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Sagas D, Adler A, Kasher C, Khamaysi K, Strauss M, Chazan B. The effect of the transition to molecular diagnosis on the epidemiology and the clinical characteristics of bacterial gastroenteritis in Northern Israel. Infect Dis (Lond) 2024; 56:157-163. [PMID: 37975631 DOI: 10.1080/23744235.2023.2282713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The transition to PCR-based diagnosis of bacterial gastroenteritis (BGE) can increase the sensitivity but might reduce the clinical specificity. The aims of this study were (1) to compare the effect of the change from culture to PCR-based diagnostics on the reported incidence and positivity rates of BGE due to Salmonella, Shigella and Campylobacter species and (2) to compare the demographics, medical background, clinical characteristics and pre-analytic variables between cases with PCR-positive, culture-negative samples to cases with PCR-positive, culture-positive samples. METHODS The study was performed at the Emek Medical Centre that serves a population of 0.5 million people in Northern Israel. The study included two parts: (1) a retrospective cohort study, comparing the incidence and positivity rates of laboratory-diagnosed BGE from January 2016 until December 22nd, 2019 when culture was the sole method to January 2020 until April 2023 when PCR was used; (2) a prospective cohort study, conducted between November 2020 until April 2023 that compared the demographics and clinical characteristics of BGE cases that were diagnosed by PCR alone versus cases that were diagnosed by both PCR and culture. RESULTS The incidence rate between-periods comparability ratio was only 113% since the incidence rate did not increase during 2020, the first year of the COVID-19 pandemic. The sample positivity rate increased since 2020, with between-periods comparability ratio of 159%. In the second period, the sample positivity rates of culture vs. PCR alone differed between the pathogens and were 90.2%, 63.8% and 54.2% for Salmonella, Campylobacter and Shigella species, respectively (p < 0.001). The following variables were identified as independent predictors of culture positivity: (1) Salmonella infection (O.R. = 10.6, 95% C.I. 3.6-31.1, p < 0.001); (2) Shigella infection (O.R. = 0.46, 95% C.I.0.23-0.93, p = 0.032); (3) time from sample submission to culture (O.R.=0.73, 95% C.I. 0.58-0.92, p = 0.008); (4) the presence of abdominal pain (O.R. = 1.98, 95% C.I. 1.04-3.79, p = 0.038) and the PCR mean Ct value (O.R. = 0.89, 95% C.I.0.85-0.94, p < 0.001). CONCLUSIONS The use of PCR had led to improved sensitivity, without noticeable decrease in the clinical specificity. This was especially important in the case of the more fastidious organisms.
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Affiliation(s)
- Dana Sagas
- Clinical Microbiology, Emek Medical Center, Clalit Health Services, Afula, Israel
- Department of Epidemiology and Preventative Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Adler
- Department of Epidemiology and Preventative Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clinical Microbiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Carmel Kasher
- Infectious Diseases Unit, Emek Medical Center, Clalit Health Services, Afula, Israel
| | | | - Merav Strauss
- Clinical Microbiology, Emek Medical Center, Clalit Health Services, Afula, Israel
| | - Bibiana Chazan
- Infectious Diseases Unit, Emek Medical Center, Clalit Health Services, Afula, Israel
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
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Koeffer J, Kolb M, Sorel O, Ulekleiv C, Feenstra JDM, Eigner U. Clinical performance evaluation of TAQPATH Enteric Bacterial Select Panel for the detection of common enteric bacterial pathogens in comparison to routine stool culture and other qPCR-based diagnostic tests. Microbiol Spectr 2024; 12:e0317223. [PMID: 38054723 PMCID: PMC10783074 DOI: 10.1128/spectrum.03172-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/01/2023] [Indexed: 12/07/2023] Open
Abstract
IMPORTANCE Enteric bacterial infections caused by Salmonella, Shigella, pathogenic Escherichia coli, and Campylobacter represent one of the most common causes of infectious enteritis worldwide. The timely and accurate diagnosis of pathogens causing gastroenteritis is crucial for patient care, public health, and disease surveillance. While stool culture has long been the standard and highly specific method for detecting enteric pathogens, it is labor-intensive and time-consuming with limited sensitivity. To improve patient outcomes, there is a need to implement new cost-effective approaches for the detection of bacterial enteric pathogens with higher sensitivity and faster time to result. This study shows that multiplex real-time polymerase chain reaction-based tests, such as the TAQPATH Enteric Bacterial Select Panel, are accurate and cost-effective diagnostic alternatives for the detection and differentiation of the most common enteric bacterial pathogens, offering quicker time to result and higher sensitivity compared to routine stool culture.
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Affiliation(s)
- Jasmin Koeffer
- Department of Infectious Diseases, MVZ Labor Dr. Limbach & Kollegen GbR, Heidelberg, Germany
| | - Melissa Kolb
- Department of Infectious Diseases, MVZ Labor Dr. Limbach & Kollegen GbR, Heidelberg, Germany
| | - Oceane Sorel
- Thermo Fisher Scientific, South San Francisco, California, USA
| | | | | | - Ulrich Eigner
- Department of Infectious Diseases, MVZ Labor Dr. Limbach & Kollegen GbR, Heidelberg, Germany
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Fischer JAJ, Pei LX, Elango R, Hou K, Goldfarb DM, Karakochuk CD. Is a Lower Dose of More Bioavailable Iron (18-mg Ferrous Bisglycinate) Noninferior to 60-mg Ferrous Sulfate in Increasing Ferritin Concentrations While Reducing Gut Inflammation and Enteropathogen Detection in Cambodian Women? A Randomized Controlled Noninferiority Trial. J Nutr 2023; 153:2453-2462. [PMID: 37271416 DOI: 10.1016/j.tjnut.2023.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Global guidelines recommend untargeted iron supplementation for women in regions of anemia prevalence ≥40%, such as Cambodia. However, the potential harms of untargeted iron on the gut have not been rigorously studied in women and likely vary depending on iron dose and form. OBJECTIVES We investigated if a lower dose of a highly bioavailable iron amino acid chelate was as effective as the standard dose of iron salts in increasing ferritin concentrations and whether any differences were observed in gut inflammation or enteropathogen detection. METHODS A double-blind, randomized placebo-controlled noninferiority trial was conducted in Cambodia. Nonpregnant women (n = 480, 18-45 y) were randomly assigned to 60-mg ferrous sulfate, 18-mg ferrous bisglycinate, or placebo for 12 wk. Nonfasting blood and stool specimens were collected at baseline and 12 wk. Ferritin and fecal calprotectin were measured with an ELISA. A molecular assay was used to detect 11 enteropathogens in a random subset of n = 100 women. Generalized linear mixed-effects models were used to estimate the adjusted mean difference in ferritin concentrations at 12 wk (primary outcome), as compared with our 'a priori' noninferiority margin of 20 μg/L. RESULTS Baseline anemia and iron deficiency prevalence was low (17% and 6%, respectively). The adjusted mean difference in ferritin concentrations between the iron groups was 14.6 (95% confidence interval [CI]: 7.6, 21.6) μg/L. Mean ferritin concentration at 12 wk was higher in the ferrous sulfate (99 [95% CI: 95, 103] μg/L, P < 0.001) than in ferrous bisglycinate (84 [95% CI: 80, 88] μg/L) and placebo groups (78 [95% CI: 74, 82] μg/L). No differences in fecal calprotectin concentrations or enteropathogen detection were observed across groups at 12 wk. CONCLUSIONS Ferrous bisglycinate (18-mg) was not as effective as ferrous sulfate (60-mg) in increasing ferritin concentrations and did not differentially influence biomarkers of gut health in this predominantly iron-replete population of Cambodian women. This trial was registered at clinicaltrials.gov registry as NCT04017598.
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Affiliation(s)
- Jordie A J Fischer
- Food, Nutrition and Health, The University of British Columbia, Vancouver, Canada; BC Children's Hospital Research Institute, Vancouver, Canada
| | - Lulu X Pei
- Food, Nutrition and Health, The University of British Columbia, Vancouver, Canada; BC Children's Hospital Research Institute, Vancouver, Canada
| | - Rajavel Elango
- BC Children's Hospital Research Institute, Vancouver, Canada; Department of Pediatrics, the University of British Columbia, Vancouver, Canada
| | - Kroeun Hou
- Helen Keller International, Phnom Penh, Cambodia
| | - David M Goldfarb
- BC Children's Hospital Research Institute, Vancouver, Canada; Department of Pathology and Laboratory Medicine, the University of British Columbia, Vancouver, Canada
| | - Crystal D Karakochuk
- Food, Nutrition and Health, The University of British Columbia, Vancouver, Canada; BC Children's Hospital Research Institute, Vancouver, Canada.
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4
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Current methodologies and future direction of Campylobacter isolation and detection from food matrices, clinical samples, and the agricultural environment. J Microbiol Methods 2022; 201:106562. [PMID: 36049611 DOI: 10.1016/j.mimet.2022.106562] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 12/27/2022]
Abstract
Campylobacter spp. are the leading cause of bacterial foodborne infections in both developed and developing countries. The food commodities primarily attributed to campylobacteriosis include raw milk, poultry, seafood, and fresh produce. Furthermore, insects, animal/bird fecal material, and agricultural water have been shown to be the sources of Campylobacter contamination in these commodities. Both established and emerging species of Campylobacter have been recovered from food and environmental sources. Therefore, optimal detection and isolation of Campylobacter spp., including the emerging species, is critical for improved surveillance, prevention, and traceback of Campylobacter outbreaks. This review focuses on the existing variability in Campylobacter enrichment and isolation procedures used by researchers and regulatory agencies worldwide, for various matrices. Additionally, the challenges associated with developing and validating new culture, molecular, and immunological methods for rapid and sensitive Campylobacter detection are discussed.
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Rousou X, Furuya-Kanamori L, Kostoulas P, Doi SAR. Diagnostic accuracy of multiplex nucleic acid amplification tests for Campylobacter infection: a systematic review and meta-analysis. Pathog Glob Health 2022; 117:259-272. [PMID: 35815907 PMCID: PMC10081061 DOI: 10.1080/20477724.2022.2097830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Campylobacter infection is one of the most frequently reported foodborne diseases with approximately 230,000 and 1.5 million cases each year in Europe and the USA, respectively. Culture methods are the reference for the diagnosis of Campylobacter infections; however, these methods are complex and time-consuming. Multiplex nucleic acid amplification test is favored due to its rapidity, automatization in the procedure followed and the quick simultaneous testing of numerous foodborne pathogens. The aim of this meta-analysis was to evaluate the accuracy of these tests for the diagnosis of Campylobacter infection. Scopus, Science Direct, PubMed, Web of Science, and Mendeley were searched for peer-reviewed articles. The split component synthesis method with the use of the inverse variance heterogeneity model was chosen for the quantitative meta-analysis. Sensitivity analysis was performed by age category and index test. The literature search found 34 studies involving 28,105 patients with suspected gastroenteritis. The sensitivity and specificity were 95.3% (92.3; 97.1) and 97.1% (95.1; 98.3), respectively, and AUC (area under the curve) was 0.963 (0.947; 0.974). Pediatric patients had a lower sensitivity (87.4, 48.2; 98.1) and higher specificity (99.2, 91.6; 99.9) estimate compared to all ages category (sensitivity 95.3, 91.3; 97.5, specificity 96.7, 93.7; 98.3). Among the various index tests, Seeplex/Allplex and Amplidiag/Novodiag had the lowest estimate for sensitivity (88.9, 73.8; 95.8) and specificity (95.2, 86; 98.4), respectively. BDMax had the highest (sensitivity 98.1, 96.1; 99 and specificity 98.5, 97; 99.3). Multiplex nucleic acid tests showed excellent accuracy and could play an influential role in diagnosing Campylobacter infections.
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Affiliation(s)
- Xanthoula Rousou
- Laboratory of Epidemiology and Artificial Intelligence, Faculty of Public and One Health, School of Health Sciences, University of Thessaly, Karditsa, Greece
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, the University of Queensland, Herston, Queensland, Australia
| | - Polychronis Kostoulas
- Laboratory of Epidemiology and Artificial Intelligence, Faculty of Public and One Health, School of Health Sciences, University of Thessaly, Karditsa, Greece
| | - Suhail A R Doi
- Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar
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Teh R, Tee WD, Tan E, Fan K, Koh CJ, Tambyah PA, Oon J, Tee N, Soh AYS, Siah KTH. Review of the role of gastrointestinal multiplex polymerase chain reaction in the management of diarrheal illness. J Gastroenterol Hepatol 2021; 36:3286-3297. [PMID: 34129249 DOI: 10.1111/jgh.15581] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/19/2021] [Accepted: 06/13/2021] [Indexed: 01/25/2023]
Abstract
Acute and chronic diarrheal illness secondary to gastrointestinal infection is a significant cause of morbidity and mortality around the world. A cornerstone of management includes prompt diagnosis and appropriate treatment of culprit pathogens. Timely diagnosis can improve patient care, assist in infection control, and prevent disease outbreaks. Historical methods of diagnosis include traditional culture methods and stool analysis. These are limited by long turnaround time and inability to simultaneously assess multiple pathogens. The advent of multiplexed nucleic acid amplification tests first began with the Food and Drug Administration-approved respiratory virus multiplex polymerase chain reaction (PCR) panel in 2009, followed by gastrointestinal infections in 2013, and neurological infections in 2014. We conducted a review of current literature pertaining to the clinical utility of a gastrointestinal multiplex PCR in management of acute and chronic diarrhea in patients. To date, seven platforms approved by the US Food and Drug Administration are used in detection of various bacterial, viral, and parasitic causative organisms for diagnosis of gastrointestinal infections. The sensitivity and specificity of each assay vary depending on the tested organism. Interpretation of a positive result has to be tailored to the clinical context. Further studies are required to establish the utility of gastrointestinal multiplex PCR from a cost-based perspective, whether specific enteropathogens such as Clostridioides difficile are better assessed with toxin gene detection and whether new parameters such as cycle threshold values can improve clinical application of test results.
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Affiliation(s)
- Readon Teh
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore
| | - Wei De Tee
- Division of Gastroenterology and Hepatology, Ng Teng Fong General Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eunice Tan
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kristie Fan
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Calvin Jianyi Koh
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Paul Ananth Tambyah
- Division of Infectious Diseases, National University Hospital, Singapore.,Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jolene Oon
- Division of Infectious Diseases, National University Hospital, Singapore
| | - Nancy Tee
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Alex Yu Sen Soh
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Lee HW, Han SB, Rhim JW. Application of a Multiplex Polymerase Chain Reaction Test for Diagnosing Bacterial Enteritis in Children in a Real-Life Clinical Setting. CHILDREN-BASEL 2021; 8:children8070538. [PMID: 34202436 PMCID: PMC8307519 DOI: 10.3390/children8070538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to determine the subjects for bacterial multiplex polymerase chain reaction (mPCR) testing and to interpret the mPCR test results based on patients' clinical symptoms and diagnoses. The medical records of 710 pediatric patients who underwent a bacterial mPCR test were retrospectively reviewed. Clinical characteristics and mPCR test results were compared between patients with positive (n = 199) and negative mPCR test results (n = 511) and between patients with invasive pathogens (n = 95) and toxigenic pathogens (n = 70). Positive mPCR test results were significantly associated with older age (p < 0.001), diagnosis of acute gastroenteritis (p = 0.021), presence of hematochezia (p < 0.001), and absence of cough (p = 0.004). The diagnosis of acute gastroenteritis (p = 0.003), presence of fever (p = 0.027) and diarrhea (p = 0.043), and higher C-reactive protein levels (p = 0.025) were significantly associated with the identification of invasive pathogens in patients with positive mPCR test results. Thus, selective bacterial mPCR testing should be performed based on the patients' clinical symptoms and diagnoses, and the results should be interpreted in consideration with identified pathogens.
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Affiliation(s)
- Hyun-Woo Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.-W.L.); (J.-W.R.)
| | - Seung-Beom Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.-W.L.); (J.-W.R.)
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea
- Correspondence: ; Tel.: +82-42-220-9218
| | - Jung-Woo Rhim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.-W.L.); (J.-W.R.)
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea
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Ahn JS, Seo SI, Kim J, Kim T, Kang JG, Kim HS, Shin WG, Jang MK, Kim HY. Efficacy of stool multiplex polymerase chain reaction assay in adult patients with acute infectious diarrhea. World J Clin Cases 2020; 8:3708-3717. [PMID: 32953847 PMCID: PMC7479561 DOI: 10.12998/wjcc.v8.i17.3708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/04/2020] [Accepted: 08/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recently, stool multiplex polymerase chain reaction (PCR) tests have been developed for identifying diarrhea-causing bacterial pathogens. Furthermore, fecal calprotectin is a well-known effective marker for intestinal mucosal inflammation.
AIM To evaluate the efficacy of stool multiplex PCR and fecal calprotectin in acute infectious diarrhea.
METHODS Overall, 400 patients with acute infectious diarrhea were enrolled from Kangdong Sacred Heart Hospital (January 2016 to December 2018). Multiplex PCR detected 7 enteropathogenic bacteria including Salmonella, Campylobacter, Shigella, Escherichia coli O157:H7, Aeromonas, Vibrio, and Clostridium difficile. We reviewed clinical and laboratory findings using stool multiplex PCR.
RESULTS Stool multiplex PCR test detected considerably more bacterial pathogens than stool culture (49.2% vs 5.2%), with Campylobacter as the most common pathogen (54%). Patients with positive stool PCR showed elevated fecal calprotectin expression compared to patients with negative stool PCR (1124.5 ± 816.9 mg/kg vs 609 ± 713.2 mg/kg, P = 0.001). C-reactive protein (OR = 1.01, 95%CI: 1.001-1.027, P = 0.034) and sigmoidoscopy-detected colitis (OR = 4.76, 95%CI: 1.101-20.551, P = 0.037) were independent factors in stool PCR-based detection of bacterial pathogens. Sensitivity and specificity of calprotectin were evaluated to be 70.5% and 60.9%, respectively (adjusted cut-off value = 388 mg/kg).
CONCLUSION Stool multiplex PCR test has increased sensitivity in detecting pathogens than conventional culture, and it is correlated with calprotectin expression. Stool multiplex PCR and calprotectin may be effective in predicting clinical severity of infectious diarrhea.
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Affiliation(s)
- Jae Sung Ahn
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul KS013, South Korea
| | - Seung In Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
| | - Jinseob Kim
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul KS013, South Korea
| | - Taewan Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul KS013, South Korea
| | - Jin Gu Kang
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul KS013, South Korea
| | - Hyoung Su Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
| | - Woon Geon Shin
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
| | - Myoung Kuk Jang
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
| | - Hak Yang Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
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Gueudet T, Paolini MC, Buissonnière A, Trens A, Rousée JM, Lefranc M, Bénéjat L, Ducournau A, Mégraud F, Bessède E, Lehours P. How to Interpret a Positive Campylobacter PCR Result Using the BD MAX TM System in the Absence of Positive Culture? J Clin Med 2019; 8:jcm8122138. [PMID: 31817056 PMCID: PMC6947629 DOI: 10.3390/jcm8122138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/27/2019] [Accepted: 11/29/2019] [Indexed: 12/26/2022] Open
Abstract
The aim of this study was to evaluate, using two independent polymerase chain reaction (PCR) formats, the results of Campylobacter detection by the BD MAXTM Enteric Bacterial Panel PCR (Becton Dickinson, Le Pont de Claix, France) in the absence of positive culture. A total of 77 samples found positive for Campylobacter on BD MAXTM but negative by culture were studied. Upon reception, one in-house real-time-PCR for Campylobacter sp. and a PCR with the RIDAGENE Bacterial Stool Panel (r-biopharm, Darmstadt, Germany) were performed. The data obtained using these two PCR formats were evaluated with respect to the cycle threshold (Ct) and fluorescence intensity values (FI) obtained on BD MAXTM. Ct and FI values were also obtained for 80 positive Campylobacter cases by culture. Among the 77 samples, 33 were positive with the two PCRs, and 37 remained negative. For the 33 double-positive PCRs samples, the Ct values obtained on BD MAXTM were lower than 30 in 93.9%, and FI > 2000 for 97% of cases. For the 37 double-negative PCRs samples, the Ct values obtained on BD MAXTM were <30 in only 18.9%, however FI were >2000 for 40.5% of cases. Positive culture cases had Ct values < 30 in 96.2% and FI > 2000 in 98.8%. We showed that the Ct values obtained on BD MAXTM can help to interpret the results. Almost 96% of the Campylobactersp. cases detected by culture or with the two reference PCRs positive showed a Ct value on BD MAXTM, meaning that stools detected as positive with BD MAXTM and having a Ct > 30 may be false positives.
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Affiliation(s)
- Thomas Gueudet
- Laboratoire SCHUH, BIO67-BIOSPHERE, 67000 Strasbourg, France; (T.G.); (A.T.); (J.M.R.)
| | | | - Alice Buissonnière
- CHU Pellegrin, Laboratoire de Bactériologie, CNR Campylobacters et Hélicobacters, 33076 Bordeaux, France; (A.B.); (L.B.); (A.D.); (F.M.); (E.B.)
| | - Anne Trens
- Laboratoire SCHUH, BIO67-BIOSPHERE, 67000 Strasbourg, France; (T.G.); (A.T.); (J.M.R.)
| | - Jean Marc Rousée
- Laboratoire SCHUH, BIO67-BIOSPHERE, 67000 Strasbourg, France; (T.G.); (A.T.); (J.M.R.)
| | | | - Lucie Bénéjat
- CHU Pellegrin, Laboratoire de Bactériologie, CNR Campylobacters et Hélicobacters, 33076 Bordeaux, France; (A.B.); (L.B.); (A.D.); (F.M.); (E.B.)
| | - Astrid Ducournau
- CHU Pellegrin, Laboratoire de Bactériologie, CNR Campylobacters et Hélicobacters, 33076 Bordeaux, France; (A.B.); (L.B.); (A.D.); (F.M.); (E.B.)
| | - Francis Mégraud
- CHU Pellegrin, Laboratoire de Bactériologie, CNR Campylobacters et Hélicobacters, 33076 Bordeaux, France; (A.B.); (L.B.); (A.D.); (F.M.); (E.B.)
- INSERM UMR1053 BaRITOn, 33076 Bordeaux, France
| | - Emilie Bessède
- CHU Pellegrin, Laboratoire de Bactériologie, CNR Campylobacters et Hélicobacters, 33076 Bordeaux, France; (A.B.); (L.B.); (A.D.); (F.M.); (E.B.)
- INSERM UMR1053 BaRITOn, 33076 Bordeaux, France
| | - Philippe Lehours
- CHU Pellegrin, Laboratoire de Bactériologie, CNR Campylobacters et Hélicobacters, 33076 Bordeaux, France; (A.B.); (L.B.); (A.D.); (F.M.); (E.B.)
- INSERM UMR1053 BaRITOn, 33076 Bordeaux, France
- Correspondence: ; Tel.: +33-556-795-977; Fax: +33-557-821-977
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10
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Imdad A, Retzer F, Thomas LS, McMillian M, Garman K, Rebeiro PF, Deppen SA, Dunn JR, Woron AM. Impact of Culture-Independent Diagnostic Testing on Recovery of Enteric Bacterial Infections. Clin Infect Dis 2019; 66:1892-1898. [PMID: 29293941 DOI: 10.1093/cid/cix1128] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/22/2017] [Indexed: 12/25/2022] Open
Abstract
Background Culture-independent diagnostic tests (CIDTs) are increasingly used to identify enteric pathogens. However, foodborne illness surveillance systems have relied upon culture confirmation to estimate disease burden and identify outbreaks through molecular subtyping. This study examined the impacts of CIDT and estimated costs for culture verification of Shigella, Salmonella, Shiga toxin-producing Escherichia coli (STEC), and Campylobacter at the Tennessee Department of Health Public Health Laboratory (PHL). Methods This observational study included laboratory and epidemiological surveillance data collected between years 2013-2016 from patients with the reported enteric illness. We calculated pathogen recovery at PHL based on initial diagnostic test type reported at the clinical laboratory. Adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated with modified Poisson regression. Estimates of cost were calculated for pathogen recovery from CIDT-positive specimens compared to recovery from culture-derived isolates. Results During the study period, PHL received 5553 specimens from clinical laboratories from patients with the enteric illness. Pathogen recovery was 57% (984/1713) from referred CIDT-positive stool specimens and 95% (3662/3840) from culture-derived isolates (PR, 0.61 [95% CI, .56-.66]). Pathogen recovery from CIDT-positive specimens varied based on pathogen type: Salmonella (72%), Shigella (64%), STEC (57%), and Campylobacter (26%). Compared to stool culture-derived isolates, the cost to recover pathogens from 100 CIDT-positive specimens was higher for Shigella (US $6192), Salmonella (US $18373), and STEC (US $27783). Conclusions Pathogen recovery was low from CIDT-positive specimens for enteric bacteria. This has important implications for the current enteric disease surveillance system, outbreak detection, and costs for public health programs.
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Affiliation(s)
- Aamer Imdad
- D. Brent Polk Division of Pediatric Gastroenterology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Fiona Retzer
- Tennessee Department of Health, Nashville, Tennessee
| | | | | | - Katie Garman
- Tennessee Department of Health, Nashville, Tennessee
| | - Peter F Rebeiro
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Stephen A Deppen
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John R Dunn
- Tennessee Department of Health, Nashville, Tennessee
| | - Amy M Woron
- State Laboratories Division, Hawaii Department of Health, Pearl City
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Xu C, Akakuru OU, Zheng J, Wu A. Applications of Iron Oxide-Based Magnetic Nanoparticles in the Diagnosis and Treatment of Bacterial Infections. Front Bioeng Biotechnol 2019; 7:141. [PMID: 31275930 PMCID: PMC6591363 DOI: 10.3389/fbioe.2019.00141] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 05/28/2019] [Indexed: 12/12/2022] Open
Abstract
Diseases caused by bacterial infections, especially drug-resistant bacteria have seriously threatened human health throughout the world. It has been predicted that antimicrobial resistance alone will cause 10 million deaths per year and that early diagnosis and therapy will efficiently decrease the mortality rate caused by bacterial infections. Considering this severity, it is urgent to develop effective methods for the early detection, prevention and treatment of these infections. Until now, numerous efforts based on nanoparticles have been made to detect and kill pathogenic bacteria. Iron oxide-based magnetic nanoparticles (MNPs), as potential platforms for bacteria detection and therapy, have drawn great attention owing to their magnetic property. These MNPs have also been broadly used as bioimaging contrast agents and drug delivery and magnetic hyperthermia agents to diagnose and treat bacterial infections. This review therefore overviews the recent progress on MNPs for bacterial detection and therapy, including bacterial separation and enrichment in vitro, bacterial infection imaging in vivo, and their therapeutic activities on pathogenic bacteria. Furthermore, some bacterial-specific targeting agents, used to selectively target the pathogenic bacteria, are also introduced. In addition, the challenges and future perspective of MNPs for bacterial diagnosis and therapy are given at the end of this review. It is expected that this review will provide a better understanding toward the applications of MNPs in the detection and therapy of bacterial infections.
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Affiliation(s)
- Chen Xu
- Cixi Institute of Biomedical Engineering, Chinese Academy of Science (CAS) Key Laboratory of Magnetic Materials and Devices & Key Laboratory of Additive Manufacturing Materials of Zhejiang Province, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
- Department of Experimental Medical Science, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, China
| | - Ozioma Udochukwu Akakuru
- Cixi Institute of Biomedical Engineering, Chinese Academy of Science (CAS) Key Laboratory of Magnetic Materials and Devices & Key Laboratory of Additive Manufacturing Materials of Zhejiang Province, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Jianjun Zheng
- Department of Radiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Aiguo Wu
- Cixi Institute of Biomedical Engineering, Chinese Academy of Science (CAS) Key Laboratory of Magnetic Materials and Devices & Key Laboratory of Additive Manufacturing Materials of Zhejiang Province, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
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12
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Pigment Visibility on Rectal Swabs Used To Detect Enteropathogens: a Prospective Cohort Study. J Clin Microbiol 2019; 57:JCM.00213-19. [PMID: 30944189 DOI: 10.1128/jcm.00213-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 03/22/2019] [Indexed: 12/11/2022] Open
Abstract
Data are lacking regarding the impact of visible pigment on rectal swab diagnostic accuracy. We describe the test characteristics of rectal swabs with and without pigment in children with gastroenteritis. Between December 2014 and September 2017, children (age, <18 years) with ≥3 episodes of vomiting and/or diarrhea in a 24-h period and symptoms for <7 days were enrolled through two pediatric emergency departments and from a province-wide nursing telephone advice line in Alberta, Canada. Specimens were analyzed by employing nucleic acid amplification panels. The primary outcomes were the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the rectal swabs, with stool specimen results being used as the reference standard. An enteropathogen was detected in 76.0% (1,399/1,841) of the paired specimens. A total of 54.4% (1,001/1841) of the swabs had visible pigment. The respective enteropathogen detection characteristics of swabs with and without visible pigment were as follows: 92.2% (95% confidence interval [CI], 90.0%, 94.0%) versus 83.7% (95% CI, 80.5%, 86.4%) for sensitivity, 94.3% (95% CI, 90.5%, 96.6%) versus 91.2% (95% CI, 86.3%, 94.5%) for specificity, 97.9% (95% CI, 96.4%, 98.8%) versus 96.5% (95% CI, 94.5%, 97.8%) for PPV, and 80.9% (95% CI, 76.0%, 85.1%) versus 65.8% (95% CI, 60.0%, 71.1%) for NPV. Processing of swabs without visible pigment would increase the rate of identification of positive swabs from 50.0% (682/1,365) to 88.3% (1,205/1,365). There is a modest decrease in the reliability of a negative test on swabs without evidence of pigment, but the overall yield is significantly greater when they are not excluded from testing. Hence, rectal swabs without visible feces should not be routinely rejected from testing.
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13
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Buss JE, Cresse M, Doyle S, Buchan BW, Craft DW, Young S. Campylobacter culture fails to correctly detect Campylobacter in 30% of positive patient stool specimens compared to non-cultural methods. Eur J Clin Microbiol Infect Dis 2019; 38:1087-1093. [PMID: 30783889 PMCID: PMC6520473 DOI: 10.1007/s10096-019-03499-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/27/2019] [Indexed: 12/19/2022]
Abstract
Campylobacter diagnosis is hampered because many laboratories continue to use traditional stool culture, which is slow and suffers false-negative results. This large multi-site study used a composite reference method consisting of a new FDA-cleared immunoassay and four molecular techniques to compare to culture. Prospectively collected patient fecal specimens (1552) were first preliminarily categorized as positive or negative by traditional culture. All specimens were also tested by EIA, and any EIA-positive or culture-discrepant results were further characterized by 16S rRNA qPCR, eight species-specific PCR assays, bidirectional sequencing, and an FDA-cleared multiplex PCR panel. The five non-culture methods showed complete agreement on all positive and discrepant specimens which were then assigned as true-positive or true-negative specimens. Among 47 true-positive specimens, culture incorrectly identified 13 (28%) as negative, and 1 true-negative specimen as positive, for a sensitivity of 72.3%. Unexpectedly, among the true-positive specimens, 4 (8%) were the pathogenic species C. upsaliensis. Culture had a 30% false result rate compared to immunoassay and molecular methods. More accurate results lead to better diagnosis and treatment of suspected campylobacteriosis.
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Affiliation(s)
| | | | | | - Blake W Buchan
- Wisconsin Diagnostic Laboratories, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David W Craft
- Penn State Milton S. Hershey Medical Center and College of Medicine, Pathology and Laboratory Medicine, Hershey, PA, USA
| | - Steve Young
- TriCore Reference Laboratories, Albuquerque, NM, USA
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14
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Yoo J, Park J, Lee HK, Yu JK, Lee GD, Park KG, Oak HC, Park YJ. Comparative Evaluation of Seegene Allplex Gastrointestinal, Luminex xTAG Gastrointestinal Pathogen Panel, and BD MAX Enteric Assays for Detection of Gastrointestinal Pathogens in Clinical Stool Specimens. Arch Pathol Lab Med 2019; 143:999-1005. [PMID: 30763118 DOI: 10.5858/arpa.2018-0002-oa] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Infectious gastroenteritis is caused by various pathogens, including bacteria, viruses, and parasites. OBJECTIVE.— To compare the performance of Seegene Allplex Gastrointestinal (24 targets: 13 bacteria, 5 viruses, and 6 parasites in 4 panels), Luminex xTAG Gastrointestinal Pathogen Panel (15 targets: 9 bacteria, 3 viruses, and 3 parasites), and BD MAX Enteric panel (5 bacteria and 3 parasites). We estimated the agreement among 3 molecular assays. DESIGN.— A total of 858 stool samples (554 bacterial/parasite and 304 viral pathogens) were included. A consensus positive/negative was defined as concordant results from at least 2 tests. To evaluate the agreement among the assays, κ value was calculated. RESULTS.— The overall positive percentage agreements of Seegene, Luminex, and BD MAX were 94% (258 of 275), 92% (254 of 275), and 78% (46 of 59), respectfully. For Salmonella, Luminex showed low negative percentage agreement because of frequent false positives (n = 31) showing low median fluorescent intensity. For viruses, positive/negative percentage agreements of Seegene and Luminex were 99%/96% and 93%/99%, respectively. Compared with routine microbiology testing, Seegene, Luminex, and BD MAX additionally identified 39, 40, and 12 pathogens, respectively. Sixty-one cases (16 cases with Seegene, 51 cases with Luminex, and 1 case with BD MAX) showed positive results for multiple pathogens, but only 3 were consensus positive. CONCLUSIONS.— These multiplex molecular assays appear to be promising tools for the detection and identification of multiple gastrointestinal pathogens simultaneously. However, careful interpretation of positive results for multiple pathogens is required.
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Affiliation(s)
- Jaeeun Yoo
- From the Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs Yoo, J. Park, H. K. Lee, and Y.-J. Park); the Department of Laboratory Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea (Mss Yu and K. G. Park and Mr G. D. Lee); and the Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge (Ms Oak)
| | - Joonhong Park
- From the Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs Yoo, J. Park, H. K. Lee, and Y.-J. Park); the Department of Laboratory Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea (Mss Yu and K. G. Park and Mr G. D. Lee); and the Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge (Ms Oak)
| | - Hae Kyung Lee
- From the Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs Yoo, J. Park, H. K. Lee, and Y.-J. Park); the Department of Laboratory Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea (Mss Yu and K. G. Park and Mr G. D. Lee); and the Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge (Ms Oak)
| | - Jin Kyung Yu
- From the Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs Yoo, J. Park, H. K. Lee, and Y.-J. Park); the Department of Laboratory Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea (Mss Yu and K. G. Park and Mr G. D. Lee); and the Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge (Ms Oak)
| | - Gun Dong Lee
- From the Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs Yoo, J. Park, H. K. Lee, and Y.-J. Park); the Department of Laboratory Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea (Mss Yu and K. G. Park and Mr G. D. Lee); and the Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge (Ms Oak)
| | - Kang Gyun Park
- From the Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs Yoo, J. Park, H. K. Lee, and Y.-J. Park); the Department of Laboratory Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea (Mss Yu and K. G. Park and Mr G. D. Lee); and the Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge (Ms Oak)
| | - Hayeon Caitlyn Oak
- From the Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs Yoo, J. Park, H. K. Lee, and Y.-J. Park); the Department of Laboratory Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea (Mss Yu and K. G. Park and Mr G. D. Lee); and the Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge (Ms Oak)
| | - Yeon-Joon Park
- From the Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (Drs Yoo, J. Park, H. K. Lee, and Y.-J. Park); the Department of Laboratory Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea (Mss Yu and K. G. Park and Mr G. D. Lee); and the Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge (Ms Oak)
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Li H, Luo YF, Wang YS, Xiao YL, Cai HR, Xie CM. Pseudomonas aeruginosa induces cellular senescence in lung tissue at the early stage of two-hit septic mice. Pathog Dis 2018; 76:5289408. [PMID: 30649401 DOI: 10.1093/femspd/ftz001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 01/11/2019] [Indexed: 02/07/2023] Open
Abstract
We presume that severe secondary Pseudomonas aeruginosa (PA) infection can lead to cellular senescence in lung tissue and thus contribute to high mortality. We established a two-hit mouse model using cecal ligation and puncture (CLP) followed by sublethal PA lung infection. In lung tissue, increased infiltration of inflammatory cells, elevated lung injury and augmented cellular senescence was shown in mice with CLP followed by sublethal PA infection, and these observations reached a higher rank when higher (H) loads PA (PAO1) were administered to CLP mice (CLP + PAO1-H). Accordingly, oxidative stress-related element gp91phox and inflammation regulator NF-κB were greatly activated in CLP + PAO1-H mice compared to others. There was no obvious inflammation or cellular senescence in sham control, PAO1-infected mice. Consequently, CLP + PAO1-H mice had the highest expression levels of inflammatory cytokines IL-6, TNFα and iNOS among those groups. There was lower bacterial clearance ability in CLP + PAO1-H mice than in other mice. CLP + PAO1-H only had approximately 10% survival after 7 days of investigation and was much lower than others. In conclusion, higher mortality due to increased lung inflammation and cellular senescence are observed in mice with increased loads of PA infection secondary to CLP.
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Affiliation(s)
- Hui Li
- Department of Respiratory Medicine, the Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Yi-Feng Luo
- Department of Respiratory Medicine, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Yong-Sheng Wang
- Department of Respiratory Medicine, the Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Yong-Long Xiao
- Department of Respiratory Medicine, the Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Hou-Rong Cai
- Department of Respiratory Medicine, the Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China
| | - Can-Mao Xie
- Department of Respiratory Medicine, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
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16
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Kotar T, Pirš M, Steyer A, Cerar T, Šoba B, Skvarc M, Poljšak Prijatelj M, Lejko Zupanc T. Evaluation of rectal swab use for the determination of enteric pathogens: a prospective study of diarrhoea in adults. Clin Microbiol Infect 2018; 25:733-738. [PMID: 30315956 DOI: 10.1016/j.cmi.2018.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/27/2018] [Accepted: 09/30/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES A stool sample is the sample of choice for microbiological testing of enteric pathogens causing diarrhoea, but a rectal swab can be a more practical alternative. A prospective observational study was performed to evaluate the diagnostic performance of flocked rectal swab specimens using the syndromic molecular approach to determine the aetiology of diarrhoea in adults. METHODS We compared the performance of rectal swabs with stool samples as the reference standard in determining viral, bacterial and protozoal pathogens using real-time multiplex PCR as well as standard stool culture. Paired samples of stool and rectal swab specimens were collected from 304 adult patients with diarrhoea, presented at the Department of Infectious Diseases, University Medical Centre Ljubljana, between June 2016 and August 2017. RESULTS Overall sensitivity of rectal swab samples in the syndromic molecular approach was 83.2% (95% CI 77.2%-88.1%). Pathogen group-specific analysis of rectal swabs showed sensitivity of 65.6% (95% CI 52.7%-77.1%) for viruses and 57.1% (95% CI 28.9%-82.3%) for parasites. For bacteria, sensitivity was 86.5% (95% CI 79.5%-91.8%) when PCR was performed and 61.4% (95% CI 52.4%-69.9%) when culture for bacteria was performed. Mean threshold cycle (Ct) values for most pathogens were higher in rectal swab specimens than in stool specimens. CONCLUSIONS Our results indicate that rectal swabs can be used in the diagnosis of diarrhoea in adults when stool specimens are not available or when rapid aetiological determination is needed. However, rectal swabs should be analysed using a molecular approach. The mean Ct value for most pathogens is higher in rectal swab specimens than in stool specimens.
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Affiliation(s)
- T Kotar
- Infectious Diseases, University Clinical Centre Ljubljana, Ljubljana, Slovenia.
| | - M Pirš
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - A Steyer
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - T Cerar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - B Šoba
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - M Skvarc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - M Poljšak Prijatelj
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - T Lejko Zupanc
- Infectious Diseases, University Clinical Centre Ljubljana, Ljubljana, Slovenia
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17
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Verification and large scale clinical evaluation of a national standard protocol for Salmonella spp ./Shigella spp. screening using real-time PCR combined with guided culture. J Microbiol Methods 2018; 145:14-19. [DOI: 10.1016/j.mimet.2017.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/12/2017] [Accepted: 12/17/2017] [Indexed: 11/17/2022]
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Abstract
PURPOSE OF REVIEW Molecular-based diagnostic methods for the detection of gastrointestinal pathogens are becoming increasingly commonplace in microbiology laboratories. This review aims to summarize recent developments in this field and discuss the clinical application and limitations of implementing these techniques. RECENT FINDINGS Recent evaluations of multiplex PCR assays show increased sensitivity whenever compared with standard microbiological culture-based methods. In addition to shorter turnaround times, assays can detect an increased repertoire of pathogens from a single specimen and provide useful information for infection prevention and control practices. There are many limitations, however, associated with their use, including clinical interpretation of results and lack of concordance between different test panels. Newer technologies, such as metagenomic analysis, can provide comprehensive information useful to both patient management and public health surveillance. SUMMARY Molecular techniques are capable of replacing culture in the diagnosis of gastrointestinal infections. Whether all positive results, however, represent true infection is still debateable, as is the clinical significance of identifying more than one pathogen. As it currently stands, microbiological culture remains vital for public health surveillance, monitoring antibiotic resistance and managing outbreaks.
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Serichantalergs O, Ruekit S, Pandey P, Anuras S, Mason C, Bodhidatta L, Swierczewski B. Incidence of Campylobacter concisus and C. ureolyticus in traveler's diarrhea cases and asymptomatic controls in Nepal and Thailand. Gut Pathog 2017; 9:47. [PMID: 28824712 PMCID: PMC5561605 DOI: 10.1186/s13099-017-0197-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/10/2017] [Indexed: 12/17/2022] Open
Abstract
Background Campylobacter concisus and C. ureolyticus have emerged in recent years as being associated with acute and prolonged gastroenteritis and implicated in the development of inflammatory bowel diseases. However, there are limited data on the prevalence of these microorganisms in Southeast Asia. In this study, 214 pathogen-negative stool samples after laboratory examination for common enteric pathogens to include C. jejuni and C. coli by culture from two case–control traveler’s diarrhea (TD) studies conducted in Thailand (cases = 26; controls = 30) and Nepal (cases = 83; controls = 75) respectively were assayed by PCR for the detection of Campylobacter 16S rRNA and two specific heat shock protein genes specific for C. concisus (cpn60) and C. ureolyticus (Hsp60) respectively. Results Campylobacter 16S rRNA was detected in 28.5% (61/214) of the pathogen-negative TD stool samples (CIWEC Travel Medicine Clinic, Kathmandu, Nepal: cases = 36, control = 14; Bamrungrad International Hospital, Bangkok, Thailand: cases = 9, controls = 2). C. consisus was identified significantly more often in TD cases in Nepal (28.9%; 24/83) as compared to controls (4%; 3/75) (OR = 9.76; 95% CI 2.80–34.02; P = 0.0003) while C. consisus was detected in only two cases (2/26; 7.7%) and none of the controls stool samples from Thailand. C. ureolyticus was detected in four cases (4.8%; 4/83) and four controls (5.3%; 4/75) and in one case (3.8%; 1/26) and one control (3.1%; 1/30) from Nepal and Thailand respectively. C. jejuni and C. coli were isolated in 18.3 and 3.4% of the cases and in 4.0 and 1.4% of the controls in stool samples from both Thailand and Nepal respectively while C. concisus nor C. ureolyticus were not tested for in these samples. Conclusion These findings suggest that C. concisus potentially is a pathogen associated with TD in Nepal. To our knowledge, this is the first report of C. concisus and C. ureolyticus detected from traveler’s diarrhea cases from travelers to Nepal and Thailand.
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Affiliation(s)
- Oralak Serichantalergs
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok, 10400 Thailand
| | - Sirigade Ruekit
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok, 10400 Thailand
| | - Prativa Pandey
- CIWEC Clinic Travel Medicine Center, GPO Box 12895, Kapurdhara Marg, Kathmandu, 44600 Nepal
| | - Sinn Anuras
- Bumrungrad International Hospital, 33 Soi Sukhumvit 3, Khwaeng Khlong Toei Nuea, Khet Watthana, Bangkok, 10110 Thailand
| | - Carl Mason
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok, 10400 Thailand
| | - Ladaporn Bodhidatta
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok, 10400 Thailand
| | - Brett Swierczewski
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok, 10400 Thailand
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