E. coli collections from healthy humans. The gathered data are presented in this minireview and clearly show that potential ExPEC strains are present among fecal isolates with a prevalence of around ≥ 10%.
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Affiliation(s)
| | - Darja Žgur-Bertok
- Department of Biology, Biotechnical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
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Szemiako K, Krawczyk B, Samet A, Śledzińska A, Nowicki B, Nowicki S, Kur J. A subset of two adherence systems, acute pro-inflammatory pap genes and invasion coding dra, fim, or sfa, increases the risk of Escherichia coli translocation to the bloodstream. Eur J Clin Microbiol Infect Dis 2013; 32:1579-82. [PMID: 23801304 PMCID: PMC3825633 DOI: 10.1007/s10096-013-1913-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/09/2013] [Indexed: 01/25/2023]
Abstract
An analysis of the phylogenetic distribution and virulence genes of Escherichia coli isolates which predispose this bacteria to translocate from the urinary tract to the bloodstream is presented. One-dimensional analysis indicated that the occurrence of P fimbriae and α-hemolysin coding genes is more frequent among the E. coli which cause bacteremia. However, a two-dimensional analysis revealed that a combination of genes coding two adherence factors, namely, P + Dr, P + S, S + Dr, S + fim, and hemolysin + one adherence factor, were associated with bacteremia and, therefore, with the risk of translocation to the vascular system. The frequent and previously unrecognized co-existence of pro-inflammatory P fimbriae with the invasion promoting Dr adhesin in the same E. coli isolate may represent high-risk and potentially lethal pathogens.
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Affiliation(s)
- K Szemiako
- Department of Microbiology, Chemical Faculty, Gdańsk University of Technology, Narutowicza 11/12, 80-233, Gdańsk, Poland
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Wroblewska-Seniuk K, Nowicki S, Lebouguénec C, Nowicki B, Yallampalli C. Maternal/fetal mortality and fetal growth restriction: role of nitric oxide and virulence factors in intrauterine infection in rats. Am J Obstet Gynecol 2011; 205:83.e1-7. [PMID: 21481839 PMCID: PMC3143246 DOI: 10.1016/j.ajog.2011.02.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 01/26/2011] [Accepted: 02/14/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The mechanism of infection-related deaths of pregnant rats and intrauterine growth restriction are not understood. We assessed whether nitric oxide (NO) has differential effects on infection with Escherichia coli Dr/Afa mutants that lack either AfaE or AfaD invasins. STUDY DESIGN Sprague-Dawley rats were infected intrauterinally with the clinical strain of E coli AfaE(+)D(+) or 1 of its isogenic mutants in the presence or absence of the NO synthesis inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME). Maternal/fetal mortality rates, fetoplacental weight, and infection rates were evaluated. RESULTS Maternal and/or fetal death was associated with the presence of at least 1 virulence factor (AfaE(+)D(+)>AfaE(+)D(-)>AfaE(-)D(+)) and was increased by L-NAME treatment. The fetal and placental weights were lower than controls and were further reduced by L-NAME treatment. CONCLUSION These results demonstrate that NO enhanced AfaE- and AfaD-mediated virulence and plays an important role in Dr/Afa(+)E coli gestational tropism.
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Affiliation(s)
- Katarzyna Wroblewska-Seniuk
- Department of neonatal Infectious Diseases, Chair of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Stella Nowicki
- Departments of Obstetrics & Gynecology and Microbiology & Immunology Meharry Medical College, Nashville, Tennessee, USA
| | - Chantal Lebouguénec
- Institut Pasteur, Unité Pathogénie Bactérienne des Muqueuses, Département de Microbiologie, F-75015 Paris, France
- Institut Pasteur, Unité Biologie des Bactéries Pathogènes à Gram Positif, Département de Microbiologie, F-75015 Paris, France
- CNRS, URA2172, F-75015 Paris, France
| | - Bogdan Nowicki
- Departments of Obstetrics & Gynecology and Microbiology & Immunology Meharry Medical College, Nashville, Tennessee, USA
| | - Chandra Yallampalli
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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