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Tielli A, Ouorou R, Pull L, Souare K, Bouchaud O, Brutus L, Gay F, Siriez JY. Might procalcitonin help predict imported falciparum malaria in children? Travel Med Infect Dis 2024; 60:102731. [PMID: 38821330 DOI: 10.1016/j.tmaid.2024.102731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/26/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Procalcitonin (PCT) has been proposed as a marker for malaria severity in adults, with a threshold of 10 ng/ml for severe falciparum disease. Whether PCT is useful in children is debated. PATIENTS & METHODS A retrospective case-control study was conducted to compare initial PCT levels in children with uncomplicated malaria and a control group, and between children with uncomplicated and severe malaria. RESULTS Results showed significantly higher PCT levels in malaria cases compared to the control group and in malaria severe cases compared to uncomplicated cases. A Receiving Operator Characteristic curve established a PCT threshold of 0.65 ng/ml with a negative predictive value of 98.8 % based on a prevalence of 10 %. Analyzing the pooled results of five studies suggested a threshold of 6.17 ng/ml for differentiating uncomplicated and severe malaria. CONCLUSION PCT might be a useful tool to help rule out malaria and predict potential disease severity in returning travelers.
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Affiliation(s)
- Alexandra Tielli
- Service D'accueil des Urgences Pédiatriques, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), 75019, Paris, France
| | - Rachidou Ouorou
- Sorbonne Université, INSERM Institut Pierre-Louis Épidémiologie et Santé Publique, Hôpital Pitié-Salpêtrière, AP-HP, 75013, Paris, France
| | - Lauren Pull
- Service D'accueil des Urgences Pédiatriques, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), 75019, Paris, France
| | - Karamo Souare
- Service D'accueil des Urgences Pédiatriques, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), 75019, Paris, France
| | - Olivier Bouchaud
- Service des Maladies Infectieuses et Tropicales, Hôpital Avicenne, AP-HP, 93000, Bobigny, France
| | - Laurent Brutus
- Département de Médecine Générale, Faculté de Médecine, Université de Nantes, 44035, Nantes Cedex, France
| | - Frédérick Gay
- Sorbonne Université, INSERM Institut Pierre-Louis Épidémiologie et Santé Publique, Hôpital Pitié-Salpêtrière, AP-HP, 75013, Paris, France.
| | - Jean-Yves Siriez
- Service D'accueil des Urgences Pédiatriques, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), 75019, Paris, France
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Tripathy R, Das BK, Panda AK. Procalcitonin is elevated in severe malaria and is a promising biomarker of severe malaria and multi-organ dysfunction: A cross-sectional study and meta-analysis. Int Immunopharmacol 2023; 124:110923. [PMID: 37716164 DOI: 10.1016/j.intimp.2023.110923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Elevated procalcitonin (PCT) has been reported in bacterial infection and is positively associated with the severity of the disease. Patients with severe Plasmodium falciparum malaria also display higher procalcitonin levels compared to those with non-severe disease, indicating a possible role for bacterial infection in severe disease, however this observation remained variable in different study population. Furthermore, the significance of PCT in different clinical categories of severe malaria has not been evaluated so far. METHODS A total of 74 P. falciparum-infected subjects were enrolled in the study comprising of 55 cases complicated malaria [cerebral malaria- 14; non-cerebral severe malaria- 21; multi-organ dysfunction- 20] and 19 uncomplicated cases. Serum levels of PCT were quantified by fluorescence immunoassay. For meta-analysis, the literature search was performed in different databases, and all relevant articles were screened, and eligible reports were identified based on predefined inclusion and exclusion criteria. The meta-analysis was performed by comprehensive meta-analysis software V3 and MedCalc 20.218. RESULTS Patients with severe P. falciparum malaria had significantly higher PCT levels compared to uncomplicated cases (p = 0.01). Analysis of PCT in different categories of patients with severe malaria revealed significantly elevated PCT in multi-organ dysfunctions compared to those with uncomplicated malaria (p = 0.004) and cerebral malaria (p = 0.05). Interestingly the receiver operating characteristics curve analysis showed procalcitonin as a promising biomarker for differentiating severe malaria (AUC: 0.697, p = 0.01) and multi-organ dysfunction (AUC: 0.704, p = 0.007) from uncomplicated malaria and other clinical categories of falciparum malaria, respectively. Furthermore, meta-analysis also revealed an elevated procalcitonin in severe malaria and it could be an important biomarker in the management of severe disease. CONCLUSIONS PCT is elevated in P. falciparum-infected patients and could be a good biomarker for diagnosis of severe malaria and multi-organ dysfunction. It can help in the management of severe disease with additional treatment options.
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Affiliation(s)
- Rina Tripathy
- Department of Biochemistry, Sardar Vallabhbhai Patel Post Graduate Institute of Pediatrics, Cuttack, Odisha 753002, India.
| | - Bidyut K Das
- Department of Clinical Immunology and Rheumatology, SCB Medical College, Cuttack, Odisha 753007, India.
| | - Aditya K Panda
- Department of Biotechnology, Berhampur University, Bhanja Bihar, Berhampur, Odisha 760007, India; Centre of Excellence on "Bioprospecting of Ethnopharmaceuticals of Southern Odisha" (CoE-BESO), Berhampur University, Bhanja Bihar, Berhampur, Odisha 760007, India.
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3
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Balerdi-Sarasola L, Parolo C, Fleitas P, Cruz A, Subirà C, Rodríguez-Valero N, Almuedo-Riera A, Letona L, Álvarez-Martínez MJ, Valls ME, Vera I, Mayor A, Muñoz J, Camprubí-Ferrer D. Host biomarkers for early identification of severe imported Plasmodium falciparum malaria. Travel Med Infect Dis 2023; 54:102608. [PMID: 37348666 DOI: 10.1016/j.tmaid.2023.102608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Severe imported P. falciparum malaria is a source of morbi-mortality in non-endemic regions. WHO criteria don't accurately classify patients at risk of complications. There is a need to evaluate new tools such as biomarkers to better identify patients with severe imported malaria. METHODS A case-control study was conducted in Barcelona, from January 2011-January 2021. Adult patients with microbiologically confirmed P. falciparum malaria were classified according to WHO criteria. Patients with imported non-malarial fevers were included as controls. In each group, angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), soluble triggering receptor expressed on myeloid cells (sTREM-1), C-reactive protein (CRP) and platelets were measured and their concentrations were compared between groups. New groups were made with a modified WHO severity classification and biomarkers' performance was evaluated using multiple imputation models. RESULTS 131 participants were included: 52 severe malaria, 30 uncomplicated malaria and 49 non-malarial fever cases. All biomarkers except sTREM-1 showed significant differences between groups. Using the modified WHO severity classification, Ang-2 and CRP presented the best AUROC; 0.79 (95%CI 0.64-0.94) and 0.80(95%CI 0.67-0.93). A model combining CRP and Ang-2 showed the best AUROC, of 0.84(95%CI 0.68-0.99), with the highest sensitivity and specificity: 84.6%(95%CI 58.9-98.1) and 77.4% (95%CI 65.9-87.7), respectively. CONCLUSIONS The combination of Ang-2 and CRP may be a reliable tool for the early identification of severe imported malaria. The use of a rapid prognostic test including the mentioned biomarkers could optimize imported malaria management, with the potential to decrease the rate of complications and hospitalizations in patients with imported malaria.
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Affiliation(s)
| | - C Parolo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - P Fleitas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - A Cruz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - C Subirà
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - A Almuedo-Riera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - L Letona
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - M J Álvarez-Martínez
- Microbiology Department, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - M Eugenia Valls
- Microbiology Department, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - I Vera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - A Mayor
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - J Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; CIBERINFEC, ISCIII - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - D Camprubí-Ferrer
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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Kreyer M, Behringer V, Deimel C, Fruth B. Neopterin Levels in Bonobos Vary Seasonally and Reflect Symptomatic Respiratory Infections. ECOHEALTH 2023:10.1007/s10393-023-01633-y. [PMID: 37184594 DOI: 10.1007/s10393-023-01633-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 05/16/2023]
Abstract
As environmental changes exacerbate the threat coming from infectious diseases in wild mammal species, monitoring their health and gaining a better understanding of the immune functioning at the species level have become critically important. Neopterin is a biomarker of cell-mediated immune responses to intracellular infections. We investigated the variation of urinary neopterin (uNeo) levels of wild, habituated bonobos (Pan paniscus) in relation to individual and environmental factors. We used 309 urine samples collected between 2010 and 2018 at the LuiKotale field site, DRC. Based on current knowledge on zoo-housed conspecifics and closely related species, we predicted uNeo levels to increase (1) during infections, (2) with increasing age, (3) over the gestation period and in estrous females; and (4) to vary seasonally. Our results showed uNeo levels varied over a one-year period and increased in individuals showing respiratory symptoms. Contrary to chimpanzees, uNeo levels did not vary with age or female reproductive status, possibly due to our small sample size. Our study provides a baseline for a better understanding of bonobo's immunocompetence in the context of socio-ecological pressures and for monitoring the health of wild populations.
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Affiliation(s)
- Mélodie Kreyer
- Department for the Ecology of Animal Societies, Max-Planck Institute of Animal Behavior, Bücklestraße 5 a, 78467, Constance, Germany.
- Centre for Research and Conservation, Royal Zoological Society of Antwerp, Antwerp, Belgium.
- School of Biological and Environmental Sciences, Faculty of Science, Liverpool John Moores University, Liverpool, UK.
| | - Verena Behringer
- Endocrinology Laboratory, German Primate Center, Leibniz Institute for Primate Research, Göttingen, Germany
| | - Caroline Deimel
- Research Group Evolutionary Physiology, Max Planck Institute for Ornithology, Seewiesen, Germany
| | - Barbara Fruth
- Department for the Ecology of Animal Societies, Max-Planck Institute of Animal Behavior, Bücklestraße 5 a, 78467, Constance, Germany
- Centre for Research and Conservation, Royal Zoological Society of Antwerp, Antwerp, Belgium
- School of Biological and Environmental Sciences, Faculty of Science, Liverpool John Moores University, Liverpool, UK
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Blankson SO, Rietmeyer L, Tettey P, Dikroh L, Tornyigah B, Adamou R, Moussiliou A, Padounou C, Amoussou A, Mensah BA, Alao MJ, Awandare G, Ndam NT, Roussilhon C, Tahar R. High Plasma Levels of Neopterin Are Associated with Increased Mortality among Children with Severe Malaria in Benin. Diagnostics (Basel) 2023; 13:diagnostics13030528. [PMID: 36766633 PMCID: PMC9914932 DOI: 10.3390/diagnostics13030528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023] Open
Abstract
Among the barriers to accessing adequate treatment and high-level monitoring for malaria febrile patients is the lack of effective prognostic markers. Neopterin, which is a marker of monocyte/macrophage activation, was found have increased during severe malaria. In this study, we used quantitative ELISA in order to assess the levels of plasma soluble neopterin in 151 patients from a cohort of Beninese children with severe malaria. We evaluated the prognostic accuracy of this molecule in order to predict the outcome of the disease. Our results show that neopterin levels were not significantly different between patients with different forms of severe malaria, including severe non-cerebral malaria (SNCM) and cerebral malaria (CM). However, the levels of this molecule were found to be higher in patients with severe malarial anemia (SMA) among both CM and SNCM cases (p-value = 0.02). Additionally, the levels of this molecule were found to be higher in patients who died from these pathologies compared to those who survived among the two clinical groups (p-value < 0.0001) and within the same group (p-value < 0.0001 for the CM group, p-value = 0.0046 for the SNCM group). The AUC-ROC for fatality among all the severe cases was 0.77 with a 95%CI of (0.69-0.85). These results suggest that plasma neopterin levels constitute a potential biomarker for predicting fatality among severe falciparum malaria patients.
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Affiliation(s)
- Samuel Odarkwei Blankson
- MERIT, IRD, Université de Paris Cité, 75006 Paris, France
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra LG 54, Ghana
| | | | - Patrick Tettey
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra LG 54, Ghana
| | - Liliane Dikroh
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra LG 54, Ghana
| | - Bernard Tornyigah
- MERIT, IRD, Université de Paris Cité, 75006 Paris, France
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra LG 54, Ghana
| | - Rafiou Adamou
- Institut de Recherche Clinique du Benin (IRCB), Calavi, Benin
| | | | | | - Annick Amoussou
- Service de Pédiatrie, Centre Hospitalo-Universitaire, Suruléré (CHU-Suruléré), Cotonou, Benin
| | - Benedicta Ayiedu Mensah
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra LG 54, Ghana
| | - Maroufou J. Alao
- Département de Pédiatrie, Hôpital Mère-Enfant la Lagune (CHUMEL), Cotonou, Benin
| | - Gordon Awandare
- West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra LG 54, Ghana
| | - Nicaise Tuikue Ndam
- MERIT, IRD, Université de Paris Cité, 75006 Paris, France
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra LG 54, Ghana
| | | | - Rachida Tahar
- MERIT, IRD, Université de Paris Cité, 75006 Paris, France
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra LG 54, Ghana
- Correspondence: ; Tel.: +331-70-64-94-33
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Mahittikorn A, Kotepui KU, Mala W, Wilairatana P, Kotepui M. Procalcitonin as a Candidate Biomarker for Malarial Infection and Severe Malaria: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11389. [PMID: 36141662 PMCID: PMC9517210 DOI: 10.3390/ijerph191811389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
Procalcitonin (PCT), as a marker of malaria severity, remains to be investigated. The present study collated and compared the levels of PCT between patients with severe malaria, uncomplicated malaria, and control participants to assess their role in predicting malaria infection and disease severity. The systematic review was registered at PROSPERO with registration number CRD42021297243. The search for relevant studies that reported PCT in patients with malaria was performed in PubMed, Scopus, and Web of Science. The following meta-analyses were conducted; (1) the pooled mean PCT levels in patients with severe and uncomplicated malaria, and (2) the pooled mean difference in PCT levels between patients with severe and uncomplicated malaria. Fifteen studies were included for qualitative and quantitative syntheses. The meta-analysis results show that the pooled mean PCT levels in patients with uncomplicated malaria were 3.92 ng/mL (95% CI: 2.26-5.58 ng/mL, I2: 96.5, five studies), whereas the pooled mean PCT levels in patients with severe malaria were 14.13 ng/mL (95% CI: 8.75-19.5 ng/mL, I2: 92.6, six studies). The meta-analysis showed that patients with severe malaria had an equal mean of PCT compared to those with uncomplicated malaria when the random-effects model was used (p: 0.055, weighted mean difference: 6.93, 95% CI: -0.16-14.02, I2: 84.6%, four studies). There were probable correlations between the level of parasitemia, immunity level, and possibly bacterial or other parasitic co-infection that could affect the PCT level among different clinical severities of malaria. Therefore, the PCT level alone does not seem to be a suitable biomarker to discriminate the severe/uncomplicated or infected/uninfected cases. Further studies should investigate the increased PCT levels in combination with other markers in association with malaria infection and severity.
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Affiliation(s)
- Aongart Mahittikorn
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Kwuntida Uthaisar Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat 80160, Thailand
| | - Wanida Mala
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat 80160, Thailand
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Manas Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat 80160, Thailand
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Huang L, Jin H, Zhang H, Liu Y, Shi X, Kang X, Zeng Y, Wang L. Factors associated with prolonged hospital stay of imported malaria cases in Chengdu, China: a retrospective study. BMC Infect Dis 2022; 22:496. [PMID: 35619071 PMCID: PMC9134717 DOI: 10.1186/s12879-022-07464-6] [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] [Received: 04/25/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although China has entered the post-malaria-elimination era, imported cases remain a public health concern in China. METHODS We retrospectively analyzed data from cases of imported malaria from January 2017 to December 2020 in Chengdu Public Health Clinical Center. We assessed potential clinical, epidemiological, geographical, and seasonal effects on duration of hospital stay. Cox proportional hazards model was used to identify predictive factors for prolonged hospital stay. Multivariate logistic regression was used to assess the potential risk factors associated with severe cases. RESULTS The highest number of imported cases of malaria were from the Democratic Republic of the Congo (23%, 34/150) and most patients (74%, 26/34) were infected by Plasmodium falciparum. The Edwards test indicated no significant seasonality in imported cases of malaria (χ2 = 2.51, p = 0.28). Bacterial infection (adjusted hazard ratio [aHR] for discharge = 0.58, p = 0.01) and thrombocytopenia (aHR = 0.66, p = 0.02) were risk factors for prolonged hospital stay. The C-reactive protein (OR = 1.02, p = 0.01) and procalcitonin (OR = 1.03, p = 0.01) were risk factors for severe cases. CONCLUSIONS Bacterial infection and thrombocytopenia are risk factors for prolonged hospital stay among imported malaria cases. The C-reactive protein and procalcitonin level were risk factors for severe cases.
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Affiliation(s)
- Liang Huang
- Chengdu Public Health Clinical Center, Chengdu City, 610000, Sichuan Province, China
| | - Hong Jin
- Chengdu Public Health Clinical Center, Chengdu City, 610000, Sichuan Province, China
| | - Hong Zhang
- Chengdu Public Health Clinical Center, Chengdu City, 610000, Sichuan Province, China
| | - Yang Liu
- Sichuan Center for Disease Control and Prevention, Chengdu City, 610000, Sichuan Province, China
| | - Xinxing Shi
- Chengdu Public Health Clinical Center, Chengdu City, 610000, Sichuan Province, China
| | - Xintong Kang
- Chengdu Public Health Clinical Center, Chengdu City, 610000, Sichuan Province, China
| | - Yilan Zeng
- Chengdu Public Health Clinical Center, Chengdu City, 610000, Sichuan Province, China
| | - Lin Wang
- Chengdu Public Health Clinical Center, Chengdu City, 610000, Sichuan Province, China.
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8
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Katte JC, Penanje K, Agoons BB, Djahmeni EN, Mbacham-Ngwafor S, Moor VJA, Koki P, Mbacham W. Procalcitonin levels in children affected by severe malaria compared to those with uncomplicated malaria in the absence of bacterial infection: a cross-sectional study. Trop Dis Travel Med Vaccines 2022; 8:5. [PMID: 35287734 PMCID: PMC8922881 DOI: 10.1186/s40794-022-00163-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Procalcitonin is an inflammatory marker strongly associated with the presence of bacterial infection. It has been considered raised in severe malaria infection as opposed to uncomplicated malaria. There are suggestions that it may be raised only when there is concomitant unnoticeable bacterial infection during a malaria crisis. We aimed to assess the difference in plasma procalcitonin levels between children affected by severe and uncomplicated malaria. METHODS We assessed plasma procalcitonin levels in 83 children diagnosed with malaria with no clinical and biological evidence of concomitant bacterial infection. Severity of malaria was established using WHO guidelines. Procalcitonin was determined using the ELISA method. Non-parametric Mann-Whitney U test was used to compare medians across the 2 groups. Statistical significance was set for all p values < 0.05. RESULTS Of the 83 participants, 28 had uncomplicated malaria, and 55 had severe malaria. PCT levels were obtained in 24 and 40 subjects of each group, respectively, and were similar in both groups; [2.76 (2.52-2.93) vs 2.74 (2.52-2.98) ng/ml, p = 0.916]. The parasite density was lower in the uncomplicated malaria group than in the severe malaria group, but not statistically significant; [22,192 (9110-44 654) vs 31 684 (13 960-73 500) parasites/μl, p = 0.178]. There was no correlation between the parasite density in the general study population and PCT levels (r = 0.072, p = 0.572). CONCLUSION In the absence of overt bacterial infection, procalcitonin levels are not different between children affected with uncomplicated malaria and those with severe malaria. Therefore, bacterial infection should be thoroughly checked for in children with raised serum procalcitonin diagnosed with severe malaria.
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Affiliation(s)
- Jean-Claude Katte
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon. .,National Obesity Centre and Endocrinology and Metabolic Diseases Unit, Yaounde Central Hospital, Yaounde, Cameroon.
| | - Kiya Penanje
- Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Batakeh B Agoons
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Eric Noel Djahmeni
- National Obesity Centre and Endocrinology and Metabolic Diseases Unit, Yaounde Central Hospital, Yaounde, Cameroon
| | - Sharon Mbacham-Ngwafor
- Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Vicky Jocelyne Ama Moor
- Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Paul Koki
- Mother and Child Centre, Chantal Biya Foundation, Yaounde, Cameroon
| | - Wilfred Mbacham
- Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon.,Laboratory for Public Health Biotechnologies, the Biotechnology Centre, University of Yaounde 1, Yaounde, Cameroon
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Behringer V, Deimel C, Stevens JMG, Kreyer M, Lee SM, Hohmann G, Fruth B, Heistermann M. Cell-Mediated Immune Ontogeny Is Affected by Sex but Not Environmental Context in a Long-Lived Primate Species. Front Ecol Evol 2021. [DOI: 10.3389/fevo.2021.629094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Ecoimmunology conceptualizes the role of immunity in shaping life history in a natural context. Within ecoimmunology, macroimmunology is a framework that explains the effects of habitat and spatial differences on variation in immune phenotypes across populations. Within these frameworks, immune ontogeny—the development of the immune system across an individual life span—has received little attention. Here, we investigated how immune ontogeny from birth until adulthood is affected by age, sex, and developmental environment in a long-lived primate species, the bonobo. We found a progressive, significant decline of urinary neopterin levels, a marker for the cell-mediated immune response, from birth until 5 years of age in both sexes. The overall pattern of age-related neopterin changes was sex-specific, with males having higher urinary neopterin levels than females in the first 3 years of life, and females having higher levels than males between 6 and 8 years. Environmental condition (zoo-housed vs. wild) did not influence neopterin levels, nor did age-related changes in neopterin levels differ between environments. Our data suggest that the post-natal development of cell-mediated immune ontogeny is sex-specific but does not show plasticity in response to environmental conditions in this long-lived primate species. This indicates that cell-mediated immune ontogeny in the bonobo follows a stereotypic and maybe a genetically determined pattern that is not affected by environmental differences in pathogen exposure and energy availability, but that sex is an important, yet often overlooked factor shaping patterns of immune ontogeny. Investigating the causes and consequences of variation in immunity throughout life is critical for our understanding of life-history evolution and strategies, mechanisms of sexual selection, and population dynamics with respect to pathogen susceptibility. A general description of sex-specific immune ontogeny as done here is a crucial step in this direction, particularly when it is considered in the context of a species’ ecology and evolutionary history.
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de Oliveira Matos A, Dos Santos Dantas PH, Figueira Marques Silva-Sales M, Sales-Campos H. The role of the triggering receptor expressed on myeloid cells-1 (TREM-1) in non-bacterial infections. Crit Rev Microbiol 2020; 46:237-252. [PMID: 32326783 DOI: 10.1080/1040841x.2020.1751060] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The triggering receptor expressed on myeloid cells 1 (TREM-1) is a receptor of the innate immune system, expressed mostly by myeloid cells and primarily associated with pro- inflammatory responses. Although the exact nature of its ligands has not yet been fully elucidated, many microorganisms or danger signals have been proposed as inducers of its activation or the secretion of sTREM-1, the soluble form with putative anti-inflammatory effects. In the course of the 20 years since its first description, several studies have investigated the involvement of TREM-1 in bacterial infections. However, the number of studies describing the role of TREM-1 in fungal, viral and parasite-associated infections has only increased in the last few years, showing a diverse contribution of the receptor in these scenarios, with beneficial or detrimental activities depending on the context. Therefore, this review aims to discuss how TREM-1 may influence viral, fungal and parasitic infection outcomes, highlighting its potential as a therapeutic target and biomarker for diagnosis and prognosis of non-bacterial infectious diseases.
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Löhrich T, Behringer V, Wittig RM, Deschner T, Leendertz FH. The Use of Neopterin as a Noninvasive Marker in Monitoring Diseases in Wild Chimpanzees. ECOHEALTH 2018; 15:792-803. [PMID: 30117002 DOI: 10.1007/s10393-018-1357-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 05/28/2023]
Abstract
Pathogen analysis in wild great apes is both time- and resource-consuming. Therefore, we examined the potential use of urinary neopterin, a sensitive marker of cell-mediated immune system activation, as a disease marker and unspecific screening tool to facilitate informed pathogen analysis in great ape health monitoring. To test this, urinary neopterin was correlated to other disease markers such as sickness behaviors, fever, and urine parameters. Seasonal variation in urinary neopterin levels was investigated as well. The study encompassed noninvasively collected longitudinal data of young wild chimpanzees from the Taï National Park, Côte d´Ivoire. Relationships between disease markers were examined using a linear mixed model and a case study approach. Seasonal variation in urinary neopterin was tested using a linear mixed model. While the linear mixed model found no obvious relationship between urinary neopterin levels and other disease markers, the case study approach revealed a pattern resembling those found in humans. Urinary neopterin levels indicated seasonal immune system activation peaking in times of low ambient temperatures. We suggest the use of urinary neopterin as an unspecific screening tool in great ape health monitoring to identify relevant samples, individuals, and time periods for selective pathogen analysis and zoonotic risk assessment.
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Affiliation(s)
- Therese Löhrich
- Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
- Department of Primatology, Max Planck Institute for Evolutionary Anthropology, 04103, Leipzig, Germany
- Institute of Microbiology and Epizootics, Free University, 14163, Berlin, Germany
| | - Verena Behringer
- Department of Primatology, Max Planck Institute for Evolutionary Anthropology, 04103, Leipzig, Germany
| | - Roman M Wittig
- Department of Primatology, Max Planck Institute for Evolutionary Anthropology, 04103, Leipzig, Germany
- Taï Chimpanzee Project, Centre Suisse de Recherches Scientifiques, Abidjan 01, Côte d'Ivoire
| | - Tobias Deschner
- Department of Primatology, Max Planck Institute for Evolutionary Anthropology, 04103, Leipzig, Germany
| | - Fabian H Leendertz
- Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany.
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Antinori S, Corona A, Castelli A, Rech R, Borghi B, Giannotti C, Colombo R, Fossali T, Ballone E, Minari C, Perotti A, Bergomi P, Galimberti L, Milazzo L, Ricaboni D, Scorza D, Grande R, Genderini F, Ieri M, Raimondi F, Catena E, Galli M, Corbellino M. Severe Plasmodium falciparum malaria in the intensive care unit: A 6-year experience in Milano, Italy. Travel Med Infect Dis 2017; 17:43-49. [PMID: 28554853 DOI: 10.1016/j.tmaid.2017.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/02/2017] [Accepted: 05/23/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Severe imported Plasmodium falciparum malaria is a potentially life-threatening disease with a reported mortality rate of 5-10% when patients are admitted to the Intensive Care Unit. METHODS To retrospectively review the clinical aspects, the value of severity predictive scores and the management of patients with severe P. falciparum malaria admitted to an ICU in Milano, Italy between January 2010 and December 2015. RESULTS Twelve patients were included: seven were male and five female with a median age of 43 years. All were initially treated with intravenous quinine. Median parasitaemia upon admission was 14,5% (range 1-20%). At the time of ICU admission, 3 patients (25%) had 5 or more World Health Organization criteria for severe malaria while another 6 of them developed one or more of the latter during their stay in ICU. Five required mechanical ventilation because of respiratory failure due to ARDS. Four patients required renal replacement therapy. Three patients underwent blood exchange transfusion. All patients survived. CONCLUSIONS Our retrospective evaluation of adults patients admitted to the ICU with severe imported P. falciparum malaria demonstrated a favourable outcome. Severity predictive scores currently in use probably overestimate the risk of malaria mortality in patients treated in health care systems of high income countries.
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Affiliation(s)
- Spinello Antinori
- Department of Clinical and Biomedical Sciences Luigi Sacco, University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy.
| | - Alberto Corona
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Antonio Castelli
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Roberto Rech
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Beatrice Borghi
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Claudia Giannotti
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Riccardo Colombo
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Tommaso Fossali
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Elisabetta Ballone
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Caterina Minari
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Andrea Perotti
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Paola Bergomi
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Laura Galimberti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Davide Ricaboni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Daniele Scorza
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Romualdo Grande
- Department of Diagnostic Services, Clinical Microbiology, Virology and Bioemergence Diagnostics, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Francesco Genderini
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Marco Ieri
- Hematology and Transfusion Medicine, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Ferdinando Raimondi
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Emanuele Catena
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Massimo Galli
- Department of Clinical and Biomedical Sciences Luigi Sacco, University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
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Imported falciparum malaria in adults: host- and parasite-related factors associated with severity. The French prospective multicenter PALUREA cohort study. Intensive Care Med 2016; 42:1588-1596. [DOI: 10.1007/s00134-016-4356-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 04/11/2016] [Indexed: 01/25/2023]
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Righi E, Merelli M, Arzese A, Siega PD, Scarparo C, Bassetti M. Determination of PCT on admission is a useful tool for the assessment of disease severity in travelers with imported Plasmodium falciparum malaria. Acta Parasitol 2016; 61:412-8. [PMID: 27078668 DOI: 10.1515/ap-2016-0055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 01/20/2016] [Indexed: 01/01/2023]
Abstract
Procalcitonin (PCT) and C-reactive protein (CRP) may be useful to predict complicated forms of malaria. A total of 30 consecutive travelers diagnosed with Plasmodium falciparum malaria over a two-year period were included in the study. Patients with complicated Plasmodium falciparum malaria showed higher levels of parasitemia (P = 0.0001), PCT (P = 0.0018), CRP (P = 0.0005), bilirubinemia (P = 0.004), and a lower platelet count (P<0.0001) compared with patients with uncomplicated forms. PCT levels above 5 ng/mL showed the highest value of specificity (0.86) and positive predictive factor (0.67) among other parameters, and equal sensitivity (0.67) was displayed by CRP levels above 150 mg/dl. None of the patients with complicated malaria showed PCT levels within normal limits (<0.5 ng/ml). Both PCT and CRP correlated with parasitemia (P<0.001) and showed areas under ROC curve of 0.83. At multivariate analysis, only PCT was associated with an increased risk of complicated malaria (OR 8.2, IC 95% 1.2-57.2, P = 0.03). The determination of PCT on admission showed better results compared to CRP, platelet count, and bilirubinemia and can be useful in non-endemic areas for the initial clinical assessment of disease severity in travelers with Plasmodium falciparum malaria.
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Rubach MP, Mukemba J, Florence S, Lopansri BK, Hyland K, Volkheimer AD, Yeo TW, Anstey NM, Weinberg JB, Mwaikambo ED, Granger DL. Impaired systemic tetrahydrobiopterin bioavailability and increased oxidized biopterins in pediatric falciparum malaria: association with disease severity. PLoS Pathog 2015; 11:e1004655. [PMID: 25764173 PMCID: PMC4357384 DOI: 10.1371/journal.ppat.1004655] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 01/05/2015] [Indexed: 12/17/2022] Open
Abstract
Decreased bioavailability of nitric oxide (NO) is a major contributor to the pathophysiology of severe falciparum malaria. Tetrahydrobiopterin (BH4) is an enzyme cofactor required for NO synthesis from L-arginine. We hypothesized that systemic levels of BH₄ would be decreased in children with cerebral malaria, contributing to low NO bioavailability. In an observational study in Tanzania, we measured urine levels of biopterin in its various redox states (fully reduced [BH₄] and the oxidized metabolites, dihydrobiopterin [BH₂] and biopterin [B₀]) in children with uncomplicated malaria (UM, n = 55), cerebral malaria (CM, n = 45), non-malaria central nervous system conditions (NMC, n = 48), and in 111 healthy controls (HC). Median urine BH4 concentration in CM (1.10 [IQR:0.55-2.18] μmol/mmol creatinine) was significantly lower compared to each of the other three groups - UM (2.10 [IQR:1.32-3.14];p<0.001), NMC (1.52 [IQR:1.01-2.71];p = 0.002), and HC (1.60 [IQR:1.15-2.23];p = 0.005). Oxidized biopterins were increased, and the BH4:BH2 ratio markedly decreased in CM. In a multivariate logistic regression model, each Log10-unit decrease in urine BH4 was independently associated with a 3.85-fold (95% CI:1.89-7.61) increase in odds of CM (p<0.001). Low systemic BH4 levels and increased oxidized biopterins contribute to the low NO bioavailability observed in CM. Adjunctive therapy to regenerate BH4 may have a role in improving NO bioavailability and microvascular perfusion in severe falciparum malaria.
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Affiliation(s)
- Matthew P. Rubach
- Department of Medicine, Duke University and VA Medical Centers, Durham, North Carolina, United States of America
| | - Jackson Mukemba
- Department of Pediatrics, Hubert Kairuki Memorial University, Dar es Salaam, United Republic of Tanzania
| | - Salvatore Florence
- Department of Pediatrics, Hubert Kairuki Memorial University, Dar es Salaam, United Republic of Tanzania
| | - Bert K. Lopansri
- Department of Medicine, Intermountain Healthcare, Salt Lake City, Utah, United States of America
- Department of Medicine, University of Utah School of Medicine and VA Medical Center, Salt Lake City, Utah, United States of America
| | - Keith Hyland
- Neurochemistry Division, Medical Neurogenetics, Atlanta, Georgia, United States of America
| | - Alicia D. Volkheimer
- Department of Medicine, Duke University and VA Medical Centers, Durham, North Carolina, United States of America
| | - Tsin W. Yeo
- Global and Tropical Health Division, Menzies School for Health Research and Charles Darwin University, Darwin, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Department of Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School for Health Research and Charles Darwin University, Darwin, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - J. Brice Weinberg
- Department of Medicine, Duke University and VA Medical Centers, Durham, North Carolina, United States of America
| | - Esther D. Mwaikambo
- Department of Pediatrics, Hubert Kairuki Memorial University, Dar es Salaam, United Republic of Tanzania
| | - Donald L. Granger
- Department of Medicine, University of Utah School of Medicine and VA Medical Center, Salt Lake City, Utah, United States of America
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Lo TH, Tseng KY, Tsao WS, Yang CY, Hsieh SL, Chiu AWH, Takai T, Mak TW, Tarng DC, Chen NJ. TREM-1 regulates macrophage polarization in ureteral obstruction. Kidney Int 2014; 86:1174-86. [PMID: 24918157 DOI: 10.1038/ki.2014.205] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 04/21/2014] [Accepted: 04/24/2014] [Indexed: 12/14/2022]
Abstract
Chronic kidney disease (CKD) is an emerging worldwide public health problem. Inflammatory cell infiltration and activation during the early stages in injured kidneys is a common pathologic feature of CKD. Here, we determined whether an important inflammatory regulator, triggering receptor expressed on myeloid cells (TREM)-1, is upregulated in renal tissues collected from mouse ureteral obstruction-induced nephritis. TREM-1 is crucial for modulating macrophage polarization, and has a pivotal role in mediating tubular injury and interstitial collagen deposition in obstructive nephritis. Lysates from nephritic kidneys triggered a TREM-1-dependent M1 polarization ex vivo, consistent with the observation that granulocyte-macrophage colony-stimulating factor (GM-CSF)-derived M1 macrophages express higher levels of TREM-1 in comparison with M-CSF-derived cells. Moreover, agonistic TREM-1 cross-link significantly strengthens the inductions of iNOS and GM-CSF in M1 cells. These observations are validated by a strong clinical correlation between infiltrating TREM-1-expressing/iNOS-positive macrophages and renal injury in human obstructive nephropathy. Thus, TREM-1 may be a potential diagnostic and therapeutic target in human kidney disease.
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Affiliation(s)
- Tzu-Han Lo
- Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan (ROC)
| | - Kai-Yu Tseng
- Institute of Microbiology and Immunology, School of Life Sciences, National Yang-Ming University, Taipei, Taiwan (ROC)
| | - Wen-Shan Tsao
- Institute of Microbiology and Immunology, School of Life Sciences, National Yang-Ming University, Taipei, Taiwan (ROC)
| | - Chih-Ya Yang
- 1] Institute of Microbiology and Immunology, School of Life Sciences, National Yang-Ming University, Taipei, Taiwan (ROC) [2] Genomic Research Center, Academia Sinica, Taipei, Taiwan (ROC)
| | - Shie-Liang Hsieh
- 1] Institute of Microbiology and Immunology, School of Life Sciences, National Yang-Ming University, Taipei, Taiwan (ROC) [2] Genomic Research Center, Academia Sinica, Taipei, Taiwan (ROC) [3] Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (ROC) [4] Inflammation and Immunity Research Center, National Yang-Ming University, Taipei, Taiwan (ROC) [5] Immunology Center, Taipei Veterans General Hospital, Taipei, Taiwan (ROC) [6] Institute for Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Allen Wen-Hsiang Chiu
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan (ROC)
| | - Toshiyuki Takai
- Department of Experimental Immunology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Tak W Mak
- The Campbell Family Institute for Breast Cancer Research, Ontario Cancer Institute, University Health Network and Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Der-Cherng Tarng
- 1] Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan (ROC) [2] Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (ROC) [3] Inflammation and Immunity Research Center, National Yang-Ming University, Taipei, Taiwan (ROC) [4] Immunology Center, Taipei Veterans General Hospital, Taipei, Taiwan (ROC) [5] Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (ROC)
| | - Nien-Jung Chen
- 1] Institute of Microbiology and Immunology, School of Life Sciences, National Yang-Ming University, Taipei, Taiwan (ROC) [2] Inflammation and Immunity Research Center, National Yang-Ming University, Taipei, Taiwan (ROC)
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Neopterin in Diagnosis and Monitoring of Infectious Diseases. J Biomark 2013; 2013:196432. [PMID: 26317013 PMCID: PMC4437389 DOI: 10.1155/2013/196432] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 10/28/2013] [Indexed: 12/01/2022] Open
Abstract
Neopterin is produced by activated monocytes, macrophages, and dendritic cells upon stimulation by interferon gamma produced by T-lymphocytes. Quantification of neopterin in body fluids has been achieved by standard high-performance liquid chromatography, radioimmunoassays, and enzyme-linked immunosorbent assays. Neopterin levels predict HIV-related mortality more efficiently than clinical manifestations. Successful highly active antiretroviral therapy is associated with a decrease in neopterin levels. Elevated neopterin levels were associated with hepatitis by hepatitis A, B, and C viruses. Serum neopterin levels were found to be a predictor of response to treatment of chronic HCV infection with pegylated interferon combined with ribavirin. Neopterin levels of patients with pulmonary tuberculosis were found to be higher in patients with more extensive radiological changes. Elimination of blood donors with elevated neopterin levels to reduce risk of transmission of infections with known and unknown viral pathogens has been undertaken. Neopterin measurement is hereby more cost effective but less sensitive than screening using polymerase chain reaction based assays. In conclusion neopterin is a nonspecific marker of activated T-helper cell 1 dominated immune response. It may be a useful marker for monitoring of infectious disease activity during treatment and for more accurate estimation of extent of disease and prognosis.
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18
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Brouwer EE, van Hellemond JJ, van Genderen PJ, Slot E, van Lieshout L, Visser LG, Wismans PJ. A case report of transfusion-transmitted Plasmodium malariae from an asymptomatic non-immune traveller. Malar J 2013; 12:439. [PMID: 24304475 PMCID: PMC3866504 DOI: 10.1186/1475-2875-12-439] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 11/28/2013] [Indexed: 11/10/2022] Open
Abstract
Background The incidence of transfusion-transmitted malaria is very low in non-endemic countries due to strict donor selection. The optimal strategy to mitigate the risk of transfusion-transmitted malaria in non-endemic countries without unnecessary exclusion of blood donations is, however, still debated and asymptomatic carriers of Plasmodium species may still be qualified to donate blood for transfusion purposes. Case description In April 2011, a 59-year-old Dutch woman with spiking fevers for four days was diagnosed with a Plasmodium malariae infection. The patient had never been abroad, but nine weeks before, she had received red blood cell transfusion for anaemia. The presumptive diagnosis of transfusion-transmitted quartan malaria was made and subsequently confirmed by retrospective PCR analysis of donor blood samples. The donor was a 36-year-old Dutch male who started donating blood in May 2006. His travel history outside Europe included a trip to Kenya, Tanzania and Zanzibar in 2005, to Thailand in 2006 and to Costa Rica in 2007. He only used malaria prophylaxis during his travel to Africa. The donor did not show any abnormalities upon physical examination in 2011, while laboratory examination demonstrated a thrombocytopenia of 126 × 109/L as the sole abnormal finding since 2007. Thick blood smear analysis and the Plasmodium PCR confirmed an ongoing subclinical P. malariae infection. Chloroquine therapy was started, after which the infection cleared and thrombocyte count normalized. Fourteen other recipients who received red blood cells from the involved donor were traced. None of them developed malaria symptoms. Discussion This case demonstrates that P. malariae infections in non-immune travellers may occur without symptoms and persist subclinically for years. In addition, this case shows that these infections pose a threat to transfusion safety when subclinically infected persons donate blood after their return in a non-endemic malaria region. Since thrombocytopenia was the only abnormality associated with the subclinical malaria infection in the donor, this case illustrates that an unexplained low platelet count after a visit to malaria-endemic countries may be an indicator for asymptomatic malaria even when caused by non-falciparum Plasmodium species.
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Affiliation(s)
| | | | | | | | | | | | - Pieter J Wismans
- Department of Internal Medicine, Harbour Hospital and Institute for Tropical Diseases, Haringvliet 2 3011 TD, Rotterdam, The Netherlands.
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de Zeeuw J, Duggirala S, Nienhuis WA, Abass KM, Tuah W, Omansen TF, van der Werf TS, Stienstra Y. Serum levels of neopterin during antimicrobial treatment for Mycobacterium ulcerans infection. Am J Trop Med Hyg 2013; 89:498-500. [PMID: 23836576 DOI: 10.4269/ajtmh.12-0599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Neopterin is closely associated with activation of the cellular immune system. Neopterin levels differed between controls and patients with Buruli ulcer disease. No differences between patients with or without paradoxical responses were observed. Therefore, neopterin has no value in detecting paradoxical responses among patients with limited Buruli ulcer disease. Neopterin levels were lower in patients receiving clarithromycin. This finding might indicate a slower cellular immune recovery, with possible consequences in future therapy with clarithromycin.
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Affiliation(s)
- Janine de Zeeuw
- Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, The Netherlands.
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Manning L, Davis TME. The mechanistic, diagnostic and prognostic utility of biomarkers in severe malaria. Biomark Med 2013; 7:363-80. [DOI: 10.2217/bmm.13.50] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Malaria remains an important global cause of severe illness and mortality. This literature review summarizes available data on how biomarkers might be applied to diagnose, prognosticate and provide mechanistic insights in patients with severe malaria. Of the large number of candidate biomarkers, only PfHRP2 has consistently demonstrated clinical utility and, when incorporated into rapid antigen detection tests, has shown diagnostic sensitivity above 95%, which is at least as good as light microscopy. As a quantitative test, PfHRP2 also shows some promise in differentiating severe malarial from non-malarial disease in areas where asymptomatic carriage of malaria parasites is common, and possibly as a tool to estimate sequestered parasite burden and subsequent mortality. Biomarkers such as pLDH and panmalarial antigen have lower sensitivity for non-falciparum malaria in rapid antigen detection tests. There is an urgent need to discover and validate better biomarkers for incorporation into rapid antigen detection tests in countries where Plasmodium vivax is a common cause of severe disease. A large number of host-derived acute-phase reactants, markers of endothelial dysfunction and immune mediators have been proposed as biomarkers. Although they have provided mechanistic insights into the immunopathology of severe malaria, their roles as clinical tools remain uncertain.
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Affiliation(s)
- Laurens Manning
- School of Medicine & Pharmacology, Fremantle Hospital & Health Service, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Timothy Mark Earls Davis
- School of Medicine & Pharmacology, Fremantle Hospital & Health Service, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
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21
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te Witt R, Hassing RJ, Petit PP, van Belkum A, van Genderen PJ. Procalcitonin and neopterin levels do not accurately distinguish bacterial from viral infections in ill-returned travellers with fever. Trans R Soc Trop Med Hyg 2012; 106:264-6. [DOI: 10.1016/j.trstmh.2012.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 01/03/2012] [Accepted: 01/03/2012] [Indexed: 11/26/2022] Open
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22
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van Wolfswinkel ME, Hesselink DA, Hoorn EJ, de Rijke YB, Koelewijn R, van Hellemond JJ, van Genderen PJJ. Copeptin does not accurately predict disease severity in imported malaria. Malar J 2012; 11:6. [PMID: 22221299 PMCID: PMC3268091 DOI: 10.1186/1475-2875-11-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 01/05/2012] [Indexed: 11/10/2022] Open
Abstract
Background Copeptin has recently been identified to be a stable surrogate marker for the unstable hormone arginine vasopressin (AVP). Copeptin has been shown to correlate with disease severity in leptospirosis and bacterial sepsis. Hyponatraemia is common in severe imported malaria and dysregulation of AVP release has been hypothesized as an underlying pathophysiological mechanism. The aim of the present study was to evaluate the performance of copeptin as a predictor of disease severity in imported malaria. Methods Copeptin was measured in stored serum samples of 204 patients with imported malaria that were admitted to our Institute for Tropical Diseases in Rotterdam in the period 1999-2010. The occurrence of WHO defined severe malaria was the primary end-point. The diagnostic performance of copeptin was compared to that of previously evaluated biomarkers C-reactive protein, procalcitonin, lactate and sodium. Results Of the 204 patients (141 Plasmodium falciparum, 63 non-falciparum infection), 25 had severe malaria. The Area Under the ROC curve of copeptin for severe disease (0.66 [95% confidence interval 0.59-0.72]) was comparable to that of lactate, sodium and procalcitonin. C-reactive protein (0.84 [95% CI 0.79-0.89]) had a significantly better performance as a biomarker for severe malaria than the other biomarkers. Conclusions C-reactive protein but not copeptin was found to be an accurate predictor for disease severity in imported malaria. The applicability of copeptin as a marker for severe malaria in clinical practice is limited to exclusion of severe malaria.
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Affiliation(s)
- Marlies E van Wolfswinkel
- Department of Internal Medicine, Harbour Hospital and Institute for Tropical Diseases, Haringvliet 2, 3011 TD Rotterdam, The Netherlands
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Cumming BM, Watson GMF, Goldring JPD. Plasmodium falciparum: effect of antimalarial drugs, malaria pigment (β-haematin) and Plasmodium falciparum lysate on monocyte GTP-cyclohydrolase 1 gene expression. Exp Parasitol 2011; 129:312-7. [PMID: 21854775 DOI: 10.1016/j.exppara.2011.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 08/01/2011] [Accepted: 08/03/2011] [Indexed: 10/17/2022]
Abstract
In interferon-γ activated human macrophages, GTP-cyclohydrolase 1 catalyses the conversion of guanosine triphosphate to 7,8-dihydroneopterin triphosphate, which is dephosphorylated and oxidized to form neopterin. Elevated levels of neopterin have been detected in the urine and serum of malaria-infected patients. In this study, U937 cells were treated with interferon-γ and one of the following antimalarial drugs: amodiaquine, artemisinin, chloroquine, doxycycline, primaquine, pyrimethamine or quinine. The effects of treating the U937 cells with malaria pigment (β-haematin), latex beads, or Plasmodium falciparum-infected-red blood cell lysates were also investigated. U937 GTP-cyclohydrolase 1 mRNA expression was monitored using reverse-transcriptase-quantitative PCR. Artemisinin, primaquine, and quinine down-regulated GTP-cyclohydrolase 1 gene expression 1.26-, 1.29-, and 1.63-fold, respectively. The remaining drugs had insignificant effects. β-haematin up-regulated GTP-cyclohydrolase 1 mRNA expression 1.18-fold, whereas P. falciparum-infected red blood cell lysate down-regulated expression 1.56-fold. These results show the differing immunomodulatory actions of antimalarial drugs and malaria pigment taking place in monocytes.
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Affiliation(s)
- Bridgette M Cumming
- Department of Biochemistry, School of Biochemistry, Genetics and Microbiology, University of KwaZulu-Natal, Pietermaritzburg Campus, Private Bag X01, Scottsville 3209, South Africa
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