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Font-Font M, Bellés-Bellés A, Fernández-Fernández R, Torres C. Molecular characterization of Staphylococcus aureus causing menstrual toxic shock syndrome in a young woman. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:311-312. [PMID: 36710160 DOI: 10.1016/j.eimce.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/05/2022] [Indexed: 05/06/2023]
Affiliation(s)
- Maria Font-Font
- Sección Microbiología Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Alba Bellés-Bellés
- Sección Microbiología Hospital Universitari Arnau de Vilanova, Lleida, Spain.
| | | | - Carmen Torres
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
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Font-Font M, Bellés-Bellés A, Fernández-Fernández R, Torres C. Molecular characterization of Staphylococcus aureus causing menstrual toxic shock syndrome in a young woman. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Contou D, Colin G, Travert B, Jochmans S, Conrad M, Lascarrou JB, Painvin B, Ferré A, Schnell D, La Combe B, Coudroy R, Ehrmann S, Rambaud J, Wiedemann A, Asfar P, Kalfon P, Guérot E, Préau S, Argaud L, Daviet F, Dellamonica J, Dupont A, Fartoukh M, Kamel T, Béduneau G, Canouï-Poitrine F, Boutin E, Lina G, Dessap AM, Tristant A, de Prost N. Menstrual toxic shock syndrome: a French nationwide multicenter retrospective study. Clin Infect Dis 2021; 74:246-253. [PMID: 33906228 DOI: 10.1093/cid/ciab378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies describing the clinical features and short-term prognosis of patients admitted to the intensive care unit (ICU) for menstrual toxic shock syndrome (m-TSS) are lacking. METHODS This was a multicenter retrospective cohort study of patients with a clinical diagnosis of m-TSS admitted between January 1, 2005 and December 31, 2020 in 43 French pediatric (n=7) or adult (n=36) ICUs. The aim of the study was to describe the clinical features and short-term prognosis, as well as assess the 2011 Centers for Disease and Control (CDC) diagnostic criteria, of critically ill patients with m-TSS. RESULTS In total, 102 patients with m-TSS (median age: 18 [16-24] years) were admitted to one of the participating ICUs. All blood cultures (n=102) were sterile. Methicillin-sensitive Staphylococcus aureus grew from 92 of 96 vaginal samples. Screening for super-antigenic toxin gene sequences was performed for 76 of the 92 (83%) vaginal samples positive for Staphylococcus aureus and TSST-1 isolated from 66 (87%) strains. At ICU admission, no patient met the 2011 CDC criteria for confirmed m-TSS and only 53 (52%) fulfilled the criteria for probable m-TSS. Eighty-one patients (79%) were treated with anti-toxin antibiotic therapy and eight (8%) received intravenous immunoglobulins. Eighty-six (84%) patients required vasopressors and 21 (21%) tracheal intubation. No patient required limb amputation or died in the ICU. CONCLUSIONS In this large multicenter series of patients included in ICUs for m-TSS, none died or required limb amputation. The CDC criteria should not be used for the clinical diagnosis of m-TSS at ICU admission.
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Affiliation(s)
- Damien Contou
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
| | - Gwenhaël Colin
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, Les Oudairies, Boulevard Stéphane Moreau, 85925 La Roche-sur-Yon, France
| | - Brendan Travert
- Service de Réanimation Pédiatrique, Centre Hospitalier Universitaire de Nantes, 9 Quai Moncousu, 44036 Nantes, France
| | - Sébastien Jochmans
- Service de Médecine Intensive Réanimation, Groupe Hospitalier Sud Ile-de-France, Hôpital de Melun-Sénart, 270 avenue Marc Jacquet, 77000 Melun, France
| | - Marie Conrad
- Service de Réanimation, Centre Hospitalier Universitaire de Nancy, 25 Rue Lionnois, 54000 Nancy, France
| | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Nantes, 9 Quai Moncousu, 44036 Nantes, France
| | - Benoit Painvin
- Service des Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, 2 Rue Henri le Guilloux, 35033 Rennes, France
| | - Alexis Ferré
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier André Mignot de Versailles, 177 Rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - David Schnell
- Service de Médecine Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Rond point de Girac, 16959 Angoulême, France
| | - Beatrice La Combe
- Service de Réanimation Médico-Chirurgicale, Hôpital du Scorff - Groupe Hospitalier Bretagne Sud Lorient, 5 Avenue Choiseul, 56322 Lorient, France
| | - Rémi Coudroy
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021 Poitiers, France, INSERM CIC1402, ALIVE group, Université de Poitiers, France
| | - Stephan Ehrmann
- Service de Médecine Intensive et Réanimation, CHRU de Tours, CIC 1415, CRICS-TriggerSEP, Centre d'étude des pathologies respiratoires, INSERM U1100, Université de Tours, Tours, France
| | - Jérôme Rambaud
- Service de Réanimation Pédiatrique, Hôpital Trousseau, AP-HP, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Arnaud Wiedemann
- INSERM u1256 N-GERE et Réanimation Pédiatrique Spécialisée - C.H.R.U. Nancy - 5 rue du Morvan 54500 Vandœuvre-lès-Nancy, France
| | - Pierre Asfar
- SDépartement de Médecine Intensive-Réanimation, Centre Hospitalier Universitaire d'Angers, 4 Rue Larrey, 49100 Angers, France
| | - Pierre Kalfon
- Service de Réanimation, Centre Hospitalier de Chartres, 4 Rue Claude Bernard, 28630 Le Coudray, France
| | - Emmanuel Guérot
- Service de Médecine Intensive Réanimation, Hôpital européen Georges Pompidou AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Sébastien Préau
- Service de Réanimation, Centre Hospitalier Universitaire de Lille, 2 Avenue Oscar Lambret, 59000 Lille, France
| | - Laurent Argaud
- Service de Médecine Intensive-Réanimation, hôpital Édouard-Herriot, 5, place d'Arsonval, F-69437 Lyon, France
| | - Florence Daviet
- Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin des Bourrely, 13015 Marseille, France
| | - Jean Dellamonica
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, 151 route de Saint-Antoine CS23079, UR2CA Université Cote d'Azur, 06000 Nice, France
| | - Audrey Dupont
- Service de Réanimation Pédiatrique, Centre Hospitalier Universitaire de Nice, 30 Voie Romaine, 06000 Nice, France
| | - Muriel Fartoukh
- Sorbonne Université, AP-HP, Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Tenon AP-HP, 4 rue de la Chine, 75020 Paris, France
| | - Toufik Kamel
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans Hôpital de La Source, 14 Avenue de l'Hôpital, 45100 Orléans, France
| | - Gaëtan Béduneau
- Universite de Normandie, UNIROUEN, EA3830, Service de Réanimation Médicale, Centre Hospitalier Universitaire de Rouen, 37 Boulevard Gambetta, 76000 Rouen, France
| | - Florence Canouï-Poitrine
- Service de Santé Publique, Hôpital Henri-Mondor, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Emmanuelle Boutin
- Service de Santé Publique, Hôpital Henri-Mondor, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Gérard Lina
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, Groupe de Recherche CARMAS, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Anne Tristant
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Nicolas de Prost
- Service de Médecine Intensive Réanimation, Groupe de Recherche CARMAS, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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Berger S, Kunerl A, Wasmuth S, Tierno P, Wagner K, Brügger J. Menstrual toxic shock syndrome: case report and systematic review of the literature. THE LANCET. INFECTIOUS DISEASES 2019; 19:e313-e321. [PMID: 31151811 DOI: 10.1016/s1473-3099(19)30041-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/20/2019] [Accepted: 01/25/2019] [Indexed: 01/20/2023]
Abstract
Menstrual toxic shock syndrome (mTSS) is a life-threatening disease caused by superantigen-producing Staphylococcus aureus. Incidence ranges from 0·03 to 0·50 cases per 100 000 people, with overall mortality around 8%. In this Grand Round, we present the case of a previously healthy 23-year-old menstruating woman who was diagnosed with mTSS after she presented at our hospital with a septic condition for the second time. The diagnosis was confirmed by fulfilment of the clinical criteria outlined by the US Centers for Disease Control and Prevention (CDC; fever, rash, desquamation, hypotension, and multi-system involvement) as well as a nasal swab positive for the S aureus strain and presence of the gene encoding for toxic shock syndrome toxin 1 (TSST-1). In the early 1980s, when mTSS was first described, use of tampons was considered the main risk factor. Today, the complex interplay between pathogenic factors of S aureus, immunological mechanisms of the host, and changes in the vaginal ecosystem during menstruation has broadened current understanding of the disease, and the CDC criteria have appreciable limitations in everyday clinical practice.
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Affiliation(s)
- Selina Berger
- Department of Internal Medicine, Sonnenhofspital, Bern, Switzerland
| | - Anika Kunerl
- Department of Internal Medicine, Sonnenhofspital, Bern, Switzerland
| | - Stefan Wasmuth
- Department of Internal Medicine, Sonnenhofspital, Bern, Switzerland
| | - Philip Tierno
- Department of Pathology, NYU School of Medicine, NYU Langone Medical Center, New York, NY, USA
| | - Karoline Wagner
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Jan Brügger
- Department of Internal Medicine, Sonnenhofspital, Bern, Switzerland; University of Zurich, Zurich, Switzerland.
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Yang SI, Kim JH, Jeong SW, Han HJ. Acute hemorrhagic diarrhea syndrome associated with contaminated foreign bodies (used feminine hygiene products) in a Golden Retriever dog. J Vet Med Sci 2018; 80:629-633. [PMID: 29459505 PMCID: PMC5938191 DOI: 10.1292/jvms.17-0633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A one-year-old male Golden Retriever presented with acute onset of vomiting and
hemorrhagic diarrhea since 2 days. The dog was depressed, showing abdominal pain, 12%
dehydration, tachycardia, and a bounding pulse. Diagnostic imaging showed severe
dilatation and fluid retention of the entire gastrointestinal tract with decreased
motility. A foreign body was found in the gastroduodenal region, but there was no
obstruction or plication. The dog was tentatively diagnosed with acute hemorrhagic
diarrhea syndrome and rapidly recovered after supportive treatment. However, on the
morning of day 4, anorexia and vomiting recurred, and diagnostic imaging revealed
intestinal plication with free peritoneal fluid, not found on the previous image. An
emergency laparotomy revealed the foreign body to be two used feminine hygiene products.
These contaminated products were suspected to induce acute hemorrhagic diarrhea syndrome,
and led to subsequent complication in this large dog.
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Affiliation(s)
- Seung-Il Yang
- Department of Veterinary Emergency Medcine, Konkuk Veterinary Medical Teaching Hospital, Konkuk University, 120, Neungdong-ro, Gwangjin-gu, Seoul, 05029 Republic of Korea.,Department of Veterinary Surgery, Konkuk Veterinary Medical Teaching Hospital, Konkuk University, 120, Neungdong-ro, Gwangjin-gu, Seoul, 05029 Republic of Korea
| | - Jung-Hyun Kim
- Department of Veterinary Internal Medicine, Konkuk Veterinary Medical Teaching Hospital, Konkuk University, 120, Neungdong-ro, Gwangjin-gu, Seoul, 05029 Republic of Korea
| | - Soon-Wuk Jeong
- Department of Veterinary Surgery, Konkuk Veterinary Medical Teaching Hospital, Konkuk University, 120, Neungdong-ro, Gwangjin-gu, Seoul, 05029 Republic of Korea
| | - Hyun-Jung Han
- Department of Veterinary Emergency Medcine, Konkuk Veterinary Medical Teaching Hospital, Konkuk University, 120, Neungdong-ro, Gwangjin-gu, Seoul, 05029 Republic of Korea
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Breshears LM, Gillman AN, Stach CS, Schlievert PM, Peterson ML. Local Epidermal Growth Factor Receptor Signaling Mediates the Systemic Pathogenic Effects of Staphylococcus aureus Toxic Shock Syndrome. PLoS One 2016; 11:e0158969. [PMID: 27414801 PMCID: PMC4944920 DOI: 10.1371/journal.pone.0158969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 06/26/2016] [Indexed: 12/02/2022] Open
Abstract
Secreted factors of Staphylococcus aureus can activate host signaling from the epidermal growth factor receptor (EGFR). The superantigen toxic shock syndrome toxin-1 (TSST-1) contributes to mucosal cytokine production through a disintegrin and metalloproteinase (ADAM)-mediated shedding of EGFR ligands and subsequent EGFR activation. The secreted hemolysin, α-toxin, can also induce EGFR signaling and directly interacts with ADAM10, a sheddase of EGFR ligands. The current work explores the role of EGFR signaling in menstrual toxic shock syndrome (mTSS), a disease mediated by TSST-1. The data presented show that TSST-1 and α-toxin induce ADAM- and EGFR-dependent cytokine production from human vaginal epithelial cells. TSST-1 and α-toxin also induce cytokine production from an ex vivo porcine vaginal mucosa (PVM) model. EGFR signaling is responsible for the majority of IL-8 production from PVM in response to secreted toxins and live S. aureus. Finally, data are presented demonstrating that inhibition of EGFR signaling with the EGFR-specific tyrosine kinase inhibitor AG1478 significantly increases survival in a rabbit model of mTSS. These data indicate that EGFR signaling is critical for progression of an S. aureus exotoxin-mediated disease and may represent an attractive host target for therapeutics.
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Affiliation(s)
- Laura M. Breshears
- University of Minnesota, College of Pharmacy, Department of Experimental and Clinical Pharmacology, Minneapolis, Minnesota, United States of America
| | - Aaron N. Gillman
- University of Minnesota, College of Pharmacy, Department of Experimental and Clinical Pharmacology, Minneapolis, Minnesota, United States of America
| | - Christopher S. Stach
- University of Minnesota, College of Biological Sciences, Biotechnology Institute, Minneapolis, Minnesota, United States of America
| | - Patrick M. Schlievert
- University of Iowa, Carver College of Medicine, Department of Microbiology, Iowa City, Iowa, United States of America
| | - Marnie L. Peterson
- University of Minnesota, College of Pharmacy, Department of Experimental and Clinical Pharmacology, Minneapolis, Minnesota, United States of America
- * E-mail:
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Fatal multiple organ failure in an adolescent due to community-acquired methicillin-susceptible Staphylococcus aureus ST121/agrIV lineage. ACTA ACUST UNITED AC 2015. [DOI: 10.1097/mrm.0000000000000050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Toxic shock syndrome of a probable gynecologic source in an adolescent: a case report and review of the literature. J Pediatr Adolesc Gynecol 2012; 25:e133-7. [PMID: 23095525 DOI: 10.1016/j.jpag.2012.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/13/2012] [Accepted: 08/19/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Toxic shock syndrome (TSS) is an acute toxin-mediated infectious syndrome characterized by fever, hypotension, desquamation, and multiorgan involvement. It is a rare condition (incidence of 0.79/100,000 women), particularly in the adolescent population, and it may be menstrual (mTSS) or non-menstrual (nmTSS) in origin. CASE A 15-year-old girl developed symptoms of nausea, vomiting, and diarrhea that worsened over a 3-day period. At initial presentation, she was hypotensive, febrile, and tachycardic. Her condition deteriorated and within 36 hours she required intubation, vasopressor treatment, and antibiotic therapy. Multiple sites were cultured but only the vaginal culture, which grew Staphylococcus aureus, was positive. Recent menses with tampon use was reported. She responded to aggressive therapy and was discharged home 3 weeks after initial presentation. SUMMARY AND CONCLUSION We describe a rare case of TSS of a probable gynecologic source in a 15-year-old female who successfully responded to aggressive intensive care treatment. mTSS should be considered in the differential diagnosis of an adolescent presenting with signs of septic shock, particularly if there is a recent history of tampon use. Early intervention is critical to improving survival.
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Koban I, Bender CP, Assadian O, Kramer A, Hübner NO. Clinical use of the antiseptic polihexanide for genital tract infections. Skin Pharmacol Physiol 2012; 25:298-304. [PMID: 22907313 DOI: 10.1159/000340063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 06/05/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND In clinical practice, treatment of genital tract infections is based on administration of either antibiotics or antiseptics. While antibiotics may be applied systemically or topically, antiseptics may be applied only topically. In case of bacterial vaginosis (BV), antibiotic therapy may often be limited and side effects due to systemic administration may develop. Polihexanide (PHMB) is a promising option for the topical treatment of genital tract infections, in particular BV and vaginitis. METHOD A systematic search for publications on the use of PHMB for the treatment of genital infections in two electronic databases was performed. Titles, abstracts and citations were imported into a reference database. Duplicates were removed and two reviewers assessed each identified publication separately. RESULTS Among a total of 204 references, 3 prospective randomized trials were identified. Two trials treated BV infections with PHMB in comparison to clindamycin as antibiotic standard therapy with no significant differences either in safety or in efficacy. The third controlled trial investigated the clinical efficacy of PHMB compared to placebo in the treatment of human papilloma virus. Patients treated with PHMB daily for up to 16-weeks showed significantly higher (52%) clearance of genital warts as compared to patients treated with placebo (4%). CONCLUSION PHMB may be a clinically effective alternative for the treatment of BV and human papilloma virus. Although PHMB-based antiseptics are available since the late 90s, controlled trials to investigate its clinical potential for antiseptic treatment are scant. Clinical use of antiseptics for the treatment of infectious diseases should be explored and supported further.
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Affiliation(s)
- I Koban
- Unit of Periodontology, Department of Restorative Dentistry, Periodontology and Endodontology, University Medicine Greifswald, Greifswald, Germany.
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Human leukocyte antigen class II transgenic mouse model unmasks the significant extrahepatic pathology in toxic shock syndrome. THE AMERICAN JOURNAL OF PATHOLOGY 2011; 178:2760-73. [PMID: 21641398 DOI: 10.1016/j.ajpath.2011.02.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 01/10/2011] [Accepted: 02/07/2011] [Indexed: 11/22/2022]
Abstract
Among the exotoxins produced by Staphylococcus aureus and Streptococcus pyogenes, the superantigens (SAgs) are the most potent T-cell activators known to date. SAgs are implicated in several serious diseases including toxic shock syndrome (TSS), Kawasaki disease, and sepsis. However, the immunopathogenesis of TSS and other diseases involving SAgs are still not completely understood. The commonly used conventional laboratory mouse strains do not respond robustly to SAgs in vivo. Therefore, they must be artificially rendered susceptible to TSS by using sensitizing agents such as d-galactosamine (d-galN), which skews the disease exclusively to the liver and, hence, is not representative of the disease in humans. SAg-induced TSS was characterized using transgenic mice expressing HLA class II molecules that are extremely susceptible to TSS without d-galN. HLA-DR3 transgenic mice recapitulated TSS in humans with extensive multiple-organ inflammation affecting the lung, liver, kidneys, heart, and small intestines. Heavy infiltration with T lymphocytes (both CD4(+) and CD8+), neutrophils, and macrophages was noted. In particular, the pathologic changes in the small intestines were extensive and accompanied by significantly altered absorptive functions of the enterocytes. In contrast to massive liver failure alone in the d-galN sensitization model of TSS, findings of the present study suggest that gut dysfunction might be a key pathogenic event that leads to high morbidity and mortality in humans with TSS.
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Gunawardana M, Moss JA, Smith TJ, Kennedy S, Kopin E, Nguyen C, Malone AM, Rabe L, Schaudinn C, Webster P, Srinivasan P, Sweeney ED, Smith JM, Baum MM. Microbial biofilms on the surface of intravaginal rings worn in non-human primates. J Med Microbiol 2011; 60:828-837. [PMID: 21393449 DOI: 10.1099/jmm.0.028225-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Millions of intravaginal rings (IVRs) are used by women worldwide for contraception and for the treatment of vaginal atrophy. These devices also are suitable for local and systemic sustained release drug delivery, notably for antiviral agents in human immunodeficiency virus pre-exposure prophylaxis. Despite the widespread use of IVRs, no studies have examined whether surface-attached bacterial biofilms develop in vivo, an important consideration when determining the safety of these devices. The present study used scanning electron microscopy, fluorescence in situ hybridization and confocal laser scanning microscopy to study biofilms that formed on the surface of IVRs worn for 28 days by six female pig-tailed macaques, an excellent model organism for the human vaginal microbiome. Four of the IVRs released the nucleotide analogue reverse transcriptase inhibitor tenofovir at a controlled rate and the remaining two were unmedicated. Large areas of the ring surfaces were covered with monolayers of epithelial cells. Two bacterial biofilm phenotypes were found to develop on these monolayers and both had a broad diversity of bacterial cells closely associated with the extracellular material. Phenotype I, the more common of the two, consisted of tightly packed bacterial mats approximately 5 µm in thickness. Phenotype II was much thicker, typically 40 µm, and had an open architecture containing interwoven networks of uniform fibres. There was no significant difference in biofilm thickness and appearance between medicated and unmedicated IVRs. These preliminary results suggest that bacterial biofilms could be common on intravaginal devices worn for extended periods of time.
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Affiliation(s)
- Manjula Gunawardana
- Auritec Pharmaceuticals Inc., Suite 3, 1434 6th Street, Santa Monica, CA, USA.,Department of Chemistry, Oak Crest Institute of Science, 2275 E. Foothill Boulevard, Pasadena, CA, USA
| | - John A Moss
- Department of Chemistry, Oak Crest Institute of Science, 2275 E. Foothill Boulevard, Pasadena, CA, USA
| | - Thomas J Smith
- Department of Ophthalmology, University of Kentucky, Lexington, KY, USA.,Auritec Pharmaceuticals Inc., Suite 3, 1434 6th Street, Santa Monica, CA, USA.,Department of Chemistry, Oak Crest Institute of Science, 2275 E. Foothill Boulevard, Pasadena, CA, USA
| | - Sean Kennedy
- Department of Chemistry, Oak Crest Institute of Science, 2275 E. Foothill Boulevard, Pasadena, CA, USA
| | - Etana Kopin
- Auritec Pharmaceuticals Inc., Suite 3, 1434 6th Street, Santa Monica, CA, USA
| | - Cali Nguyen
- Auritec Pharmaceuticals Inc., Suite 3, 1434 6th Street, Santa Monica, CA, USA.,Department of Chemistry, Oak Crest Institute of Science, 2275 E. Foothill Boulevard, Pasadena, CA, USA
| | - Amanda M Malone
- Auritec Pharmaceuticals Inc., Suite 3, 1434 6th Street, Santa Monica, CA, USA
| | - Lorna Rabe
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Christoph Schaudinn
- Ahmanson Advanced EM & Imaging Center, House Ear Institute, 2100 W. 3rd Street, Los Angeles, CA, USA
| | - Paul Webster
- Ahmanson Advanced EM & Imaging Center, House Ear Institute, 2100 W. 3rd Street, Los Angeles, CA, USA
| | - Priya Srinivasan
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, TB Prevention, Coordinating Center for Infectious Diseases (CCID), Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth D Sweeney
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, TB Prevention, Coordinating Center for Infectious Diseases (CCID), Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James M Smith
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, TB Prevention, Coordinating Center for Infectious Diseases (CCID), Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marc M Baum
- Department of Chemistry, Oak Crest Institute of Science, 2275 E. Foothill Boulevard, Pasadena, CA, USA
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