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Gisselsson-Solen M, Hermansson A. Trends in upper respiratory tract infections and antibiotic prescriptions during the COVID-19 pandemic - a national observational study. Acta Otolaryngol 2022; 142:549-552. [PMID: 35980331 DOI: 10.1080/00016489.2022.2109727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Marie Gisselsson-Solen
- Institution of Clinical Sciences, Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Ann Hermansson
- Institution of Clinical Sciences, Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
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2
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Viral and Bacterial Co-Infections in the Lungs: Dangerous Liaisons. Viruses 2021; 13:v13091725. [PMID: 34578306 PMCID: PMC8472850 DOI: 10.3390/v13091725] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/23/2022] Open
Abstract
Respiratory tract infections constitute a significant public health problem, with a therapeutic arsenal that remains relatively limited and that is threatened by the emergence of antiviral and/or antibiotic resistance. Viral–bacterial co-infections are very often associated with the severity of these respiratory infections and have been explored mainly in the context of bacterial superinfections following primary influenza infection. This review summarizes our current knowledge of the mechanisms underlying these co-infections between respiratory viruses (influenza viruses, RSV, and SARS-CoV-2) and bacteria, at both the physiological and immunological levels. This review also explores the importance of the microbiome and the pathological context in the evolution of these respiratory tract co-infections and presents the different in vitro and in vivo experimental models available. A better understanding of the complex functional interactions between viruses/bacteria and host cells will allow the development of new, specific, and more effective diagnostic and therapeutic approaches.
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de Gier C, Granland CM, Pickering JL, Walls T, Bhuiyan M, Mills N, Richmond PC, Best EJ, Thornton RB, Kirkham LAS. PCV7- and PCV10-Vaccinated Otitis-Prone Children in New Zealand Have Similar Pneumococcal and Haemophilus influenzae Densities in Their Nasopharynx and Middle Ear. Vaccines (Basel) 2019; 7:vaccines7010014. [PMID: 30708945 PMCID: PMC6466140 DOI: 10.3390/vaccines7010014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/17/2019] [Accepted: 01/29/2019] [Indexed: 12/30/2022] Open
Abstract
Otitis media (OM) is a major reason for antibiotic consumption and surgery in children. Nasopharyngeal carriage of otopathogens, Streptococcus pneumoniae and nontypeable Haemophilus influenzae (NTHi), is a prerequisite for development of OM, and increased nasopharyngeal otopathogen density correlates with disease onset. Vaccines can reduce or eliminate otopathogen carriage, as demonstrated for pneumococcal serotypes included in pneumococcal conjugate vaccines (PCV). The 10-valent PCV (PCV10) includes an NTHi carrier protein, and in 2011 superseded 7-valent PCV on the New Zealand Immunisation Program. Data are conflicting on whether PCV10 provides protection against NTHi carriage or disease. Assessing this in otitis-prone cohorts is important for OM prevention. We compared otopathogen density in the nasopharynx and middle ear of New Zealand PCV7-vaccinated and PCV10-vaccinated otitis-prone and non-otitis-prone children to determine PCV10 impact on NTHi and S. pneumoniae carriage. We applied qPCR to specimens collected from 217 PCV7-vaccinated children (147 otitis-prone and 70 non-otitis-prone) and 240 PCV10-vaccinated children (178 otitis-prone and 62 non-otitis-prone). After correcting for age and day-care attendance, no difference was observed between NTHi density in the nasopharynx of PCV7-vaccinated versus PCV10-vaccinated otitis-prone (p = 0.563) or non-otitis-prone (p = 0.513) children. In contrast, pneumococcal nasopharyngeal density was higher in PCV10-vaccinated otitis-prone children than PCV7-vaccinated otitis-prone children (p = 0.003). There was no difference in otopathogen density in middle ear effusion from PCV7-vaccinated versus PCV10-vaccinated otitis-prone children (NTHi p = 0.918; S. pneumoniae p = 0.415). When pneumococcal carriage was assessed by vaccine serotypes (VT) and non-vaccine serotypes (NVT), there was no difference in VT density (p = 0.546) or NVT density (p = 0.315) between all PCV7-vaccinated versus all PCV10-vaccinated children. In summary, PCV10 did not reduce NTHi density in the nasopharynx or middle ear, and was associated with increased pneumococcal nasopharyngeal density in otitis-prone children in New Zealand. Development of therapies that prevent or reduce otopathogen colonisation density in the nasopharynx are warranted to reduce the burden of OM.
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Affiliation(s)
- Camilla de Gier
- School of Medicine, University of Western Australia, Perth 6009, Australia.
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute, Perth 6009, Australia.
| | - Caitlyn M Granland
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute, Perth 6009, Australia.
| | - Janessa L Pickering
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute, Perth 6009, Australia.
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch 8011, New Zealand.
| | - Mejbah Bhuiyan
- School of Medicine, University of Western Australia, Perth 6009, Australia.
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute, Perth 6009, Australia.
| | - Nikki Mills
- Starship Hospital, Auckland 1023, New Zealand.
- School of Medicine, University of Auckland, Auckland 1023, New Zealand.
| | - Peter C Richmond
- School of Medicine, University of Western Australia, Perth 6009, Australia.
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute, Perth 6009, Australia.
- Department of General Paediatrics, Perth Children's Hospital, Perth 6009, Australia.
| | - Emma J Best
- Starship Hospital, Auckland 1023, New Zealand.
- School of Medicine, University of Auckland, Auckland 1023, New Zealand.
| | - Ruth B Thornton
- School of Medicine, University of Western Australia, Perth 6009, Australia.
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute, Perth 6009, Australia.
| | - Lea-Ann S Kirkham
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute, Perth 6009, Australia.
- Centre for Child Health Research, University of Western Australia, Perth 6009, Australia.
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Animal models of acute otitis media - A review with practical implications for laboratory research. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:183-190. [PMID: 29656888 DOI: 10.1016/j.anorl.2017.06.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 06/08/2017] [Accepted: 06/12/2017] [Indexed: 11/23/2022]
Abstract
Considerable animal research has focused on developing new strategies for the prevention and treatment of acute otitis media (AOM). Several experimental models of AOM have thus been developed. A PubMed search of the English literature was conducted from 1975 to July 2016 using the search terms "animal model" and "otitis media" from which 91 published studies were included for analysis, yielding 123 animal models. The rat, mouse and chinchilla are the preferred animals for experimental AOM models with their individual advantages and disadvantages. The most common pathogens used to create AOM are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Streptococcus pneumoniae (types 3, 23 and 6A) and non-typeable Haemophilus influenzae (NTHi) are best options for inoculation into rat and mouse models. Adding viral pathogens such as RSV and Influenza A virus, along with creating ET dysfunction, are useful adjuncts in animal models of AOM. Antibiotic prophylaxis may interfere with the inflammatory response without a significant reduction in animal mortality.
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Santa Maria PL, Kim S, Varsak YK, Yang YP. Heparin binding-epidermal growth factor-like growth factor for the regeneration of chronic tympanic membrane perforations in mice. Tissue Eng Part A 2015; 21:1483-94. [PMID: 25567607 DOI: 10.1089/ten.tea.2014.0474] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We aim to explore the role of epidermal growth factor (EGF) ligand shedding in tympanic membrane wound healing and to investigate the translation of its modulation in tissue engineering of chronic tympanic membrane perforations. Chronic suppurative otitis media (CSOM) is an infected chronic tympanic membrane perforation. Up to 200 million suffer from its associated hearing loss and it is the most common cause of pediatric hearing loss in developing countries. There is a need for nonsurgical treatment due to a worldwide lack of resources. In this study, we show that EGF ligand shedding is essential for tympanic membrane healing as it's inhibition, with KB-R7785, leads to chronic perforation in 87.9% (n=58) compared with 0% (n=20) of controls. We then show that heparin binding-EGF-like growth factor (5 μg/mL), which acts to shed EGF ligands, can regenerate chronic perforations in mouse models with 92% (22 of 24) compared with 38% (10 of 26), also with eustachian tube occlusion with 94% (18 of 19) compared with 9% (2 of 23) and with CSOM 100% (16 of 16) compared with 41% (7 of 17). We also show the nonototoxicity of this treatment and its hydrogel delivery vehicle. This provides preliminary data for a clinical trial where it could be delivered by nonspecialist trained healthcare workers and fulfill the clinical need for a nonsurgical treatment for chronic tympanic membrane perforation and CSOM.
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Affiliation(s)
- Peter Luke Santa Maria
- 1 Department of Otolaryngology, Head and Neck Surgery, Stanford University , Stanford, California
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Murrah KA, Turner RL, Pang B, Perez AC, Reimche JL, King LB, Wren J, Gandhi U, Swords WE, Ornelles DA. Replication of type 5 adenovirus promotes middle ear infection by Streptococcus pneumoniae in the chinchilla model of otitis media. Pathog Dis 2015; 73:1-8. [PMID: 25251686 DOI: 10.1111/2049-632x.12216] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Adenoviral infection is a major risk factor for otitis media. We hypothesized that adenovirus promotes bacterial ascension into the middle ear through the disruption of normal function in the Eustachian tubes due to inflammation-induced changes. An intranasal infection model of the chinchilla was used to test the ability of type 5 adenovirus to promote middle ear infection by Streptococcus pneumoniae. The hyperinflammatory adenovirus mutant dl327 and the nonreplicating adenovirus mutant H5wt300ΔpTP were used to test the role of inflammation and viral replication, respectively, in promotion of pneumococcal middle ear infection. Precedent infection with adenovirus resulted in a significantly greater incidence of middle ear disease by S. pneumoniae as compared to nonadenovirus infected animals. Infection with the adenovirus mutant dl327 induced a comparable degree of bacterial ascension into the middle ear as did infection with the wild-type virus. By contrast, infection with the nonreplicating adenovirus mutant H5wt300ΔpTP resulted in less extensive middle ear infection compared to the wild-type adenovirus. We conclude that viral replication is necessary for adenoviral-induced pneumococcal middle ear disease.
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Affiliation(s)
- Kyle A Murrah
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Roberta L Turner
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Bing Pang
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Antonia C Perez
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jennifer L Reimche
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lauren B King
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John Wren
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Uma Gandhi
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - W Edward Swords
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David A Ornelles
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Abstract
Mucosal immune responses within the middle ear and eustachian tube generally provide an effective and efficient response to the presence of microbial pathogens, with approximately 80% of clinically recognizable middle ear infections resolved within 7 days. Particularly for young children aged less than 3 years of age, the proximity and direct connection of the middle ear, via the eustachian tube, to the nasopharynx provide increased risk of commensal bacteria and upper respiratory tract viruses infecting the middle ear. Mucosal immunological defense in the middle ear and eustachian tube utilizes a number of mechanisms, including physicochemical barriers of mucus and the mucosal epithelial cells and innate immune responses such as inflammation, cellular infiltration, effusion, and antimicrobial protein secretions, in addition to adaptive host immune responses. Recent advances in otopathogen recognition via microbial pattern recognition receptors and elucidation of complex signaling cascades have improved understanding of the coordination and regulation of the middle ear mucosal response. These advances support vaccine development aiming to reduce the risk of otitis media in children.
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Tong HH, Lambert G, Li YX, Thurman JM, Stahl GL, Douthitt K, Clancy C, He Y, Bowman AS. Deletion of the complement C5a receptor alleviates the severity of acute pneumococcal otitis media following influenza A virus infection in mice. PLoS One 2014; 9:e95160. [PMID: 24740152 PMCID: PMC3989264 DOI: 10.1371/journal.pone.0095160] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 03/24/2014] [Indexed: 12/04/2022] Open
Abstract
There is considerable evidence that influenza A virus (IAV) promotes adherence, colonization, and superinfection by S. pneumoniae (Spn) and contributes to the pathogenesis of otitis media (OM). The complement system is a critical innate immune defense against both pathogens. To assess the role of the complement system in the host defense and the pathogenesis of acute pneumococcal OM following IAV infection, we employed a well-established transtympanically-induced mouse model of acute pneumococcal OM. We found that antecedent IAV infection enhanced the severity of acute pneumococcal OM. Mice deficient in complement C1qa (C1qa−/−) or factor B (Bf −/−) exhibited delayed viral and bacterial clearance from the middle ear and developed significant mucosal damage in the eustachian tube and middle ear. This indicates that both the classical and alternative complement pathways are critical for the oto-immune defense against acute pneumococcal OM following influenza infection. We also found that Spn increased complement activation following IAV infection. This was characterized by sustained increased levels of anaphylatoxins C3a and C5a in serum and middle ear lavage samples. In contrast, mice deficient in the complement C5a receptor (C5aR) demonstrated enhanced bacterial clearance and reduced severity of OM. Our data support the concept that C5a-C5aR interactions play a significant role in the pathogenesis of acute pneumococcal OM following IAV infection. It is possible that targeting the C5a-C5aR axis might prove useful in attenuating acute pneumococcal OM in patients with influenza infection.
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Affiliation(s)
- Hua Hua Tong
- Department of Otolaryngology, College of Medicine and Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Garrett Lambert
- Department of Otolaryngology, College of Medicine and Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Yong Xing Li
- Department of Otolaryngology, College of Medicine and Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Joshua M Thurman
- Department of Medicine, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Gregory L Stahl
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kelsey Douthitt
- Department of Otolaryngology, College of Medicine and Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Caitlin Clancy
- Department of Otolaryngology, College of Medicine and Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Yujuan He
- Department of Otolaryngology, College of Medicine and Public Health, The Ohio State University, Columbus, Ohio, United States of America; Department of Clinical Laboratory Medicine, Chongqing Medical University, Chongqing, Sichuan, P. R. China
| | - Andrew S Bowman
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
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Murray JL, Connell JL, Stacy A, Turner KH, Whiteley M. Mechanisms of synergy in polymicrobial infections. J Microbiol 2014; 52:188-99. [PMID: 24585050 PMCID: PMC7090983 DOI: 10.1007/s12275-014-4067-3] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/06/2014] [Indexed: 01/09/2023]
Abstract
Communities of microbes can live almost anywhere and contain many different species. Interactions between members of these communities often determine the state of the habitat in which they live. When these habitats include sites on the human body, these interactions can affect health and disease. Polymicrobial synergy can occur during infection, in which the combined effect of two or more microbes on disease is worse than seen with any of the individuals alone. Powerful genomic methods are increasingly used to study microbial communities, including metagenomics to reveal the members and genetic content of a community and metatranscriptomics to describe the activities of community members. Recent efforts focused toward a mechanistic understanding of these interactions have led to a better appreciation of the precise bases of polymicrobial synergy in communities containing bacteria, eukaryotic microbes, and/or viruses. These studies have benefited from advances in the development of in vivo models of polymicrobial infection and modern techniques to profile the spatial and chemical bases of intermicrobial communication. This review describes the breadth of mechanisms microbes use to interact in ways that impact pathogenesis and techniques to study polymicrobial communities.
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Affiliation(s)
- Justine L. Murray
- Department of Molecular Biosciences, Institute of Cell and Molecular Biology, Center for Infectious Disease, The University of Texas at Austin, Austin, TX 78712 USA
| | - Jodi L. Connell
- Department of Molecular Biosciences, Institute of Cell and Molecular Biology, Center for Infectious Disease, The University of Texas at Austin, Austin, TX 78712 USA
| | - Apollo Stacy
- Department of Molecular Biosciences, Institute of Cell and Molecular Biology, Center for Infectious Disease, The University of Texas at Austin, Austin, TX 78712 USA
| | - Keith H. Turner
- Department of Molecular Biosciences, Institute of Cell and Molecular Biology, Center for Infectious Disease, The University of Texas at Austin, Austin, TX 78712 USA
| | - Marvin Whiteley
- Department of Molecular Biosciences, Institute of Cell and Molecular Biology, Center for Infectious Disease, The University of Texas at Austin, Austin, TX 78712 USA
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van den Brand JMA, Haagmans BL, van Riel D, Osterhaus ADME, Kuiken T. The pathology and pathogenesis of experimental severe acute respiratory syndrome and influenza in animal models. J Comp Pathol 2014; 151:83-112. [PMID: 24581932 PMCID: PMC7094469 DOI: 10.1016/j.jcpa.2014.01.004] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/04/2013] [Accepted: 01/06/2014] [Indexed: 02/08/2023]
Abstract
Respiratory viruses that emerge in the human population may cause high morbidity and mortality, as well as concern about pandemic spread. Examples are severe acute respiratory syndrome coronavirus (SARS-CoV) and novel variants of influenza A virus, such as H5N1 and pandemic H1N1. Different animal models are used to develop therapeutic and preventive measures against such viruses, but it is not clear which are most suitable. Therefore, this review compares animal models of SARS and influenza, with an emphasis on non-human primates, ferrets and cats. Firstly, the pathology and pathogenesis of SARS and influenza are compared. Both diseases are similar in that they affect mainly the respiratory tract and cause inflammation and necrosis centred on the pulmonary alveoli and bronchioles. Important differences are the presence of multinucleated giant cells and intra-alveolar fibrosis in SARS and more fulminant necrotizing and haemorrhagic pneumonia in H5N1 influenza. Secondly, the pathology and pathogenesis of SARS and influenza in man and experimental animals are compared. Host species, host age, route of inoculation, location of sampling and timing of sampling are important to design an animal model that most closely mimics human disease. The design of appropriate animal models requires an accurate pathological description of human cases, as well as a good understanding of the effect of experimental variables on disease outcome.
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Affiliation(s)
- J M A van den Brand
- Department of Viroscience, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands
| | - B L Haagmans
- Department of Viroscience, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands
| | - D van Riel
- Department of Viroscience, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands
| | - A D M E Osterhaus
- Department of Viroscience, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands
| | - T Kuiken
- Department of Viroscience, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands.
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Short KR, von Köckritz-Blickwede M, Langereis JD, Chew KY, Job ER, Armitage CW, Hatcher B, Fujihashi K, Reading PC, Hermans PW, Wijburg OL, Diavatopoulos DA. Antibodies mediate formation of neutrophil extracellular traps in the middle ear and facilitate secondary pneumococcal otitis media. Infect Immun 2014; 82:364-70. [PMID: 24191297 PMCID: PMC3911859 DOI: 10.1128/iai.01104-13] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 10/14/2013] [Indexed: 12/16/2022] Open
Abstract
Otitis media (OM) (a middle ear infection) is a common childhood illness that can leave some children with permanent hearing loss. OM can arise following infection with a variety of different pathogens, including a coinfection with influenza A virus (IAV) and Streptococcus pneumoniae (the pneumococcus). We and others have demonstrated that coinfection with IAV facilitates the replication of pneumococci in the middle ear. Specifically, we used a mouse model of OM to show that IAV facilitates the outgrowth of S. pneumoniae in the middle ear by inducing middle ear inflammation. Here, we seek to understand how the host inflammatory response facilitates bacterial outgrowth in the middle ear. Using B cell-deficient infant mice, we show that antibodies play a crucial role in facilitating pneumococcal replication. We subsequently show that this is due to antibody-dependent neutrophil extracellular trap (NET) formation in the middle ear, which, instead of clearing the infection, allows the bacteria to replicate. We further demonstrate the importance of these NETs as a potential therapeutic target through the transtympanic administration of a DNase, which effectively reduces the bacterial load in the middle ear. Taken together, these data provide novel insight into how pneumococci are able to replicate in the middle ear cavity and induce disease.
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Affiliation(s)
- Kirsty R. Short
- Department of Microbiology and Immunology, The University of Melbourne, Melbourne, Australia
| | | | - Jeroen D. Langereis
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Keng Yih Chew
- Department of Zoology, The University of Melbourne, Melbourne, Australia
| | - Emma R. Job
- Department of Microbiology and Immunology, The University of Melbourne, Melbourne, Australia
| | - Charles W. Armitage
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Brandon Hatcher
- Department of Pediatric Dentistry and Microbiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kohtaro Fujihashi
- Department of Pediatric Dentistry and Microbiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Patrick C. Reading
- Department of Microbiology and Immunology, The University of Melbourne, Melbourne, Australia
- WHO Collaborating Centre for Reference and Research on Influenza, Parkville, Victoria, Australia
| | - Peter W. Hermans
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Odilia L. Wijburg
- Department of Microbiology and Immunology, The University of Melbourne, Melbourne, Australia
| | - Dimitri A. Diavatopoulos
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands
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He Y, Scholes MA, Wiet GJ, Li Q, Clancy C, Tong HH. Complement activation in pediatric patients with recurrent acute otitis media. Int J Pediatr Otorhinolaryngol 2013; 77:911-7. [PMID: 23537925 PMCID: PMC3660544 DOI: 10.1016/j.ijporl.2013.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 01/31/2013] [Accepted: 03/02/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Otitis media (OM) is one of the most common childhood diseases. The relative contribution of complement activation in protection and pathogenesis during OM remains largely unknown. The purpose of this study was to investigate the beneficial and pathogenic contributions of complement activation in the middle ear of pediatric patients with recurrent acute otitis media (rAOM), and therefore to provide a rational approach to prevent sequelae of OM such as hearing loss. METHODS Twenty children undergoing pressure equalization tube placement with or without adenoidectomy for rAOM were enrolled in the study. Bacterial cultures, enzyme-linked immunosorbent assay (ELISA) for complement components and cytokines and western blot for complement activation were performed on middle ear effusion (MEE) and serum samples. The levels of complement C3a, C5a and sC5-b9 in MEEs and serum samples were compared. The levels of these factors were also examined in regards to length of episode. Pearson's correlation coefficients were calculated on variables between C5a and IL-6 or IL-8. Complement gene expression in human middle ear epithelial (HMEE) cells induced by otopathogens was evaluated. Data were analyzed with Student's t test or the Mann-Whitney rank sum test. In all cases, a P value of <0.05 was set as the measure of significance. RESULTS Our data demonstrated that the complement classical/lectin, alternative and terminal pathways were activated in the middle ear of children with rAOM. Increased complement components of C3a, C5a and sC5-b9 in MEEs were detected in patients with the episode lasting more than six weeks. There was a strong correlation between C5a and IL-6 or IL-8 in the MEEs. Additionally, otopathogens induced enhanced gene expression of factor B and C3 in HMEE cells, which is beneficial for host defense against invading pathogens. CONCLUSION Our studies provided important new insights on how complement activation contributes to inflammatory process during rAOM. Knowledge of the activity of the complement pathway in patients with rAOM may stimulate the development of new strategies to prevent middle ear inflammatory tissue destruction by directing treatment to specific pathways within the complement cascade.
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Affiliation(s)
- Yujuan He
- Department of Otolaryngology, College of Medicine and Public Health, The Ohio State University, Columbus, OH 43210, USA
- Department of Clinical Laboratory Medicine, Chongqing Medical University, Chongqing, China
| | - Melissa A. Scholes
- Department of Otolaryngology, Nationwide Children’s Hospital, Columbus, OH
| | - Gregory J. Wiet
- Department of Otolaryngology, College of Medicine and Public Health, The Ohio State University, Columbus, OH 43210, USA
- Department of Otolaryngology, Nationwide Children’s Hospital, Columbus, OH
| | - Qian Li
- Department of Otolaryngology, College of Medicine and Public Health, The Ohio State University, Columbus, OH 43210, USA
- Department of Infectious Diseases, FuDan University affiliated Hua Shan Hospital, Shanghai, China
| | - Caitlin Clancy
- Department of Otolaryngology, College of Medicine and Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Hua Hua Tong
- Department of Otolaryngology, College of Medicine and Public Health, The Ohio State University, Columbus, OH 43210, USA
- Corresponding author Mailing address: The Ohio State University, Department of Otolaryngology-Head and Neck Surgery, 4024 Cramblett Hall, Columbus, OH 43210, Phone: 614-293-8103, Fax: 614-293-5506,
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Short KR, Habets MN, Payne J, Reading PC, Diavatopoulos DA, Wijburg OL. Influenza A virus induced bacterial otitis media is independent of virus tropism for α2,6-linked sialic acid. Virol J 2013; 10:128. [PMID: 23617940 PMCID: PMC3655017 DOI: 10.1186/1743-422x-10-128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 04/15/2013] [Indexed: 01/16/2023] Open
Abstract
Background Otitis media (OM) affects ≥80% of children before the age of three. OM can arise following co-infection with influenza A virus (IAV) and the bacterium Streptococcus pneumoniae. We have previously shown that H3 IAV strains (such as Udorn/72) induced a higher rate of bacterial OM than H1 strains (such as PR8/34). This was associated with more efficient replication of H3 strains in the middle ear. Findings Here, we assess if the increased replication of IAV strains such as Udorn/72 in the middle ear is dependent upon the binding of the viral HA to α2,6-linked sialic acid. Using murine and in vitro models, the present study shows that recognition of α2,6-linked sialic acid was not required to facilitate bacterial OM. Conclusions Taken together, these data suggest that other features of the HA mediate bacterial OM.
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Affiliation(s)
- Kirsty R Short
- Department of Microbiology and Immunology, The University of Melbourne, Melbourne, VIC, 3010, Australia.
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14
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Stockmann C, Ampofo K, Hersh AL, Carleton ST, Korgenski K, Sheng X, Pavia AT, Byington CL. Seasonality of acute otitis media and the role of respiratory viral activity in children. Pediatr Infect Dis J 2013; 32:314-9. [PMID: 23249910 PMCID: PMC3618601 DOI: 10.1097/inf.0b013e31827d104e] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute otitis media (AOM) occurs as a complication of viral upper respiratory tract infections in young children. AOM and respiratory viruses both display seasonal variation. Our objective was to examine the temporal association between circulating respiratory viruses and the occurrence of pediatric ambulatory care visits for AOM. METHODS This retrospective study included 9 seasons of respiratory viral activity (2002 to 2010) in Utah. We used Intermountain Healthcare electronic medical records to assess community respiratory viral activity via laboratory-based active surveillance and to identify children <18 years with outpatient visits and International Classification of Diseases, Ninth Revision codes for AOM. We assessed the strength of the association between AOM and individual respiratory viruses using interrupted time series analyses. RESULTS During the study period, 96,418 respiratory viral tests were performed; 46,460 (48%) were positive. The most commonly identified viruses were respiratory syncytial virus (22%), rhinovirus (8%), influenza (8%), parainfluenza (4%), human metapneumovirus (3%) and adenovirus (3%). AOM was diagnosed during 271,268 ambulatory visits. There were significant associations between peak activity of respiratory syncytial virus, human metapneumovirus, influenza A and office visits for AOM. Adenovirus, parainfluenza and rhinovirus were not associated with visits for AOM. CONCLUSIONS Seasonal respiratory syncytial virus, human metapneumovirus and influenza activity were temporally associated with increased diagnoses of AOM among children. These findings support the role of individual respiratory viruses in the development AOM. These data also underscore the potential for respiratory viral vaccines to reduce the burden of AOM.
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Affiliation(s)
- Chris Stockmann
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center
| | - Krow Ampofo
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center
| | - Adam L. Hersh
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center
| | - Scott T. Carleton
- Division of Hospitalist Medicine, Department of Pediatrics, University of Utah Health Sciences Center
| | - Kent Korgenski
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center
- Primary Children's Medical Center, Intermountain Healthcare, Salt Lake City, UT
| | - Xiaoming Sheng
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center
| | - Andrew T. Pavia
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center
| | - Carrie L. Byington
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center
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15
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Abstract
Acute otitis media (AOM) is a polymicrobial disease, which usually occurs as a complication of viral upper respiratory tract infection (URI). While respiratory viruses alone may cause viral AOM, they increase the risk of bacterial middle ear infection and worsen clinical outcomes of bacterial AOM. URI viruses alter Eustachian tube (ET) function via decreased mucociliary action, altered mucus secretion and increased expression of inflammatory mediators among other mechanisms. Transient reduction in protective functions of the ET allows colonizing bacteria of the nasopharynx to ascend into the middle ear and cause AOM. Advances in research help us to better understand the host responses to viral URI, the mechanisms of viral-bacterial interactions in the nasopharynx and the development of AOM. In this review, we present current knowledge regarding viral-bacterial interactions in the pathogenesis and clinical course of AOM. We focus on the common respiratory viruses and their established role in AOM.
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Affiliation(s)
- Tal Marom
- Division of Infectious Diseases, Department of Pediatrics, University of Texas Medical Branch, Galveston, TX 77555-0371, USA
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16
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Novotny LA, Clements JD, Bakaletz LO. Kinetic analysis and evaluation of the mechanisms involved in the resolution of experimental nontypeable Haemophilus influenzae-induced otitis media after transcutaneous immunization. Vaccine 2012; 31:3417-26. [PMID: 23092856 DOI: 10.1016/j.vaccine.2012.10.033] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 08/31/2012] [Accepted: 10/09/2012] [Indexed: 01/09/2023]
Abstract
Transcutaneous immunization (TCI) is a simple and needle-free method with which to induce protective immune responses. Using a chinchilla model of nontypeable Haemophilus influenzae (NTHI)-induced otitis media (OM), we examined the efficacy afforded by TCI with a novel chimeric immunogen called 'chimV4' which targets two critical adhesins expressed by NTHI, outer membrane protein P5 and the majority subunit of NTHI Type IV pilus, PilA. Experimental OM was first established in cohorts of animals, and then TCI performed via a therapeutic immunization regime by rubbing vaccine formulations on hydrated pinnae. The kinetics of resolution of established experimental disease was evaluated by clinically-relevant assessments of OM, bacterial culture of planktonic and adherent NTHI within the middle ear and gross examination of the relative amount of NTHI mucosal biofilms within the middle ear space. Within seven days after primary TCI, a significant reduction in the signs of OM, significantly fewer NTHI adherent to the middle ear mucosa and significant resolution of mucosal biofilms was detected in animals that received chimV4+ the adjuvant LT(R192G-L211A), compared to animals administered LT(R192G-L211A) alone or saline by TCI (p<0.05) with eradication of NTHI within an additional seven days. The mechanism for rapid disease resolution involved efflux of activated dermal dendritic cells from the pinnae after TCI, secretion of factors chemotactic for CD4(+) T-cells, induction of polyfunctional IFNγ- and IL-17-producing CD4(+) T-cells and secretion of host defense peptide within the middle ear. These data support TCI as a therapeutic intervention against experimental NTHI-induced OM and begin to elucidate the host response to immunization by this noninvasive regimen.
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Affiliation(s)
- Laura A Novotny
- The Research Institute at Nationwide Children's Hospital, Center for Microbial Pathogenesis and The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, United States
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17
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Brockson ME, Novotny LA, Jurcisek JA, McGillivary G, Bowers MR, Bakaletz LO. Respiratory syncytial virus promotes Moraxella catarrhalis-induced ascending experimental otitis media. PLoS One 2012; 7:e40088. [PMID: 22768228 PMCID: PMC3387005 DOI: 10.1371/journal.pone.0040088] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 05/31/2012] [Indexed: 01/29/2023] Open
Abstract
Otitis media (OM) is a polymicrobial disease wherein prior or concurrent infection with an upper respiratory tract virus plays an essential role, predisposing the middle ear to bacterial invasion. In episodes of acute bacterial OM, respiratory syncytial virus (RSV) is the most commonly isolated virus and thus serves as an important co-pathogen. Of the predominant bacterial agents of OM, the pathogenesis of disease due to Moraxella catarrhalis is the least well understood. Rigorous study of M.catarrhalis in the context of OM has been significantly hindered by lack of an animal model. To bridge this gap, we assessed whether co-infection of chinchillas with M. catarrhalis and RSV would facilitate ascension of M. catarrhalis from the nasopharynx into the middle ear. Chinchillas were challenged intranasally with M. catarrhalis followed 48 hours later by intranasal challenge with RSV. Within 7 days, 100% of nasopharynges were colonized with M. catarrhalis and homogenates of middle ear mucosa were also culture-positive. Moreover, within the middle ear space, the mucosa exhibited hemorrhagic foci, and a small volume of serosanguinous effusion was present in one of six ears. To improve upon this model, and based on epidemiologic data, nontypeable Haemophilus influenzae (NTHI) was included as an additional bacterial co-pathogen via intranasal administration four days before M. catarrhalis challenge. With this latter protocol, M. catarrhalis was cultured from the nasopharynx and middle ear homogenates of a maximum of 88% and 79% animals, respectively, for up to 17 days after intranasal challenge with M. catarrhalis. Additionally, hemorrhagic foci were observed in 79% of middle ears upon sacrifice. Thus, these data demonstrated that co-infection with RSV and NTHI predisposed to M. catarrhalis-induced ascending experimental OM. This model can be used both in studies of pathogenesis as well as to investigate strategies to prevent or treat OM due to M. catarrhalis.
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Affiliation(s)
- M. Elizabeth Brockson
- The Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis and The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Laura A. Novotny
- The Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis and The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Joseph A. Jurcisek
- The Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis and The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Glen McGillivary
- The Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis and The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Martha R. Bowers
- The Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis and The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Lauren O. Bakaletz
- The Research Institute at Nationwide Children’s Hospital, Center for Microbial Pathogenesis and The Ohio State University College of Medicine, Columbus, Ohio, United States of America
- * E-mail:
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18
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Abstract
Viruses play an important role in acute otitis media (AOM) pathogenesis, and live viruses may cause AOM in the absence of pathogenic bacteria. Detection of AOM pathogens generally relies on bacterial culture of middle ear fluid. When viral culture is used and live viruses are detected in the middle ear fluid of children with AOM, the viruses are generally accepted as AOM pathogens. Because viral culture is not sensitive and does not detect the comprehensive spectrum of respiratory viruses, polymerase chain reaction assays are commonly used to detect viral nucleic acids in the middle ear fluid. Although polymerase chain reaction assays have greatly increased the viral detection rate, new questions arise on the significance of viral nucleic acids detected in the middle ear because nucleic acids of multiple viruses are detected simultaneously, and nucleic acids of specific viruses are detected repeatedly and in a high proportion of asymptomatic children. This article first reviews the role of live viruses in AOM and presents the point-counterpoint arguments on whether viral nucleic acids in the middle ear represent an AOM pathogen or a bystander status. Although there is evidence to support both directions, helpful information for interpretation of the data and future research direction is outlined.
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19
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Short KR, Diavatopoulos DA, Thornton R, Pedersen J, Strugnell RA, Wise AK, Reading PC, Wijburg OL. Influenza virus induces bacterial and nonbacterial otitis media. J Infect Dis 2011; 204:1857-65. [PMID: 21930608 PMCID: PMC3209809 DOI: 10.1093/infdis/jir618] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 05/12/2011] [Indexed: 01/22/2023] Open
Abstract
Otitis media (OM) is one of the most common childhood diseases. OM can arise when a viral infection enables bacteria to disseminate from the nasopharynx to the middle ear. Here, we provide the first infant murine model for disease. Mice coinfected with Streptococcus pneumoniae and influenza virus had high bacterial load in the middle ear, middle ear inflammation, and hearing loss. In contrast, mice colonized with S. pneumoniae alone had significantly less bacteria in the ear, minimal hearing loss, and no inflammation. Of interest, infection with influenza virus alone also caused some middle ear inflammation and hearing loss. Overall, this study provides a clinically relevant and easily accessible animal model to study the pathogenesis and prevention of OM. Moreover, we provide, to our knowledge, the first evidence that influenza virus alone causes middle ear inflammation in infant mice. This inflammation may then play an important role in the development of bacterial OM.
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Affiliation(s)
- Kirsty R Short
- Department of Microbiology and Immunology, The University of Melbourne, Melbourne, Victoria, Australia.
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20
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Granath A, Uddman R, Cardell LO. Increased TLR7 expression in the adenoids among children with otitis media with effusion. Acta Otolaryngol 2010; 130:57-61. [PMID: 19452306 DOI: 10.3109/00016480902963061] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Toll-like receptor 7 (TLR7) is present in the adenoids in young children and might play a role in the immunological response behind the development of otitis media with effusion (OME). OBJECTIVES To investigate the expression of the TLRs TLR4 and TLR7 in adenoids from children with OME and to compare the results with data obtained from healthy controls. SUBJECTS AND METHODS This was a controlled, prospective study. Eleven young children with long-standing OME and 10 controls with healthy middle ears were recruited consecutively when scheduled for adenoidectomy. mRNA was quantified using real-time polymerase chain reaction (PCR) and the localization of the corresponding proteins was assessed by immunohistochemistry. RESULTS mRNA for TLR4 and TLR7 could be obtained from all samples tested along with their corresponding proteins. The mRNA levels for TLR7 were increased among the children with a history of OME. No such increase was found for TLR4.
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Affiliation(s)
- Anna Granath
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
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21
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Kuiken T, van den Brand J, van Riel D, Pantin-Jackwood M, Swayne DE. Comparative pathology of select agent influenza a virus infections. Vet Pathol 2010; 47:893-914. [PMID: 20682805 DOI: 10.1177/0300985810378651] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Influenza A virus infections may spread rapidly in human populations and cause variable mortality. Two of these influenza viruses have been designated as select agents: 1918 H1N1 virus and highly pathogenic avian influenza (HPAI) virus. Knowledge of the pathology of these virus infections in humans, other naturally infected species, and experimental animals is important to understand the pathogenesis of influenza, to design appropriate models for evaluation of medical countermeasures, and to make correct diagnoses. The most important complication of influenza in humans is viral pneumonia, which often occurs with or is followed by bacterial pneumonia. Viremia and extrarespiratory disease are uncommon. HPAI viruses, including HPAI H5N1 virus, cause severe systemic disease in galliform species as well as in anseriform species and bird species of other orders. HPAI H5N1 virus infection also causes severe disease in humans and several species of carnivores. Experimental animals are used to model different aspects of influenza in humans, including uncomplicated influenza, pneumonia, and virus transmission. The most commonly used experimental animal species are laboratory mouse, domestic ferret, and cynomolgus macaque. Experimental influenza virus infections are performed in various other species, including domestic pig, guinea pig, and domestic cat. Each of these species has advantages and disadvantages that need to be assessed before choosing the most appropriate model to reach a particular goal. Such animal models may be applied for the development of more effective antiviral drugs and vaccines to protect humans from the threat of these virus infections.
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Affiliation(s)
- T Kuiken
- Erasmus MC, Department of Virology, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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22
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Grieves JL, Jurcisek JA, Quist B, Durbin RK, Peeples ME, Durbin JE, Bakaletz LO. Mapping the anatomy of respiratory syncytial virus infection of the upper airways in chinchillas (Chinchilla lanigera). Comp Med 2010; 60:225-232. [PMID: 20579438 PMCID: PMC2890398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 09/05/2009] [Accepted: 01/23/2010] [Indexed: 05/29/2023]
Abstract
Although most viral infections of the upper respiratory tract can predispose to bacterial otitis media, human respiratory syncytial virus (HRSV) is the predominant viral copathogen of this highly prevalent pediatric polymicrobial disease. Rigorous study of the specific mechanisms by which HRSV predisposes to otitis media has been hindered by lack of a relevant animal model. We recently reported that the chinchilla, the preferred rodent host for studying otitis media, is semipermissive for upper-airway HRSV infection. In the current study, we defined the anatomy and kinetics of HRSV infection and spread in the upper airway of chinchilla hosts. Chinchillas were challenged intranasally with a fluorescent-protein-expressing HRSV. Upper-airway tissues were recovered at multiple time points after viral challenge and examined by confocal microscopy and immunohistochemistry. HRSV replication was observed from the rostral- to caudalmost regions of the nasal cavity as well as throughout the Eustachian tube in a time-dependent manner. Although fluorescence was not observed and virus was not detected in nasopharyngeal lavage fluids 14 d after infection, the latest time point examined in this study, occasional clusters of immunopositive cells were present, suggesting that the nasal cavity may serve as a reservoir for HRSV. These data provide important new information concerning the time course of HRSV infection of the uppermost airway and suggest that chinchillas may be useful for modeling the HRSV-induced changes that predispose to secondary bacterial infection.
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Affiliation(s)
- Jessica L Grieves
- Centers for Microbial Pathogenesis, Department of Pediatrics, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Vaccines and Immunity, Department of Pediatrics, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Veterinary Biosciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio
| | - Joseph A Jurcisek
- Centers for Microbial Pathogenesis, Department of Pediatrics, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Brian Quist
- Centers for Microbial Pathogenesis, Department of Pediatrics, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Russell K Durbin
- Vaccines and Immunity, Department of Pediatrics, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Mark E Peeples
- Vaccines and Immunity, Department of Pediatrics, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Joan E Durbin
- Vaccines and Immunity, Department of Pediatrics, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Lauren O Bakaletz
- Centers for Microbial Pathogenesis, Department of Pediatrics, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
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23
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Bakaletz LO. Immunopathogenesis of polymicrobial otitis media. J Leukoc Biol 2010; 87:213-22. [PMID: 19843575 PMCID: PMC2812561 DOI: 10.1189/jlb.0709518] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 09/25/2009] [Accepted: 09/27/2009] [Indexed: 12/25/2022] Open
Abstract
OM, or inflammation of the middle ear, is a highly prevalent infection in children worldwide. OM is a multifactorial disease with multiple risk factors, including preceding or concurrent viral URT infection. Hence, OM is also a polymicrobial disease. The mechanisms by which viruses predispose to bacterial OM are replete; however, all are predicated on the general principle of compromise of primary host airway defenses. Thus, despite an as-yet incomplete understanding of the molecular mechanisms involved in bacterial superinfection of a virus-compromised respiratory tract, the URT viruses are known to induce histopathology of airway mucosal epithelium, up-regulate expression of eukaryotic receptors used for bacterial adherence, alter the biochemical and rheological properties of airway mucus, and affect innate and acquired host immune functions, among others. Although discussed here in the context of OM, during preceding or concurrent viral infection of the human respiratory tract, viral impairment of airway defenses and the resulting predisposition to subsequent bacterial coinfection are also known to be operational in the mid and lower airway as well.
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Affiliation(s)
- Lauren O Bakaletz
- The Research Institute at Nationwide Children's Hospital, Center for Microbial Pathogenesis, The Ohio State University College of Medicine, Columbus, OH 43205-2696, USA.
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24
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Laufer AS, Thomas JC, Figueira M, Gent JF, Pelton SI, Pettigrew MM. Capacity of serotype 19A and 15B/C Streptococcus pneumoniae isolates for experimental otitis media: Implications for the conjugate vaccine. Vaccine 2010; 28:2450-7. [PMID: 20067753 PMCID: PMC2851619 DOI: 10.1016/j.vaccine.2009.12.078] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 12/22/2009] [Accepted: 12/25/2009] [Indexed: 11/28/2022]
Abstract
Non-vaccine Streptococcus pneumoniae serotypes are increasingly associated with disease. We evaluated isolates of the same sequence type (ST199) but different serotypes (15B/C, 19A) for growth in vitro, and pathogenic potential in a chinchilla otitis media model. We also developed a quantitative PCR (qPCR) assay to quantitatively assess each isolate, circumventing the need for selectable markers. In vitro studies showed faster growth of serotype 19A over 15B/C. Both were equally capable of colonization and middle ear infection in this model. Serotype 19A is included in new conjugate vaccine formulations while serotype 15B/C is not. Non-capsular vaccine targets will be important in disease prevention efforts.
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Affiliation(s)
- Alison S Laufer
- Division of Epidemiology of Microbial Diseases, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520, United States
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25
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Stol K, van Selm S, van den Berg S, Bootsma HJ, Blokx WAM, Graamans K, Tonnaer ELGM, Hermans PWM. Development of a non-invasive murine infection model for acute otitis media. MICROBIOLOGY-SGM 2009; 155:4135-4144. [PMID: 19762437 DOI: 10.1099/mic.0.033175-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Otitis media (OM) is one of the most frequent diseases in childhood, and Streptococcus pneumoniae is among the main causative bacterial agents. Since current experimental models used to study the bacterial pathogenesis of OM have several limitations, such as the invasiveness of the experimental procedures, we developed a non-invasive murine OM model. In our model, adapted from a previously developed rat OM model, a pressure cabin is used in which a 40 kPa pressure increase is applied to translocate pneumococci from the nasopharyngeal cavity into both mouse middle ears. Wild-type pneumococci were found to persist in the middle ear cavity for 144 h after infection, with a maximum bacterial load at 96 h. Inflammation was confirmed at 96 and 144 h post-infection by IL-1beta and TNF-alpha cytokine analysis and histopathology. Subsequently, we investigated the contribution of two surface-associated pneumococcal proteins, the streptococcal lipoprotein rotamase A (SlrA) and the putative proteinase maturation protein A (PpmA), to experimental OM in our model. Pneumococci lacking the slrA gene, but not those lacking the ppmA gene, were significantly reduced in virulence in the OM model. Importantly, pneumococci lacking both genes were significantly more attenuated than the DeltaslrA single mutant. This additive effect suggests that SlrA and PpmA exert complementary functions during experimental OM. In conclusion, we have developed a highly reproducible and non-invasive murine infection model for pneumococcal OM using a pressure cabin, which is very suitable to study pneumococcal pathogenesis and virulence in vivo.
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Affiliation(s)
- K Stol
- Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - S van Selm
- Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - S van den Berg
- Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - H J Bootsma
- Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - W A M Blokx
- Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - K Graamans
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - E L G M Tonnaer
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - P W M Hermans
- Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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26
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Bakaletz LO. Chinchilla as a robust, reproducible and polymicrobial model of otitis media and its prevention. Expert Rev Vaccines 2009; 8:1063-82. [PMID: 19627188 DOI: 10.1586/erv.09.63] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is compelling evidence that many infectious diseases of humans are caused by more than one microorganism. Multiple diverse in vitro systems have been used to study these complex diseases, and although the data generated have contributed greatly to our understanding of diseases of mixed microbial etiology, having rigorous, reproducible and relevant animal models of human diseases are essential for the development of novel methods to treat or prevent them. All animal models have inherent limitations; however, they also have important advantages over in vitro methods, including the presence of organized organ systems and an intact immune system, which promote our ability to characterize the pathogenesis of, and the immune response to, sequential or coinfecting microorganisms. For the highly prevalent pediatric disease otitis media, or middle-ear infection, the chinchilla (Chinchilla lanigera) has served as a gold-standard rodent host system in which to study this multifactorial and polymicrobial disease.
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Affiliation(s)
- Lauren O Bakaletz
- The Research Institute at Nationwide Children's Hospital, Center for Microbial Pathogenesis, and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43205, USA.
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27
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Heltzer ML, Coffin SE, Maurer K, Bagashev A, Zhang Z, Orange JS, Sullivan KE. Immune dysregulation in severe influenza. J Leukoc Biol 2009; 85:1036-43. [PMID: 19276177 DOI: 10.1189/jlb.1108710] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Among previously healthy children with severe influenza, the mechanisms leading to increased pathology are not understood. We hypothesized that children with severe influenza would have high levels of circulating cytokines. To examine this, we recruited patients with severe influenza and examined plasma cytokine levels as well as the ability of peripheral blood cells to respond to stimuli. Ten patients with severe influenza were enrolled during the 2005-2007 influenza seasons. We evaluated plasma cytokine levels, circulating NK cells, and responses to TLR ligands during the illness. We compared these patients with five patients with moderate influenza, six patients with respiratory syncytial virus (RSV), and 24 noninfected controls. Patients with influenza showed depressed responses to TLR ligands when compared with RSV patients and healthy controls (P<0.05). These normalized when retested during a convalescent phase. Plasma levels of IL-6, IL-12, and IFN- were elevated in influenza patients compared with controls (P<0.05). A compromised ability to produce TNF- was reproduced by in vitro infection, and the magnitude of the effect correlated with the multiplicity of infection and induction of IFN regulatory factor 4 expression. Aberrant, systemic, innate responses to TLR ligands during influenza infection may be a consequence of specific viral attributes such as a high inoculum or rapid replication and may underlie the known susceptibility of influenza-infected patients to secondary bacterial infections.
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Affiliation(s)
- Meredith L Heltzer
- Divisions of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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McGillivary G, Mason KM, Jurcisek JA, Peeples ME, Bakaletz LO. Respiratory syncytial virus-induced dysregulation of expression of a mucosal beta-defensin augments colonization of the upper airway by non-typeable Haemophilus influenzae. Cell Microbiol 2009; 11:1399-408. [PMID: 19500108 DOI: 10.1111/j.1462-5822.2009.01339.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Otitis media (OM) is a polymicrobial disease wherein upper respiratory tract viruses compromise host airway defences, which allows bacterial flora of the nasopharynx (NP) access to the middle ear. We have shown, in vitro, that respiratory syncytial virus (RSV), a viral co-pathogen of OM, reduces transcript abundance of the antimicrobial peptide (AP), chinchilla beta-defensin-1 (cBD-1). Here, we demonstrated that chinchillas inoculated with RSV expressed approximately 40% less cBD-1 mRNA and protein than did mock-challenged animals. Further, concurrent RSV infection resulted in a 10-100-fold greater recovery of non-typeable Haemophilus influenzae (NTHI) from nasopharyngeal lavage fluids, compared with chinchillas challenged with NTHI in the absence of viral co-infection. Additionally, when either: anti-cBD-1 antibody (to bind secreted AP) or recombinant cBD-1 (to increase AP concentration at the mucosal surface) were delivered to chinchillas, we demonstrated that disruption of the availability of a single AP influenced the relative load of NTHI in the upper respiratory tract. Collectively, our data suggested that effectors of innate immunity regulate normal bacterial colonization of the NP and, further, virus-induced altered expression of APs can result in an increased load of NTHI within the NP, which likely promotes development of OM.
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Affiliation(s)
- Glen McGillivary
- The Research Institute at Nationwide Children's Hospital, Center for Microbial Pathogenesis, The Ohio State University College of Medicine, Columbus, Ohio 43205, USA
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Hoa M, Syamal M, Sachdeva L, Berk R, Coticchia J. Demonstration of Nasopharyngeal and Middle Ear Mucosal Biofilms in an Animal Model of Acute Otitis Media. Ann Otol Rhinol Laryngol 2009; 118:292-8. [DOI: 10.1177/000348940911800410] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: We performed this study to determine the role of nasopharyngeal and middle ear (ME) biofilms in acute otitis media (AOM). Methods: Sixty female 6-month-old chinchillas, free of ME disease, were utilized. Experimental animals were inoculated with influenza A followed by Streptococcus pneumonia 7 days later. Control animals were inoculated with Sorensen's phosphate buffer. Daily otoscopy and tympanometry was performed, and the animals were painlessly sacrificed on days 1, 2, 5, 8, and 14. All mucosae were harvested and prepared for scanning electron microscopy. Results: The ME inflammation, initially detected on day 2 after bacterial inoculation, peaked on day 8. Eight percent of the dually inoculated chinchillas displayed type B tympanograms, and 40% displayed type C. Otoscopic evaluation of tympanic membrane inflammation was rated from 0 to 4 (0 = normal and 4 = severe drainage and/or inflammation) according to an otoscopic grading system. Ten percent of the experimental chinchillas had a grade 2 score, 20% had grade 3, and 6.7% had grade 4. The controls demonstrated no abnormal tympanometric or otoscopic findings. Scanning electron microscopic imaging showed dense biofilms on 83% of the nasopharynges and 67% of the MEs on day 8 in the experimental animals. All animals with ME biofilms had biofilms in the nasopharynx. The controls did not demonstrate biofilm formation. Conclusions: The study parallels the natural pathogenesis of AOM in humans. The demonstration of mucosal biofilms in both the nasopharynx (58%) and the ME (47%) of animals with ME inflammation and/or infection lends further support to the importance of mucosal biofilms in the pathogenesis of AOM.
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Abstract
SUMMARY Streptococcus pneumoniae is a colonizer of human nasopharynx, but it is also an important pathogen responsible for high morbidity, high mortality, numerous disabilities, and high health costs throughout the world. Major diseases caused by S. pneumoniae are otitis media, pneumonia, sepsis, and meningitis. Despite the availability of antibiotics and vaccines, pneumococcal infections still have high mortality rates, especially in risk groups. For this reason, there is an exceptionally extensive research effort worldwide to better understand the diseases caused by the pneumococcus, with the aim of developing improved therapeutics and vaccines. Animal experimentation is an essential tool to study the pathogenesis of infectious diseases and test novel drugs and vaccines. This article reviews both historical and innovative laboratory pneumococcal animal models that have vastly added to knowledge of (i) mechanisms of infection, pathogenesis, and immunity; (ii) efficacies of antimicrobials; and (iii) screening of vaccine candidates. A comprehensive description of the techniques applied to induce disease is provided, the advantages and limitations of mouse, rat, and rabbit models used to mimic pneumonia, sepsis, and meningitis are discussed, and a section on otitis media models is also included. The choice of appropriate animal models for in vivo studies is a key element for improved understanding of pneumococcal disease.
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Greenberg D, Hoffman S, Leibovitz E, Dagan R. Acute otitis media in children: association with day care centers--antibacterial resistance, treatment, and prevention. Paediatr Drugs 2008; 10:75-83. [PMID: 18345717 DOI: 10.2165/00148581-200810020-00002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Children attending day care centers (DCCs) frequently carry antibacterial-resistant organisms in their nasopharynx, leading to acute otitis media (AOM) that may be refractory to antibacterial treatment. The development and spread of resistant organisms are facilitated in DCCs as a result of the following: (i) large numbers of children; (ii) frequent close person-to-person contact; and (iii) a wide use of antimicrobial medications. Intensive antimicrobial usage provides the selection pressure that favors the emergence of resistant organisms, while DCCs provide an ideal environment for transmission of these organisms. The American Academy of Pediatrics and American Academy of Family Physicians' guidelines recommend high-dose amoxicillin/clavulanic acid (rather than amoxicillin alone) as the first therapeutic choice in the treatment of AOM in children attending DCCs. The introduction of the 7-valent pneumococcal conjugated vaccine (PCV7) had a major role in decreasing the number of episodes of Streptococccus pneumoniae AOM secondary to the serotypes included in the vaccine. It also had a major role in reducing the nasopharyngeal carriage of vaccine-type S. pneumoniae (and in particular of antibacterial-resistant organisms), preventing, in this way, its spread to contacts in the community. However, the recent observation of increased rates of antibacterial-resistant non-vaccine serotype S. pneumoniae may erode the success of PCV7.
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Affiliation(s)
- David Greenberg
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Zhang H. Concerns of using sialidase fusion protein as an experimental drug to combat seasonal and pandemic influenza. J Antimicrob Chemother 2008; 62:219-23. [DOI: 10.1093/jac/dkn026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McGillivary G, Ray WC, Bevins CL, Munson RS, Bakaletz LO. A member of the cathelicidin family of antimicrobial peptides is produced in the upper airway of the chinchilla and its mRNA expression is altered by common viral and bacterial co-pathogens of otitis media. Mol Immunol 2006; 44:2446-58. [PMID: 17113647 PMCID: PMC1817667 DOI: 10.1016/j.molimm.2006.10.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Revised: 10/11/2006] [Accepted: 10/13/2006] [Indexed: 10/23/2022]
Abstract
Cationic antimicrobial peptides (AMPs), a component of the innate immune system, play a major role in defense of mucosal surfaces against a wide spectrum of microorganisms such as viral and bacterial co-pathogens of the polymicrobial disease otitis media (OM). To further understand the role of AMPs in OM, we cloned a cDNA encoding a cathelicidin homolog (cCRAMP) from upper respiratory tract (URT) mucosae of the chinchilla, the predominant host used to model experimental OM. Recombinant cCRAMP exhibited alpha-helical secondary structure and killed the three main bacterial pathogens of OM. In situ hybridization showed cCRAMP mRNA production in epithelium of the chinchilla Eustachian tube and RT-PCR was used to amplify cCRAMP mRNA from several other tissues of the chinchilla URT. Quantitative RT-PCR analysis of chinchilla middle ear epithelial cells (CMEEs) incubated with either viral (influenza A virus, adenovirus, or RSV) or bacterial (nontypeable H. influenzae, M. catarrhalis, or S. pneumoniae) pathogens associated with OM demonstrated distinct microbe-specific patterns of altered expression. Collectively, these data showed that viruses and bacteria modulate AMP messages in the URT, which likely contributes to the disease course of OM.
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Affiliation(s)
- Glen McGillivary
- Columbus Children’s Research Institute, Center for Microbial Pathogenesis and The Ohio State University College of Medicine & Public Health, 700 Children’s Drive, W591, Columbus, OH 43205, USA
| | - William C. Ray
- Columbus Children’s Research Institute, Center for Microbial Pathogenesis and The Ohio State University College of Medicine & Public Health, 700 Children’s Drive, W591, Columbus, OH 43205, USA
| | - Charles L. Bevins
- Department of Medical Microbiology and Immunology, University of California Davis School of Medicine, Tupper Hall Room 3146, Davis, CA 95616, USA
| | - Robert S. Munson
- Columbus Children’s Research Institute, Center for Microbial Pathogenesis and The Ohio State University College of Medicine & Public Health, 700 Children’s Drive, W591, Columbus, OH 43205, USA
| | - Lauren O. Bakaletz
- Columbus Children’s Research Institute, Center for Microbial Pathogenesis and The Ohio State University College of Medicine & Public Health, 700 Children’s Drive, W591, Columbus, OH 43205, USA
- *Corresponding author: Lauren O. Bakaletz, Ph.D., Center for Microbial Pathogenesis, The Ohio State University, College of Medicine & Public Health, Columbus Children’s Research Institute, Rm. W591, 700 Children’s Drive, Columbus, OH 43205-2696, Phone: (614) 722-2915, Fax: (614) 722-2818, E-mail:
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Chonmaitree T. Acute otitis media is not a pure bacterial disease. Clin Infect Dis 2006; 43:1423-5. [PMID: 17083015 PMCID: PMC7107863 DOI: 10.1086/509329] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 08/29/2006] [Indexed: 11/18/2022] Open
Affiliation(s)
- Tasnee Chonmaitree
- Department of Pediatrics, Division of Infectious Diseases, University of Texas Medical Branch, Galveston
- Reprints or correspondence: Dr. Tasnee Chonmaitree, Dept. of Pediatrics, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0371 ()
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Mühlemann K, Uehlinger DE, Büchi W, Gorgievski M, Aebi C. The prevalence of penicillin-non-susceptible Streptococcus pneumoniae among children aged < 5 years correlates with the biannual epidemic activity of respiratory syncytial virus. Clin Microbiol Infect 2006; 12:873-9. [PMID: 16882292 DOI: 10.1111/j.1469-0691.2006.1472_1.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study investigated whether the epidemiology of penicillin-non-susceptible pneumococci (PNSP) colonising small children correlated with the biannual epidemic activity of respiratory syncytial virus (RSV). Colonisation rates and the prevalence of PNSP among paediatric outpatients aged < 5 years was analysed between January 1998 and September 2003 using an established national surveillance network. Resistance trends were investigated using time-series analysis to assess the correlation with the biannual pattern of RSV infections and national sales of oral paediatric formulations of antibiotics and antibiotic prescriptions to children aged < 5 years for acute respiratory tract infections. PNSP rates exhibited a biannual cycle in phase with the biannual seasonal RSV epidemics (p < 0.05). Resistance rates were higher during the winter seasons of 1998-1999 (20.1%), 2000-2001 (16.0%) and 2002-2003 (19.1%), compared with the winter seasons of 1997-1998 (8.2%), 1999-2000 (11.6%) and 2001-2002 (9.5%). Antibiotic sales and prescriptions showed regular peaks during each winter, with no significant correlation with the biannual pattern of RSV activity and seasonal trends of PNSP. RSV is an important determinant of the spread of PNSP and must be considered in strategies aimed at antimicrobial resistance control.
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Affiliation(s)
- K Mühlemann
- Department for Infectious Diseases, University Hospital, Bern, Switzerland.
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Winther B, Doyle WJ, Alper CM. A high prevalence of new onset otitis media during parent diagnosed common colds. Int J Pediatr Otorhinolaryngol 2006; 70:1725-30. [PMID: 16814403 DOI: 10.1016/j.ijporl.2006.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2006] [Revised: 05/16/2006] [Accepted: 05/16/2006] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Past studies suggest that the majority of new otitis media (OM) diagnoses is a complication of a colds/flu. A prospective format was used to determine the coincidence of otitis media and parent diagnosed cold/flu episodes in young children followed over a typical cold/flu season. METHODS Eighteen families with children aged 1-8 years were followed from October 1 to April 30 using parent-completed daily diaries focused on cold/flu signs and weekly examinations using pneumatic otoscopy for diagnosis of the presence/absence of otitis media. RESULTS Overall, 108 cold episodes were documented in 36 enrolled children with 20 colds (19%) occurring during a pre-existing OM episode and 40 colds (37%) complicated by a new OM episode. Conversely, there were 82 new OM episodes, 40 (49%) were associated with a cold in the individual child and 18 (22%) with a concurrent cold in a family member. The median duration of the OM episodes was approximately 2 weeks but this was longer for OM episodes where earache was reported. CONCLUSION The results confirm past observation relating new OM episodes to a concurrent cold/flu but show these episodes to usually be of short duration. Two sources of potential bias were identified for point prevalence study formats: the presence of a pre-existing OM for a new onset cold/flu and the possibility of subclinical colds in patients with new OM episodes. These biases reinforce the need for longitudinal study formats to address this important relationship.
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Affiliation(s)
- Birgit Winther
- Department of Otolaryngology, University of Virginia Health System, United States
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Nokso-Koivisto J, Hovi T, Pitkäranta A. Viral upper respiratory tract infections in young children with emphasis on acute otitis media. Int J Pediatr Otorhinolaryngol 2006; 70:1333-42. [PMID: 16564578 PMCID: PMC7112939 DOI: 10.1016/j.ijporl.2006.01.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Revised: 01/29/2006] [Accepted: 01/30/2006] [Indexed: 11/24/2022]
Abstract
Viral upper respiratory infection is the most common reason for seeking medical care for children. Recurrent viral respiratory infections and subsequent complications (e.g. acute otitis media (AOM)) are a burden for children, their families and society. Over the past decade, our knowledge on the significance of respiratory viruses has broadened remarkably. Viruses cause large variety of respiratory diseases and cause alone diseases, which previously have been assumed to be bacterial only (e.g. AOM and pneumonia). Methods for detection analysis of respiratory viruses are developing making both the diagnosis and epidemiological investigations of respiratory infections easier. Accurate diagnosis of respiratory infections and awareness of possible viral etiology could reduce the use of antibiotics. Etiologic studies of viral infections are becoming increasingly important, with the emergence of new antiviral drugs and vaccines.
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Affiliation(s)
- Johanna Nokso-Koivisto
- Department of Virology and Immunology, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland.
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Ryan AF, Ebmeyer J, Furukawa M, Pak K, Melhus A, Wasserman SI, Chung WH. Mouse models of induced otitis media. Brain Res 2006; 1091:3-8. [PMID: 16764829 DOI: 10.1016/j.brainres.2006.02.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Accepted: 02/03/2006] [Indexed: 12/18/2022]
Abstract
The mouse has seen limited use as a model for experimental otitis media, due primarily to the small size of its middle ear. However, the genetic resources of this species offer substantial potential benefits. These include detailed genomic information, a wealth of genetic models, and gene arrays that represent virtually all mouse genes. This has led to the development of methods for inducing otitis in mice. These include surgical approaches to the middle ear, documentation of the murine middle ear response to various pathogens and inflammatory factors, as well as characterization of induced otitis media in several mouse strains. The results indicate that induced otitis media in the normal mouse is in most respects comparable to that observed in other animal models and in humans. They further suggest that the considerable genetic resources of this species can be harnessed to increase our understanding of this disease.
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Affiliation(s)
- Allen F Ryan
- Department of Surgery, Division of Otolaryngology, UCSD School of Medicine and VA Medical Center, La Jolla, CA 92093-0666, USA.
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Mühlemann K, Uehlinger DE, Büchi W, Gorgievski M, Aebi C. The prevalence of penicillin-non-susceptible Streptococcus pneumoniae among children aged < 5�years correlates with the biannual epidemic activity of respiratory syncytial virus. Clin Microbiol Infect 2006. [DOI: 10.1111/j.1469-0691.2006.01472.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ozgur SK, Beyazova U, Kemaloglu YK, Maral I, Sahin F, Camurdan AD, Kizil Y, Dinc E, Tuzun H. Effectiveness of inactivated influenza vaccine for prevention of otitis media in children. Pediatr Infect Dis J 2006; 25:401-4. [PMID: 16645502 DOI: 10.1097/01.inf.0000217370.83948.51] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the effectiveness of inactivated influenza vaccine in preventing acute otitis media (AOM) and otitis media with effusion (OME) in children aged 6 to 60 months who attend day care. STUDY DESIGN This prospective, single-blind study was conducted in 8 day care centers in Ankara, Turkey. One hundred nineteen (61 vaccinated and 58 unvaccinated against influenza) healthy children were examined at study entry and at 6-week intervals for 6 months by the same 2 otorhinolaryngologists who were blinded about the vaccination status of the children. The frequency of AOM and OME is compared between the 2 groups and the effect of influenza season on frequency of episodes was evaluated. Based on national influenza laboratory data, the influenza season was determined to be the period between December 15, 2003, and January 31, 2004. RESULT The frequencies of AOM, OME and total otitis media episodes in vaccinated children were 2.3%, 22.8% and 25.2%, respectively, and these frequencies were 5.2%, 31.1% and 36.3% in the unvaccinated group. The difference was statistically significant (P < 0.01). This difference was especially prominent in the influenza season (P < 0.05). CONCLUSION Influenza vaccine is effective in reducing AOM and OME episodes in 6- to 60-month-old day care children, especially during influenza season.
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Affiliation(s)
- Senem Konuk Ozgur
- Department of Pediatrics, Gazi University Medical Faculty, Ankara, Turkey
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Barry B. [Infectious and non infectious factors in otitis media and in sinusitis]. ACTA ACUST UNITED AC 2005; 7:219-223. [PMID: 32288530 PMCID: PMC7146782 DOI: 10.1016/s1294-5501(05)80454-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Les infections de la sphère ORL sont fréquentes et les otites chez l’enfant, les sinusites de l’adulte sont généralement perçues comme étant d’origine bactérienne ou virale. Cependant de nombreux facteurs non infectieux jouent un rôle non négligeable, mais restent souvent méconnus et d’interprétation difficile : ils conduisent encore trop souvent à des thérapeutiques antibiotiques inutiles. Ainsi dans l’otite, ont été reconnus divers facteurs de risque non infectieux tels que : atteinte mécanique de la trompe d’Eustache, immaturité immunitaire, tabagisme passif, carence martiale etc… susceptibles de favoriser l’infection de l’oreille moyenne, souvent virale dans un 1er temps, secondairement surinfectée par les espèces bactériennes du rhinopharynx ((pneumocoques, Haemophilus influenzae, Moraxella catarrhalis). Les sinusites sont d’étiologie multifactorielle et, si les mécanismes et les agents des sinusites infectieuses (virus et bactéries) sont bien connus, en revanche de multiples facteurs non infectieux peuvent être identifiés : l’allergie est un facteur fréquent qui favorise les sinusites à répétition ; moins souvent reconnus sont le diabète, le reflux gastro-oesophagien, des facteurs anatomiques, des anomalies de la fonction muco-ciliaire ou l’immunodépression dans le cadre VIH. Des recherches doivent être poursuivies pour approfondir ces mécanismes complexes.
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Affiliation(s)
- B Barry
- Service ORL, Hôpital Bichat, 46, rue Henri Huchard, 75018 Paris
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Kleemola M, Nokso-Koivisto J, Herva E, Syrjänen R, Lahdenkari M, Kilpi T, Hovi T. Is there any specific association between respiratory viruses and bacteria in acute otitis media of young children? J Infect 2005; 52:181-7. [PMID: 15992930 PMCID: PMC7173109 DOI: 10.1016/j.jinf.2005.05.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Accepted: 05/11/2005] [Indexed: 11/18/2022]
Abstract
Background Respiratory viral infections are usually preceding or coinciding with acute otitis media (AOM) in children. It is not known if a given viral infection would facilitate invasion of bacterial pathogens into the middle ear in a species-specific way. We reanalysed the microbiological results of the two prospective Finnish Otitis Media (FinOM) studies for this purpose. Methods The children had been followed from 2 months to 2 years of age in specific study clinics and all referred AOM events were analysed. Combined results of virus detection tests from middle ear fluid and nasopharyngeal aspirate and those of bacterial culture from middle ear fluid were cross-tabulated for 529 AOM events in the FinOM Cohort Study and for 364 events in the FinOM Vaccine Trial. Results In both studies the main bacterial pathogens were Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis while the main viruses detected were rhinoviruses and respiratory syncytial virus (plus enteroviruses in the Vaccine Trial). No distinct species-specific associations were observed between the viral and bacterial findings. Conclusion We did not find support to the theory that respiratory infection caused by a given viral species would favour growth of a certain bacterial pathogen in the MEF more than another.
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Affiliation(s)
- Marjaana Kleemola
- Department of Microbiology, National Public Health Institute, Helsinki, Finland
| | - Johanna Nokso-Koivisto
- Department of Microbiology, National Public Health Institute, Helsinki, Finland
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland
| | - Elja Herva
- Department of Microbiology, National Public Health Institute, Oulu, Finland
| | - Ritva Syrjänen
- Department of Vaccines, National Public Health Institute, Helsinki, Finland
| | - Mika Lahdenkari
- Department of Vaccines, National Public Health Institute, Helsinki, Finland
| | - Terhi Kilpi
- Department of Vaccines, National Public Health Institute, Helsinki, Finland
| | - Tapani Hovi
- Department of Microbiology, National Public Health Institute, Helsinki, Finland
- Corresponding author. Address: Department of Viral Diseases and Immunology, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland. Tel.: +358 9 4744 8321.
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Gitiban N, Jurcisek JA, Harris RH, Mertz SE, Durbin RK, Bakaletz LO, Durbin JE. Chinchilla and murine models of upper respiratory tract infections with respiratory syncytial virus. J Virol 2005; 79:6035-42. [PMID: 15857989 PMCID: PMC1091680 DOI: 10.1128/jvi.79.10.6035-6042.2005] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2004] [Accepted: 01/09/2005] [Indexed: 01/01/2023] Open
Abstract
Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in infants and the elderly. While the primary infection is the most serious, reinfection of the upper airway throughout life is the rule. Although relatively little is known about either RSV infection of the upper respiratory tract or host mucosal immunity to RSV, recent literature suggests that RSV is the predominant viral pathogen predisposing to bacterial otitis media (OM). Herein, we describe mouse and chinchilla models of RSV infection of the nasopharynx and Eustachian tube. Both rodent hosts were susceptible to RSV infection of the upper airway following intranasal challenge; however, the chinchilla proved to be more permissive than the mouse. The chinchilla model will likely be extremely useful to test the role of RSV in bacterial OM and the efficacy of RSV vaccine candidates designed to provide mucosal and cytotoxic T-lymphocyte immunity. Ultimately, we hope to investigate the relative ability of these candidates to potentially protect against viral predisposal to bacterial OM.
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Affiliation(s)
- Negin Gitiban
- Columbus Children's Research Institute, Rm. W591, The Ohio State University College of Medicine & Public Health, Department of Pediatrics, 700 Children's Drive, Columbus, OH 43205-2696, USA
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Abstract
Although polymicrobial diseases are not a new concept for microbiologists, they are experiencing a resurgence of interest owing to the development of suitable animal models and new molecular techniques that allow these diseases to be studied effectively. This broad review provides an excellent introduction to this fascinating topic. Examples are included of each type of polymicrobial disease and the animal models that are used to study these diseases are discussed. In many instances, schematics for the animal model are presented. Viral co-infections including bovine viral diarrhoeal viruses, porcine reproductive and respiratory syndrome, mixed hepatitis virus infections and HIV co-infection with hepatitis virus are discussed, together with attempts to model these diseases in animals. Viral and bacterial co-infections are reviewed with a special focus on otitis media and the rodent models that have been used to probe this important childhood illness. Of the polybacterial diseases, periodontitis is one of the best understood and a clinically relevant rodent model is now available. This model, and the role of biofilm formation in periodontitis are examined. Fungal infections of humans are often referred to as 'opportunistic' but in fact these infections are often fungal co-infections with viruses such as HIV and fungal mixed co-infections. The roles of these infections in disease and the rodent models used to study them are discussed. Parasite co-infections are thought to have a role in the severity of malaria and the severity of Lyme arthritis. These diseases and attempts to model them are evaluated. Finally, co-infections that are associated with virus-induced immunosuppression are discussed, together with their animal models.
Polymicrobial diseases involve two or more microorganisms that act synergistically, or in succession, to mediate complex disease processes. Although polymicrobial diseases in animals and humans can be caused by similar organisms, these diseases are often also caused by organisms from different kingdoms, genera, species, strains, substrains and even by phenotypic variants of a single species. Animal models are often required to understand the mechanisms of pathogenesis, and to develop therapies and prevention regimes. However, reproducing polymicrobial diseases of humans in animal hosts presents significant challenges.
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Affiliation(s)
- Lauren O Bakaletz
- Center for Microbial Pathogenesis, Columbus Children's Research Institute, Department of Pediatrics, The Ohio State University College of Medicine & Public Health, 700 Children's Drive, Columbus, Ohio 43205-2696, USA.
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Abstract
BACKGROUND AND METHODS Viral-bacterial coinfections in humans are well-documented. Viral infections often lead to bacterial superinfections. In vitro and animal models for influenza, as well as molecular microbiology study of viruses and bacteria, provide an understanding of the mechanisms that explain how respiratory viruses and bacteria combine to cause disease. This article focuses on viral and bacterial combinations, particularly synergism between influenza and Streptococcus pneumoniae. RESULTS Potential mechanisms for synergism between viruses and bacteria include: virus destruction of respiratory epithelium may increase bacterial adhesion; virus-induced immunosuppression may cause bacterial superinfections; and inflammatory response to viral infection may up-regulate expression of molecules that bacteria utilize as receptors. Influenza and parainfluenza viruses possess neuraminidase (NA) activity, which appears to increase bacterial adherence after viral preincubation. Experimental studies demonstrate that viral NA exposes pneumococcal receptors on host cells by removing terminal sialic acids. Other studies show that inhibition of viral NA activity reduces adherence and invasion of S. pneumoniae, independently of effects on viral replication. Clinical studies reveal that influenza vaccination reduces the incidence of secondary bacterial respiratory tract infections. CONCLUSIONS Detection of viral factors (e.g. high NA activity) that increase the likely potential of epidemic/pandemic influenza strains for causing morbidity and mortality from secondary bacterial infections provides new possibilities for intervention. Additional study is needed to identify the mechanisms for the development of bacterial complications after infections with respiratory syncytial virus and other important respiratory viruses that lack NA activity. Prevention of bacterial superinfection is likely to depend on effective antiviral measures.
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Affiliation(s)
- Ville T Peltola
- Department of Infectious Diseases, St Judes Children's Research Hospital, Memphis, TN, USA
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47
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Eriksson PO, Hellström S. Acute otitis media develops in the rat after intranasal challenge of Streptococcus pneumoniae. Laryngoscope 2003; 113:2047-51. [PMID: 14603072 DOI: 10.1097/00005537-200311000-00036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS The rat is a frequently used animal model for middle ear research. To date, acute otitis media (AOM) has been evoked after instillation of bacteria directly into the middle ear cavity or after traumatizing the tympanic membrane. The purpose of the study was to examine whether, with an intact tympanic membrane and middle ear cavity, intranasally deposited bacteria cause AOM and how tympanic membrane stimulation influences this procedure. STUDY DESIGN In vivo, murine model. METHODS In a rat model, Streptococcus pneumoniae, type 3, was intranasally inoculated for 5 consecutive days. The tympanic membrane was treated with saline or with compound 48/80 or was left untreated. The development of AOM was evaluated by otomicroscopy, light microscopy, and middle ear culture. RESULTS Ninety percent of the ears developed AOM. However, when the tympanic membranes were treated with saline or compound 48/80, only 40% and 57%, respectively, developed AOM. In all, 23 of 40 ears developed AOM and 20 ears showed growth of bacteria. CONCLUSION Repeated intranasal deposition of S. pneumoniae, type 3, causes AOM in the rat. The development of AOM can be influenced by tympanic membrane stimulation.
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Affiliation(s)
- Per Olof Eriksson
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University Hospital, Sweden.
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48
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Tong HH, Long JP, Shannon PA, DeMaria TF. Expression of cytokine and chemokine genes by human middle ear epithelial cells induced by influenza A virus and Streptococcus pneumoniae opacity variants. Infect Immun 2003; 71:4289-96. [PMID: 12874304 PMCID: PMC166016 DOI: 10.1128/iai.71.8.4289-4296.2003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2003] [Revised: 04/24/2003] [Accepted: 05/14/2003] [Indexed: 11/20/2022] Open
Abstract
Real-time PCR and enzyme-linked immunosorbent assay were used to evaluate the ability of influenza A virus and Streptococcus pneumoniae opacity variants, either alone or in combination, to induce cytokine and chemokine genes in primary cultures of human middle ear epithelial (HMEE) cells. Following treatment with influenza A virus, the induction of gene expression, which occurred in a dose- and time-dependent manner, was strong for macrophage inflammatory protein 1 alpha (MIP-1 alpha) and MIP-1 beta; moderate for tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), and IL-8; and weak for IL-1 beta and monocyte chemotactic peptide 1 (MCP-1). Except for TNF-alpha, all the gene products were detected in the cell culture supernatants. In contrast, infection of HMEE cells with S. pneumoniae alone induced low levels of mRNA expression of MIP-1 alpha and MIP-1 beta and did not significantly induce the transcription of the other cytokines and chemokines examined. However, both S. pneumoniae opacity variants increased mRNA expression of MIP-1 alpha, MIP-1 beta, IL-6, and MCP-1 in HMEE cells activated by a prior influenza A virus infection compared to levels in cells treated with either agent alone. Up-regulation of IL-6, IL-8, and MCP-1 mRNA expression and production by the virus in combination with opaque S. pneumoniae was two- to threefold higher than that induced by the virus combined with the transparent S. pneumoniae variant. These data indicate that the activation of HMEE cells by influenza A virus enhances the induction of cytokine and chemokine gene transcripts by S. pneumoniae and that this effect appears to be most pronounced when S. pneumoniae is in the opaque phase.
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Affiliation(s)
- H H Tong
- Division of Otologic Research, College of Medicine and Public Health, The Ohio State University, Columbus, Ohio 43210, USA
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49
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Abstract
Acute otitis media is usually considered a simple bacterial infection that is treated with antibiotics. However, ample evidence derived from studies ranging from animal experiments to extensive clinical trials supports a crucial role for respiratory viruses in the etiology and pathogenesis of acute otitis media. Viral infection of the upper respiratory mucosa initiates the whole cascade of events that finally leads to the development of acute otitis media as a complication. The pathogenesis of acute otitis media involves a complex interplay between viruses, bacteria, and the host's inflammatory response. In a substantial number of children, viruses can be found in the middle-ear fluid either alone or together with bacteria, and recent studies indicate that at least some viruses actively invade the middle ear. Viruses appear to enhance the inflammatory process in the middle ear, and they may significantly impair the resolution of otitis media. Prevention of the predisposing viral infection by vaccination against the major viruses would probably be the most effective way to prevent acute otitis media. Alternatively, early treatment of the viral infection with specific antiviral agents would also be effective in reducing the occurrence of acute otitis media.
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Affiliation(s)
- Terho Heikkinen
- Department of Pediatrics, Turku University Hospital, Turku, Finland.
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50
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Tong HH, Grants I, Liu X, DeMaria TF. Comparison of alteration of cell surface carbohydrates of the chinchilla tubotympanum and colonial opacity phenotype of Streptococcus pneumoniae during experimental pneumococcal otitis media with or without an antecedent influenza A virus infection. Infect Immun 2002; 70:4292-301. [PMID: 12117938 PMCID: PMC128169 DOI: 10.1128/iai.70.8.4292-4301.2002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2002] [Revised: 04/01/2002] [Accepted: 05/08/2002] [Indexed: 11/20/2022] Open
Abstract
Experimental and clinical studies suggest that influenza A virus promotes Streptococcus pneumoniae-induced otitis media; however, the mechanism underlying this synergistic interaction has not been completely defined. In this study, glycoconjugate expression patterns were evaluated on the cell surface in the chinchilla eustachian tube (ET) lumen of a cohort challenged intranasally (i.n.) with S. pneumoniae type 6A, which is predominantly transparent and a cohort with an antecedent influenza A virus infection, followed by i.n. inoculation with S. pneumoniae. The labeling patterns obtained with six lectin probes revealed that the binding of Bandeiraea simplicifolia lectin II, succinylated wheat germ agglutinin, and peanut agglutinin were significantly increased in the lumenal surface of the ET in the cohort infected with both pathogens compared to the cohort inoculated with only S. pneumoniae, which indicated that N-acetylglucosamine (GlcNAc) and D-galactose residues were exposed. A significant decreased labeling with Sambucus nigra agglutinin in the combined influenza A virus and pneumococcus infection cohort suggested that there were few sialic acid residues remaining in the ET epithelium. In addition, the colonial opacity of S. pneumoniae during the disease course was examined. The opaque phenotype was predominant among the pneumococcus isolates from the middle-ear fluid in the cohort infected with the both pathogens. Together, these data suggest that the synergic effect of influenza A virus and S. pneumoniae on the changes of the carbohydrate moieties in the ET epithelium and that the selection of the opaque variant may facilitate the pneumococcal invasion of the middle ear.
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Affiliation(s)
- H H Tong
- Department of Otolaryngology, College of Medicine and Public Health, The Ohio State University, Columbus 43210, USA
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