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Chaurasia R, Vinetz JM. In silico prediction of molecular mechanisms of toxicity mediated by the leptospiral PF07598 gene family-encoded virulence-modifying proteins. Front Mol Biosci 2023; 9:1092197. [PMID: 36756251 PMCID: PMC9900628 DOI: 10.3389/fmolb.2022.1092197] [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: 11/07/2022] [Accepted: 12/20/2022] [Indexed: 01/24/2023] Open
Abstract
Mechanisms of leptospirosis pathogenesis remain unclear despite the identification of a number of potential leptospiral virulence factors. We recently demonstrated potential mechanisms by which the virulence-modifying (VM) proteins-defined as containing a Domain of Unknown function (DUF1561), encoded by the PF07598 gene family-found only in group 1 pathogenic Leptospira-might mediate the clinical pathogenesis of leptospirosis. VM proteins belongs to classical AB toxin paradigm though have a unique AB domain architecture, unlike other AB toxins such as diphtheria toxin, pertussis toxin, shiga toxin, or ricin toxin which are typically encoded by two or more genes and self-assembled into a multi-domain holotoxin. Leptospiral VM proteins are secreted R-type lectin domain-containing exotoxins with discrete N-terminal ricin B-like domains involved in host cell surface binding, and a C-terminal DNase/toxin domain. Here we use the artificial intelligence-based AlphaFold algorithm and other computational tools to predict and elaborate on details of the VM protein structure-function relationship. Comparative AlphaFold and CD-spectroscopy defined the consistent secondary structure (Helix and ß-sheet) content, and the stability of the functional domains were further supported by molecular dynamics simulation. VM proteins comprises distinctive lectic family (QxW)3 motifs, the Mycoplasma CARDS toxin (D3 domain, aromatic patches), C-terminal similarity with mammalian DNase I. In-silico study proposed that Gln412, Gln523, His533, Thr59 are the high binding energy or ligand binding residues plausibly anticipates in the functional activities. Divalent cation (Mg+2-Gln412) and phosphate ion (PO4]-3-Arg615) interaction further supports the functional activities driven by C-terminal domain. Computation-driven structure-function studies of VM proteins will guide experimentation towards mechanistic understandings of leptospirosis pathogenesis, which underlie development of new therapeutic and preventive measures for this devastating disease.
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Philip N, Priya SP, Jumah Badawi AH, Mohd Izhar MH, Mohtarrudin N, Tengku Ibrahim TA, Sekawi Z, Neela VK. Pulmonary haemorrhage as the earliest sign of severe leptospirosis in hamster model challenged with Leptospira interrogans strain HP358. PLoS Negl Trop Dis 2022; 16:e0010409. [PMID: 35584087 PMCID: PMC9116642 DOI: 10.1371/journal.pntd.0010409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background Severe leptospirosis is challenging as it could evolve rapidly and potentially fatal if appropriate management is not performed. An understanding of the progression and pathophysiology of Leptospira infection is important to determine the early changes that could be potentially used to predict the severe occurrence of leptospirosis. This study aimed to understand the kinetics pathogenesis of Leptospira interrogans strain HP358 in the hamster model and identify the early parameters that could be used as biomarkers to predict severe leptospirosis. Methodology/Principal findings Male Syrian hamsters were infected with Leptospira interrogans strain HP358 and euthanized after 24 hours, 3, 4, 5, 6 and 7 days post-infection. Blood, lungs, liver and kidneys were collected for leptospiral detection, haematology, serum biochemistry and differential expression of pro- and anti-inflammatory markers. Macroscopic and microscopic organ damages were investigated. Leptospira interrogans strain HP358 was highly pathogenic and killed hamsters within 6–7 days post-infection. Pulmonary haemorrhage and blood vessel congestion in organs were noticed as the earliest pathological changes. The damages in organs and changes in biochemistry value were preceded by changes in haematology and immune gene expression. Conclusion/Significance This study deciphered haemorrhage as the earliest manifestation of severe leptospirosis and high levels of IL-1β, CXCL10/IP-10, CCL3/MIP-α, neutrophils and low levels of lymphocytes and platelets serve as a cumulative panel of biomarkers in severe leptospirosis. As the severe form of leptospirosis could progress rapidly and be potentially fatal if not treated earlier, deciphering the pathophysiology kinetics of infection is crucial to determine the parameters of disease severity. To understand this, we challenged hamsters with the highly virulent Leptospira interrogans strain HP358. Pulmonary haemorrhage was observed as the earliest pathological change followed by liver and kidneys damages. The increased expression of IL-1β, CXCL10/IP-10, CCL3/MIP-α, high neutrophils and low lymphocytes and platelets production observed in the present study indicate that these parameters could serve as a cumulative panel of biomarkers in severe leptospirosis.
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Affiliation(s)
- Noraini Philip
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Sivan Padma Priya
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- RAK College of Dental Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Ahmad Hussein Jumah Badawi
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohd Hafidz Mohd Izhar
- Comparative Medicine and Technology Unit, Institute of Bioscience, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Norhafizah Mohtarrudin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Tengku Azmi Tengku Ibrahim
- Department of Veterinary Preclinical Sciences, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Zamberi Sekawi
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Vasantha Kumari Neela
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- * E-mail:
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3
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Chaurasia R, Marroquin AS, Vinetz JM, Matthias MA. Pathogenic Leptospira Evolved a Unique Gene Family Comprised of Ricin B-Like Lectin Domain-Containing Cytotoxins. Front Microbiol 2022; 13:859680. [PMID: 35422779 PMCID: PMC9002632 DOI: 10.3389/fmicb.2022.859680] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/08/2022] [Indexed: 12/29/2022] Open
Abstract
Leptospirosis is a globally important neglected zoonotic disease. Previous data suggest that a family of virulence-modifying (VM) proteins (PF07598) is a distinctive feature of group I pathogenic Leptospira that evolved as important virulence determinants. Here, we show that one such VM protein, LA3490 (also known as Q8F0K3), is expressed by Leptospira interrogans serovar Lai, as a secreted genotoxin that is potently cytotoxic to human cells. Structural homology searches using Phyre2 suggested that VM proteins are novel R-type lectins containing tandem N-terminal ricin B-chain-like β-trefoil domains. Recombinant LA3490 (rLA3490) and an N-terminal fragment, t3490, containing only the predicted ricin B domain, bound to the terminal galactose and N-acetyl-galactosamine residues, asialofetuin, and directly competed for asialofetuin-binding sites with recombinant ricin B chain. t3490 alone was sufficient for binding, both to immobilized asialofetuin and to the HeLa cell surface but was neither internalized nor cytotoxic. Treatment of HeLa cells with rLA3490 led to cytoskeleton disassembly, caspase-3 activation, and nuclear fragmentation, and was rapidly cytolethal. rLA3490 had DNase activity on mammalian and bacterial plasmid DNA. The combination of cell surface binding, internalization, nuclear translocation, and DNase functions indicate that LA3490 and other VM proteins evolved as novel forms of the bacterial AB domain-containing toxin paradigm.
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Affiliation(s)
- Reetika Chaurasia
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Alan S Marroquin
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Joseph M Vinetz
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Michael A Matthias
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
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4
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Chen M, Lu W, Wu S, Wang S, Lu T, Peng C. Metagenomic next-generation sequencing in the diagnosis of leptospirosis presenting as severe diffuse alveolar hemorrhage: a case report and literature review. BMC Infect Dis 2021; 21:1230. [PMID: 34876042 PMCID: PMC8650322 DOI: 10.1186/s12879-021-06923-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leptospirosis is a common infectious disease in tropical and semitropical regions, and it is typically neglected. Leptospirosis-associated acute diffuse alveolar hemorrhage is one of its fatal complications. The use of bronchoalveolar lavage fluid (BALF) metagenomic next-generation sequencing in the diagnosis of Leptospira interrogans infection has rarely been reported. CASE PRESENTATION We present the case of a 62-year-old female who was transferred to our hospital with dyspnea, and severe hemoptysis and was supported by a tracheal intubation ventilator. Bronchoalveolar lavage fluid (BALF) metagenomic next-generation sequencing (mNGS) reported Leptospira interrogans. A diagnosis of diffuse alveolar hemorrhage caused by leptospirosis was made. After immediately receiving antibiotics and hormone therapy, the patient achieved a complete recovery upon discharge. CONCLUSION Leptospirosis presenting as severe diffuse alveolar hemorrhage is rare but should be considered in the differential diagnosis. mNGS can help identify pathogens and treat them early, which can improve prognosis.
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Affiliation(s)
- Meiqin Chen
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang, China
| | - Weili Lu
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang, China
| | - Shugen Wu
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang, China
| | - Shun Wang
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang, China
| | - Tao Lu
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang, China
| | - Chunxian Peng
- Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, Zhejiang, China.
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Wilson TM, Ritter JM, Martines RB, Gonçalves AAB, Fair P, Galloway R, Weiner Z, Romano APM, Costa GRT, Melo CB, Zaki SR, Castro MB. Pathology and One Health implications of fatal Leptospira interrogans infection in an urbanized, free-ranging, black-tufted marmoset (Callithrix penicillata) in Brazil. Transbound Emerg Dis 2021; 68:3207-3216. [PMID: 34387927 DOI: 10.1111/tbed.14287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
Leptospirosis is a zoonotic neglected disease of worldwide public health concern. Leptospira species can infect a wide range of wild and domestic mammals and lead to a spectrum of disease, including severe and fatal forms. Herein, we report for the first time a fatal Leptospira interrogans infection in a free-ranging nonhuman primate (NHP), a black-tufted marmoset. Icterus, pulmonary haemorrhage, interstitial nephritis, and hepatocellular dissociation were the main findings raising the suspicion of leptospirosis. Diagnostic confirmation was based on specific immunohistochemical and PCR assays for Leptospira species. Immunolocalization of leptospiral antigens and identification of pathogenic species (L. interrogans species) were important for better understanding the pathogenesis of the disease. One Health-related implications of free-ranging NHPs in anthropized areas and transmission dynamics of human and animal leptospirosis are discussed.
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Affiliation(s)
- Tais M Wilson
- Veterinary Pathology Laboratory, University of Brasília, Brasília, Brazil.,Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Atlanta, Georgia, USA.,Graduate Program in Animal Science, University of Brasília, Brasilia, Brazil
| | - Jana M Ritter
- Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Atlanta, Georgia, USA
| | - Roosecelis B Martines
- Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Atlanta, Georgia, USA
| | - Alexandra A B Gonçalves
- Veterinary Pathology Laboratory, University of Brasília, Brasília, Brazil.,Graduate Program in Animal Science, University of Brasília, Brasilia, Brazil
| | - Pamela Fair
- Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Atlanta, Georgia, USA
| | - Renee Galloway
- Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Atlanta, Georgia, USA
| | - Zachary Weiner
- Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Atlanta, Georgia, USA
| | - Alessandro P M Romano
- Technical Group on Arbovirus Surveillance, General Coordination of Communicable Diseases, Department of Communicable Disease Surveillance, Secretariat of Health Surveillance, Brazilian Ministry of Health, Brasilia, Brazil
| | - Gabriela R T Costa
- Environmental Health Surveillance Directorate of the Federal District, Brasilia, Brazil
| | - Cristiano B Melo
- Graduate Program in Animal Science, University of Brasília, Brasilia, Brazil
| | - Sherif R Zaki
- Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Atlanta, Georgia, USA
| | - Marcio B Castro
- Veterinary Pathology Laboratory, University of Brasília, Brasília, Brazil.,Graduate Program in Animal Science, University of Brasília, Brasilia, Brazil
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Boertjes E, Hillebrand S, Bins JE, Oswald L. Pulmonary haemorrhage in Weil's disease. BMJ Case Rep 2020; 13:13/1/e227570. [PMID: 31996379 PMCID: PMC7021118 DOI: 10.1136/bcr-2018-227570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Leptospirosisis a zoonosis caused by spirochaetes from the species Leptospira. The more severe form of leptospirosis, known as Weil’s disease, is characterised by the triad of jaundice, renal impairment and haemorrhages. Pulmonary involvement occurs in 20%–70% of the patients, with severity ranging from non-productive cough to respiratory failure mainly due to pulmonary haemorrhage. Recognition of Weil’s disease in patients presenting with pulmonary symptoms can be difficult. This case illustrates a classic case of pulmonary haemorrhagic involvement in Weil’s disease.
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Affiliation(s)
- Emma Boertjes
- Internal Medicine, Sint Franciscus Vlietland Groep, Rotterdam, The Netherlands
| | - Stefanie Hillebrand
- Internal Medicine, Sint Franciscus Vlietland Groep, Rotterdam, The Netherlands
| | | | - Laurien Oswald
- Respiratory Medicine, Sint Franciscus Vlietland Group, Rotterdam, The Netherlands
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7
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Smith S, Liu YH, Carter A, Kennedy BJ, Dermedgoglou A, Poulgrain SS, Paavola MP, Minto TL, Luc M, Hanson J. Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality. PLoS Negl Trop Dis 2019; 13:e0007929. [PMID: 31790405 PMCID: PMC6907868 DOI: 10.1371/journal.pntd.0007929] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/12/2019] [Accepted: 11/15/2019] [Indexed: 12/13/2022] Open
Abstract
Background Severe leptospirosis can have a case-fatality rate of over 50%, even with intensive care unit (ICU) support. Multiple strategies–including protective ventilation and early renal replacement therapy (RRT)–have been recommended to improve outcomes. However, management guidelines vary widely around the world and there is no consensus on the optimal approach. Methodology/Principal findings All cases of leptospirosis admitted to the ICU of Cairns Hospital in tropical Australia between 1998 and 2018 were retrospectively reviewed. The patients’ demographics, presentation, management and clinical course were examined. The 55 patients’ median (interquartile range (IQR)) age was 47 (32–62) years and their median (IQR) APACHE III score was 67 (48–105). All 55 received appropriate antibiotic therapy, 45 (82%) within the first 6 hours. Acute kidney injury was present in 48/55 (87%), 18/55 (33%) required RRT, although this was usually not administered until traditional criteria for initiation were met. Moderate to severe acute respiratory distress syndrome developed in 37/55 (67%), 32/55 (58%) had pulmonary haemorrhage, and mechanical ventilation was required in 27/55 (49%). Vasopressor support was necessary in 34/55 (62%). Corticosteroids were prescribed in 20/55 (36%). The median (IQR) fluid balance in the initial three days of ICU care was +1493 (175–3567) ml. Only 2/55 (4%) died, both were elderly men with multiple comorbidities. Conclusion In patients with severe leptospirosis in tropical Australia, prompt ICU support that includes early antibiotics, protective ventilation strategies, conservative fluid resuscitation, traditional thresholds for RRT initiation and corticosteroid therapy is associated with a very low case-fatality rate. Prospective studies are required to establish the relative contributions of each of these interventions to optimal patient outcomes. Severe leptospirosis continues to carry a high mortality. To improve outcomes, several countries have developed national guidelines for the management of severe disease. However, there is substantial variation in these guidelines despite the fact that severe leptospirosis has a very similar presentation around the world. In tropical Australia, the case-fatality rate of severe leptospirosis is only 4%. This retrospective study reviewed 55 patients with leptospirosis requiring support in an Australian Intensive Care Unit (ICU) in an effort to identify the management strategies that might explain these excellent outcomes. The low case-fatality rate was associated with prompt multimodal ICU support that included early antibiotics, protective ventilation strategies, conservative fluid resuscitation, traditional thresholds for renal replacement therapy initiation and corticosteroid therapy. However prospective, multinational studies–which include the resource-poor settings that bear the greatest burden of disease–are necessary to define which of these interventions have the greatest therapeutic value.
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Affiliation(s)
- Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Yu-Hsuan Liu
- Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia
| | - Angus Carter
- Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia
- James Cook University, Cairns Campus, Cairns, Queensland, Australia
| | - Brendan J. Kennedy
- Infectious Diseases Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Communicable Disease Control Branch, Adelaide, South Australia, Australia
| | | | | | | | - Tarryn L. Minto
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Michael Luc
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
- * E-mail:
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8
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Smith S, Kennedy BJ, Dermedgoglou A, Poulgrain SS, Paavola MP, Minto TL, Luc M, Liu YH, Hanson J. A simple score to predict severe leptospirosis. PLoS Negl Trop Dis 2019; 13:e0007205. [PMID: 30759081 PMCID: PMC6391019 DOI: 10.1371/journal.pntd.0007205] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/26/2019] [Accepted: 01/30/2019] [Indexed: 02/01/2023] Open
Abstract
Background The case-fatality rate of severe leptospirosis can exceed 50%. While prompt supportive care can improve survival, predicting those at risk of developing severe disease is challenging, particularly in settings with limited diagnostic support. Methodology/Principal findings We retrospectively identified all adults with laboratory-confirmed leptospirosis in Far North Queensland, Australia, between January 1998 and May 2016. Clinical, laboratory and radiological findings at presentation were correlated with the patients’ subsequent clinical course. Medical records were available in 402 patients; 50 (12%) had severe disease. The presence of oliguria (urine output ≤500 mL/24 hours, odds ratio (OR): 16.4, 95% confidence interval (CI): 6.9–38.8, p<0.001), abnormal auscultatory findings on respiratory examination (OR 11.2 (95% CI: 4.7–26.5, p<0.001) and hypotension (systolic blood pressure ≤100 mmHg, OR 4.3 (95% CI 1.7–10.7, p = 0.002) at presentation independently predicted severe disease. A three-point score (the SPiRO score) was devised using these three clinical variables, with one point awarded for each. A score could be calculated in 392 (98%) patients; the likelihood of severe disease rose incrementally: 8/287 (3%), 14/70 (20%), 18/26 (69%) and 9/9 (100%) for a score of 0, 1, 2 and 3 respectively (p = 0.0001). A SPiRO score <1 had a negative predictive value for severe disease of 97% (95% CI: 95–99%). Conclusions/Significance A simple, three-point clinical score can help clinicians rapidly identify patients at risk of developing severe leptospirosis, prompting early transfer to referral centres for advanced supportive care. This inexpensive, bedside assessment requires minimal training and may have significant utility in the resource-limited settings which bear the greatest burden of disease. Leptospirosis, a neglected tropical disease with a global distribution, is estimated to kill 60,000 people every year. Predicting those at risk of developing severe disease is challenging, and a simple scoring system to quantify the risk of severe disease has proven elusive. Identifying the high-risk patient is important, as it might expedite the initiation of life-saving supportive care. This review of 402 adult patients with leptospirosis in tropical Australia determined that three clinical variables identified at presentation independently predicted severe disease (a subsequent requirement for Intensive Care Unit admission, intubation, vasopressor support, renal replacement therapy or the development of pulmonary haemorrhage). These three variables (abnormal auscultatory findings on respiratory examination, hypotension and oliguria) were used to generate a simple, three-point clinical score which can be determined rapidly and reliably at the bedside by health care workers with minimal training. This simple score may help the clinical management of patients with leptospirosis, particularly in lower and middle-income countries that bear the greatest burden of disease.
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Affiliation(s)
- Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
- James Cook University, Cairns Campus, Cairns, Queensland, Australia
| | - Brendan J. Kennedy
- Infectious Diseases Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Communicable Disease Control Branch, Adelaide, South Australia, Australia
| | | | | | | | - Tarryn L. Minto
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Michael Luc
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Yu-Hsuan Liu
- Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
- * E-mail:
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9
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Le Turnier P, Epelboin L. [Update on leptospirosis]. Rev Med Interne 2018; 40:306-312. [PMID: 30591382 DOI: 10.1016/j.revmed.2018.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/19/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022]
Abstract
Leptospirosis is a worldwide spirochetal zoonosis whose global incidence is increasing and is probably underestimated. Leptospirosis has long been associated with occupational contact with animals (rats and cattle) and has become in developed countries a pathology more related to recreational activities with exposure to fresh water (canoeing, swimming, canyoning) and to an environment contaminated by urine from leptospires excretory rodents. Leptospirosis should be one of the differential diagnoses to be considered when returning from travel to tropical areas, particularly Southeast Asia, and particularly during the rainy season. The clinical symptoms, particularly in the initial phase, are not specific and can limit to a flu-like syndrome or "dengue-like" making diagnosis often difficult. It is then necessary to look carefully for clinical (muscle pain, cough, conjunctival involvement, jaundice) and biological arguments (thrombocytopenia, cholestasis, rhabdomyolysis, frank elevation of CRP) that will help to diagnose leptospirosis and lead to quick antibiotic therapy before the progression to a severe icterohaemorrhagic (Weil's disease) or respiratory form associated with significant mortality. Treatment is based on injectable beta-lactams in severe forms (mainly cephalosporins) and amoxicillin, doxycycline or azithromycin in non-severe forms. Some atypical or delayed forms of leptospirosis occurring in the late immune phase of the disease are to know. Rapid diagnostic tools are currently being studied to improve diagnosis in remote areas and facilitate access to early treatment.
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Affiliation(s)
- P Le Turnier
- Inserm, service des maladies infectieuses et tropicales, centre hospitalier universitaire de Nantes et CIC 1413, 44000 Nantes, France.
| | - L Epelboin
- Unité des maladies infectieuses et tropicales, centre hospitalier Andrée-Rosemon, Cayenne, Guyane; Équipe EA 3593, ecosystèmes amazoniens et pathologie tropicale, université de la Guyane, Cayenne, Guyane
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10
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De Brito T, da Silva AMG, Abreu PAE. Pathology and pathogenesis of human leptospirosis: a commented review. Rev Inst Med Trop Sao Paulo 2018; 60:e23. [PMID: 29846473 PMCID: PMC5975557 DOI: 10.1590/s1678-9946201860023] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/23/2018] [Indexed: 12/23/2022] Open
Abstract
Leptospirosis is an acute bacterial septicemic febrile disease caused by pathogenic leptospires, which affect humans and animals in all parts of the world. Transmission can occur by direct contact with infected animals or, more commonly, through indirect contact with water or soil contaminated with urine from infected animals. Leptospires enter the body by penetrating mucous membranes or skin abrasions and disseminate through the hematogenic route. In humans, leptospirosis may cause a wide spectrum of symptoms. Most cases have a biphasic clinical presentation, which begins with the septicemic phase followed by immune manifestations. The severe forms of the disease may be life threatening with multisystem damage including renal failure, hepatic dysfunction, vascular damage, pulmonary hemorrhage and muscle lesions. In this review, we present and discuss the pathogenesis of the human disease and the mechanisms of cell membrane injuries, which occur mainly due to the presence of leptospires and/or their antigen/s in the host tissues.
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Affiliation(s)
- Thales De Brito
- Universidade de São Paulo, Instituto de Medicina Tropical de São
Paulo, LIM 06, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de
Patologia, São Paulo, São Paulo, Brazil
| | - Ana Maria Gonçalves da Silva
- Universidade de São Paulo, Instituto de Medicina Tropical de São
Paulo, LIM 06, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de
Patologia, São Paulo, São Paulo, Brazil
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11
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Hypoxemic Respiratory Failure from Acute Respiratory Distress Syndrome Secondary to Leptospirosis. Case Rep Crit Care 2017; 2017:9062107. [PMID: 29158922 PMCID: PMC5660762 DOI: 10.1155/2017/9062107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 09/13/2017] [Indexed: 01/07/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS), characterized by hypoxemic respiratory failure, is associated with a mortality of 30–50% and is precipitated by both direct and indirect pulmonary insults. Treatment is largely supportive, consisting of lung protective ventilation and thereby necessitating Intensive Care Unit (ICU) admission. The most common precipitant is community-acquired bacterial pneumonia, but other putative pathogens include viruses and fungi. On rare occasions, ARDS can be secondary to tropical disease. Accordingly, a history should include travel to endemic regions. Leptospirosis is a zoonotic disease most common in the tropics and typically associated with mild pulmonary complications. We describe a case of a 25-year-old male with undiagnosed leptospirosis, presenting with fever and severe hypoxemic respiratory failure, returning from a Costa Rican holiday. There was no other organ failure. He was intubated and received lung protective ventilation. His condition improved after ampicillin and penicillin G were added empirically. This case illustrates the rare complication of ARDS from leptospirosis, the importance of taking a travel history, and the need for empiric therapy because of diagnostic delay.
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Raffray L, Giry C, Thirapathi Y, Reboux AH, Jaffar-Bandjee MC, Gasque P. Increased levels of soluble forms of E-selectin and ICAM-1 adhesion molecules during human leptospirosis. PLoS One 2017; 12:e0180474. [PMID: 28686648 PMCID: PMC5501535 DOI: 10.1371/journal.pone.0180474] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/15/2017] [Indexed: 01/09/2023] Open
Abstract
Leptospirosis is a multisystemic zoonotic disease with infiltration of visceral organs by Leptospira. The capacity of the vascular endothelium to grant immune cell recruitment and activation in target organs during the disease course remains poorly characterized. We ascertained the levels of expression of several soluble cell adhesion molecules (CAM) notably expressed by endothelial cells in human leptospirosis. We prospectively enrolled 20 hospitalized patients and compared them to 10 healthy controls. Disease severity was defined by one or more organ failures, or death. Plasmatic concentrations of soluble CAM were assessed by multiplex bead assay at the time of patient presentation (M0) and 1 month after hospital discharge. The levels of soluble E-selectin (sCD62E) and soluble intercellular adhesion molecule 1 (sICAM-1, sCD53) were significantly increased in patients compared to controls (p<0.0001) and at 1 month (p<0.0001) with median values at 978 ng/ml (interquartile ranges 787–1164; sCD62E) and 1021 ng/ml (690–1428; sCD53). At M0, Soluble P-selectin level (sCD62P) was found to be decreased with levels at 60 ng/ml (0–631) versus 711 ng/ml (343–1113) for healthy controls (p<0.05). Levels of sICAM-3 (sCD50), sVCAM-1 (vascular cell adhesion molecule, sCD106) and sPECAM-1 (platelet endothelial cell adhesion molecule, sCD31) were not different from healthy subjects at M0. This study shows that two adhesion molecules, shed as soluble forms, are elevated during the acute phase of leptospirosis: E-selectin and s-ICAM1. These molecules may interfere with the process of immune cell recruitment to clear Leptospira at tissue levels.
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Affiliation(s)
- Loic Raffray
- Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249, CHU de La Réunion, UMR PIMIT Unité Mixte Processus Infectieux en Milieu Insulaire Tropical, Plateforme Technologique CYROI, Sainte-Clotilde, La Réunion, France
- Laboratoire de Biologie, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
- Internal Medicine Unit, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
- * E-mail: (LR); (PG)
| | - Claude Giry
- Microbiology/Virology Laboratory, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
| | - Yoga Thirapathi
- Internal Medicine Unit, GHER Hospital, St Benoit, La Réunion, France
| | - Anne-Hélène Reboux
- Nephrology Dialysis and Transplantation Unit, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
| | - Marie-Christine Jaffar-Bandjee
- Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249, CHU de La Réunion, UMR PIMIT Unité Mixte Processus Infectieux en Milieu Insulaire Tropical, Plateforme Technologique CYROI, Sainte-Clotilde, La Réunion, France
- Microbiology/Virology Laboratory, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
| | - Philippe Gasque
- Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249, CHU de La Réunion, UMR PIMIT Unité Mixte Processus Infectieux en Milieu Insulaire Tropical, Plateforme Technologique CYROI, Sainte-Clotilde, La Réunion, France
- Laboratoire de Biologie, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
- * E-mail: (LR); (PG)
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Hsieh CL, Tseng A, He H, Kuo CJ, Wang X, Chang YF. Leptospira Immunoglobulin-Like Protein B Interacts with the 20th Exon of Human Tropoelastin Contributing to Leptospiral Adhesion to Human Lung Cells. Front Cell Infect Microbiol 2017; 7:163. [PMID: 28536676 PMCID: PMC5422739 DOI: 10.3389/fcimb.2017.00163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/18/2017] [Indexed: 01/21/2023] Open
Abstract
Leptospira immunoglobulin-like protein B (LigB), a surface adhesin, is capable of mediating the attachment of pathogenic leptospira to the host through interaction with various components of the extracellular matrix (ECM). Human tropoelastin (HTE), the building block of elastin, confers resilience and elasticity to lung, and other tissues. Previously identified Ig-like domains of LigB, including LigB4 and LigB12, bind to HTE, which is likely to promote Leptospira adhesion to lung tissue. However, the molecular mechanism that mediates the LigB-HTE interaction is unclear. In this study, the LigB-binding site on HTE was further pinpointed to a N-terminal region of the 20th exon of HTE (HTE20N). Alanine mutants of basic and aromatic residues on HTE20N significantly reduced binding to the LigB. Additionally, HTE-binding site was narrowed down to the first β-sheet of LigB12. On this binding surface, residues F1054, D1061, A1065, and D1066 were critical for the association with HTE. Most importantly, the recombinant HTE truncates could diminish the binding of LigB to human lung fibroblasts (WI-38) by 68%, and could block the association of LigA-expressing L. biflexa to lung cells by 61%. These findings should expand our understanding of leptospiral pathogenesis, particularly in pulmonary manifestations of leptospirosis.
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Affiliation(s)
- Ching-Lin Hsieh
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell UniversityIthaca, NY, USA
| | - Andrew Tseng
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell UniversityIthaca, NY, USA
| | - Hongxuan He
- National Research Center for Wildlife Borne Diseases, Institute of Zoology, Chinese Academy of SciencesBeijing, China
| | - Chih-Jung Kuo
- Department of Veterinary Medicine, National Chung Hsing UniversityTaichung, Taiwan
| | - Xuannian Wang
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell UniversityIthaca, NY, USA.,Research Center for Biotechnology, Xinxiang UniversityXinxiang, China
| | - Yung-Fu Chang
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell UniversityIthaca, NY, USA
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Vieira ML, de Andrade SA, Morais ZM, Vasconcellos SA, Dagli MLZ, Nascimento ALTO. Leptospira Infection Interferes with the Prothrombinase Complex Assembly during Experimental Leptospirosis. Front Microbiol 2017; 8:500. [PMID: 28400758 PMCID: PMC5368274 DOI: 10.3389/fmicb.2017.00500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/10/2017] [Indexed: 01/18/2023] Open
Abstract
Leptospirosis is a worldwide zoonotic and neglected infectious disease of human and veterinary concern, caused by pathogenic Leptospira species. Although bleeding is a common symptom of severe leptospirosis, the cause of hemorrhage is not completely understood. In severe infections, modulation of hemostasis by pathogens is an important virulence mechanism, and hemostatic impairments such as coagulation/fibrinolysis dysfunction are frequently observed. Here, we analyze the coagulation status of experimentally infected hamsters in an attempt to determine coagulation interferences and the origin of leptospirosis hemorrhagic symptomatology. Hamsters were experimentally infected with L. interrogans. The lungs, kidneys, and livers were collected for culture, histopathology, and coagulation assays. L. interrogans infection disturbs normal coagulation in the organs of animals. Our results suggest the presence of a thrombin-like factor or FX activator, which is able to activate FII in the leptospirosis organ extracts. The activity of those factors is accelerated in the prothrombinase complex. Additionally, we show for the first time that live leptospires act as a surface for the prothrombinase complex assembly. Our results contribute to the understanding of leptospirosis pathophysiological mechanisms and may open new routes for the discovery of novel treatments in the severe manifestations of the disease.
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Affiliation(s)
- Monica L Vieira
- Laboratorio Especial de Desenvolvimento de Vacinas, Instituto Butantan São Paulo, Brazil
| | - Sonia A de Andrade
- Laboratório de Síntese Orgânica - Laboratório Especial de Toxinologia Aplicada São Paulo, Brazil
| | - Zenaide M Morais
- Laboratório de Zoonoses Bacterianas, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo São Paulo, Brazil
| | - Silvio A Vasconcellos
- Laboratório de Zoonoses Bacterianas, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo São Paulo, Brazil
| | - Maria Lucia Z Dagli
- Departmento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo São Paulo, Brazil
| | - Ana Lucia T O Nascimento
- Laboratorio Especial de Desenvolvimento de Vacinas, Instituto ButantanSão Paulo, Brazil; Programa de Pós-Graduação Interunidades em Biotecnologia, Instituto de Ciências Biomédicas, Universidade de São PauloSão Paulo, Brazil
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Lessa-Aquino C, Lindow JC, Randall A, Wunder E, Pablo J, Nakajima R, Jasinskas A, Cruz JS, Damião AO, Nery N, Ribeiro GS, Costa F, Hagan JE, Reis MG, Ko AI, Medeiros MA, Felgner PL. Distinct antibody responses of patients with mild and severe leptospirosis determined by whole proteome microarray analysis. PLoS Negl Trop Dis 2017; 11:e0005349. [PMID: 28141801 PMCID: PMC5302828 DOI: 10.1371/journal.pntd.0005349] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/10/2017] [Accepted: 01/22/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Leptospirosis is an important zoonotic disease worldwide. Humans usually present a mild non-specific febrile illness, but a proportion of them develop more severe outcomes, such as multi-organ failure, lung hemorrhage and death. Such complications are thought to depend on several factors, including the host immunity. Protective immunity is associated with humoral immune response, but little is known about the immune response mounted during naturally-acquired Leptospira infection. METHODS AND PRINCIPAL FINDINGS Here, we used protein microarray chip to profile the antibody responses of patients with severe and mild leptospirosis against the complete Leptospira interrogans serovar Copenhageni predicted ORFeome. We discovered a limited number of immunodominant antigens, with 36 antigens specific to patients, of which 11 were potential serodiagnostic antigens, identified at acute phase, and 33 were potential subunit vaccine targets, detected after recovery. Moreover, we found distinct antibody profiles in patients with different clinical outcomes: in the severe group, overall IgM responses do not change and IgG responses increase over time, while both IgM and IgG responses remain stable in the mild patient group. Analyses of individual patients' responses showed that >74% of patients in the severe group had significant IgG increases over time compared to 29% of patients in the mild group. Additionally, 90% of IgM responses did not change over time in the mild group, compared to ~51% in the severe group. CONCLUSIONS In the present study, we detected antibody profiles associated with disease severity and speculate that patients with mild disease were protected from severe outcomes due to pre-existing antibodies, while patients with severe leptospirosis demonstrated an antibody profile typical of first exposure. Our findings represent a significant advance in the understanding of the humoral immune response to Leptospira infection, and we have identified new targets for the development of subunit vaccines and diagnostic tests.
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Affiliation(s)
| | - Janet C. Lindow
- Fiocruz, Gonçalo Moniz Research Institute, Brazilian Ministry of Health, Salvador, BA, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America
| | - Arlo Randall
- Antigen Discovery Inc, Irvine, CA, United States of America
| | - Elsio Wunder
- Fiocruz, Gonçalo Moniz Research Institute, Brazilian Ministry of Health, Salvador, BA, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America
| | - Jozelyn Pablo
- Department of Medicine, Division of Infectious Disease, University of California Irvine, Irvine, California, United States of America
| | - Rie Nakajima
- Department of Medicine, Division of Infectious Disease, University of California Irvine, Irvine, California, United States of America
| | - Algis Jasinskas
- Department of Medicine, Division of Infectious Disease, University of California Irvine, Irvine, California, United States of America
| | - Jaqueline S. Cruz
- Fiocruz, Gonçalo Moniz Research Institute, Brazilian Ministry of Health, Salvador, BA, Brazil
| | - Alcineia O. Damião
- Fiocruz, Gonçalo Moniz Research Institute, Brazilian Ministry of Health, Salvador, BA, Brazil
| | - Nívison Nery
- Fiocruz, Gonçalo Moniz Research Institute, Brazilian Ministry of Health, Salvador, BA, Brazil
| | - Guilherme S. Ribeiro
- Institute of Collective Health, Federal University of Bahia, Salvador, BA, Brazil
| | - Federico Costa
- Fiocruz, Gonçalo Moniz Research Institute, Brazilian Ministry of Health, Salvador, BA, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, BA, Brazil
| | - José E. Hagan
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America
| | - Mitermayer Galvão Reis
- Fiocruz, Gonçalo Moniz Research Institute, Brazilian Ministry of Health, Salvador, BA, Brazil
| | - Albert I. Ko
- Fiocruz, Gonçalo Moniz Research Institute, Brazilian Ministry of Health, Salvador, BA, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America
| | | | - Philip L. Felgner
- Department of Medicine, Division of Infectious Disease, University of California Irvine, Irvine, California, United States of America
- * E-mail:
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Søndergaard MM, Tursunovic A, Thye-Rønn P, Bang JC, Hansen IMJ. Leptospirosis-Associated Severe Pulmonary Hemorrhagic Syndrome with Lower Back Pain as an Initial Symptom. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:883-886. [PMID: 27881835 PMCID: PMC5127633 DOI: 10.12659/ajcr.900477] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Patient: Female, 45 Final Diagnosis: Leptospirosis Symptoms: Back pain • fever • headache • Hemopthysis • nausea • sepsis Medication: — Clinical Procedure: — Specialty: Infectious Diseases
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Affiliation(s)
- Mads Madsen Søndergaard
- Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark
| | - Amela Tursunovic
- Department of Cardiology, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark
| | - Peter Thye-Rønn
- Diagnostic Center, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark
| | - Jacob Christian Bang
- Department of Radiology, Odense University Hospital, Svendborg Hospital, Svendborg, Czech Republic
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Pires-Neto RC, Del Carlo Bernardi F, Alves de Araujo P, Mauad T, Dolhnikoff M. The Expression of Water and Ion Channels in Diffuse Alveolar Damage Is Not Dependent on DAD Etiology. PLoS One 2016; 11:e0166184. [PMID: 27835672 PMCID: PMC5106024 DOI: 10.1371/journal.pone.0166184] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/24/2016] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Aquaporins and ion channels are membrane proteins that facilitate the rapid movement of water and solutes across biological membranes. Experimental and in vitro studies reported that the function of these channels and pulmonary edema resolution are impaired in acute lung injury (ALI). Although current evidence indicates that alveolar fluid clearance is impaired in patients with ALI/diffuse alveolar damage (DAD), few human studies have addressed the alterations in pulmonary channels in this clinical condition. Additionally, it is not known whether the primary cause of DAD is a relevant variable for the channel dysfunction. METHODS Autopsied lungs of 43 patients with acute respiratory failure (ARF) due to DAD of three different etiologies, non-pulmonary sepsis, H1N1 viral infection and leptospirosis, were compared to 18 normal lungs. We quantified the expression of aquaporin (AQP) 1, AQP3, AQP5, epithelial Na+ channel (ENaC) and sodium potassium ATPase (Na-K-ATPase) in the alveolar septum using immunohistochemistry and image analysis. RESULTS The DAD group presented with increased expression of AQP3, AQP5 and Na-K-ATPase and decreased expression of ENaC compared to controls. However, there was no difference in protein expression within the DAD groups of different etiologies. CONCLUSION Water and ion channels are altered in patients with ARF due to DAD. The cause of DAD does not seem to influence the level of impairment of these channels.
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Affiliation(s)
- Ruy Camargo Pires-Neto
- Departamento de Patologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Priscila Alves de Araujo
- Departamento de Patologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thais Mauad
- Departamento de Patologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marisa Dolhnikoff
- Departamento de Patologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Mat Nor MB, Md Ralib A, Ibrahim NA, Abdul-Ghani MR. High frequency oscillatory ventilation in leptospirosis pulmonary hemorrhage syndrome: A case series study. Indian J Crit Care Med 2016; 20:342-8. [PMID: 27390458 PMCID: PMC4922287 DOI: 10.4103/0972-5229.183906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Hypoxemia in severe leptospirosis-associated pulmonary hemorrhage syndrome (LPHS) is a challenging clinical scenario not usually responsive to maximal support on mechanical ventilation. We described the efficacy and safety of high frequency oscillatory ventilation (HFOV) as rescue therapy in acute respiratory failure secondary to LPHS. This is a retrospective case study of five patients with diagnosis of severe LPHS, who were admitted to Intensive Care Unit from October 2014 to January 2015. They developed refractory hypoxemia on conventional mechanical ventilation and rescue therapy was indicated. All patients responded rapidly by showing improvements in oxygen index and PaO2/FiO2 ratio within first 72 h of therapy. Despite severity of illness evidenced by high Simplified Acute Physiological II and Sequential Organ Failure Assessment scores, all patients were discharged from hospital alive. In view of the rapid onset and extent of hemorrhage which may culminate quickly into asphyxiation and death, HFOV may indeed be lifesaving in severe LPHS.
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Affiliation(s)
- Mohd Basri Mat Nor
- Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia, Jalan Hospital Campus, 25100 Kuantan, Pahang, Malaysia
| | - Azrina Md Ralib
- Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia, Jalan Hospital Campus, 25100 Kuantan, Pahang, Malaysia
| | - Noor Airini Ibrahim
- Department of Surgery, Anaesthesiology Unit, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, 43400 Selangor, Malaysia
| | - Mohd Rasydan Abdul-Ghani
- Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia, Jalan Hospital Campus, 25100 Kuantan, Pahang, Malaysia
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Expression Profile of Cytokines and Enzymes mRNA in Blood Leukocytes of Dogs with Leptospirosis and Its Associated Pulmonary Hemorrhage Syndrome. PLoS One 2016; 11:e0148029. [PMID: 26824356 PMCID: PMC4732604 DOI: 10.1371/journal.pone.0148029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 01/12/2016] [Indexed: 12/18/2022] Open
Abstract
Background Dogs with leptospirosis show similar organ manifestations and disease course as human patients, including acute kidney injury and pulmonary hemorrhage, making this naturally-occurring infection a good animal model for human leptospirosis. Expression patterns of cytokines and enzymes have been correlated with disease manifestations and clinical outcome in humans and animals. The aim of this study was to describe mRNA expression of pro- and anti-inflammatory mediators in canine leptospirosis and to compare it with other renal diseases to identify patterns characterizing the disease and especially its pulmonary form. Methodology and Principal Findings The mRNA abundance of cytokines (IL-1α, IL-1β, IL-8, IL-10, TNF-α, TGF-β) and enzymes (5-LO, iNOS) was measured prospectively in blood leukocytes from 34 dogs with severe leptospirosis and acute kidney injury, including 22 dogs with leptospirosis-associated pulmonary hemorrhages. Dogs with leptospirosis were compared to 14 dogs with acute kidney injury of other origin than leptospirosis, 8 dogs with chronic kidney disease, and 10 healthy control dogs. Canine leptospirosis was characterized by high 5-LO and low TNF-α expression compared to other causes of acute kidney injury, although the decreased TNF-α expression was also seen in chronic kidney disease. Leptospirosis-associated pulmonary hemorrhage was not characterized by a specific pattern, with only mild changes noted, including increased IL-10 and decreased 5-LO expression on some days in affected dogs. Fatal outcome from pulmonary hemorrhages was associated with low TNF-α, high IL-1β, and high iNOS expression, a pattern possibly expressed also in dogs with other forms of acute kidney injury. Conclusion The patterns of cytokine and enzyme expression observed in the present study indicate a complex pro- and anti-inflammatory response to the infection with leptospires. The recognition of these signatures may be of diagnostic and prognostic relevance for affected individuals and they may indicate options for newer therapies targeting the identified pathways.
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Specific CD4+ T-Cell Reactivity and Cytokine Release in Different Clinical Presentations of Leptospirosis. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 22:1276-84. [PMID: 26491036 DOI: 10.1128/cvi.00397-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/14/2015] [Indexed: 02/06/2023]
Abstract
Clinical manifestations of leptospirosis are highly variable: from asymptomatic to severe and potentially fatal. The outcome of the disease is usually determined in the immunological phase, beginning in the second week of symptoms. The underlying mechanisms, predictive factors, and individual immune responses that contribute to clinical variations are not well understood. The aim of this study was to determine the specifics of CD4(+) T-cell reactivity and cytokine release after stimulation with leptospiral antigens in patients with leptospirosis of different disease severities (patients with mild and severe symptoms) and in control subjects (with and without proven exposure to Leptospira). Whole-blood specimens were stimulated with Leptospira antigens in vitro. Subsequently, intracellular staining of cytokines was performed, and flow cytometry was used to assess the expression of CD40 ligand (CD40L) and the production of gamma interferon (IFN-γ), interleukin-10 (IL-10), IL-2, and tumor necrosis factor alpha (TNF-α) by CD4(+) T cells. The production of inflammatory cytokines such as TNF-α by CD4(+) T cells after stimulation with leptospiral antigens was highest in patients with severe disease. In contrast, the ratio of IL-10 production to TNF-α production was higher in exposed subjects than in patients with mild and severe disease. Levels of proinflammatory cytokines such as TNF-α may be useful markers of the severity of the immunological phase of leptospirosis. IL-10 production by T cells after antigen-specific stimulation may indicate a more successful downregulation of the inflammatory response and may contribute to an asymptomatic course of the disease.
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Abstract
PURPOSE OF REVIEW In this review, we introduce the epidemiological features, clinical types, laboratory diagnosis, and routine surveillance of leptospirosis in China. RECENT FINDINGS Leptospirosis has been prevalent sporadically in China in recent years, but its incidence has decreased, probably due to the lower leptospire-carrying rate in pigs. Leptospira interrogans serogroup Icterohaemorrhagiae serovar Lai is the most common pathogen in Chinese leptospirosis patients and Apodemus agrarius is its major animal host. At least 75% of Chinese leptospirosis patients suffer from the mild influenza-like type of leptospirosis that is caused by any serovars of L. interrogans. However, leptospirosis patients with the pulmonary diffuse hemorrhagic type have a high mortality (40-60%). L. interrogans serovar Lai is the causative agent in 75% of the pulmonary diffuse hemorrhagic leptospirosis patients. Several outer membrane protein antigens exist in all the L. interrogans serovars prevailing in China and predominant T- and B-cell combined epitopes in the outer membrane protein antigens have been identified that can be used for developing novel universal leptospirosis vaccines. SUMMARY Leptospirosis cases in the Chinese population have gradually decreased in recent years, but it is still an important zoonotic infectious disease. The development of universal vaccines is critical for the prevention and control of leptospirosis.
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Libório AB, Braz MBM, Seguro AC, Meneses GC, Neves FMDO, Pedrosa DC, Cavalcanti LPDG, Martins AMC, Daher EDF. Endothelial glycocalyx damage is associated with leptospirosis acute kidney injury. Am J Trop Med Hyg 2015; 92:611-6. [PMID: 25624405 DOI: 10.4269/ajtmh.14-0232] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Leptospirosis is a common disease in tropical countries, and the kidney is one of the main target organs. Membrane proteins of Leptospira are capable of causing endothelial damage in vitro, but there have been no studies in humans evaluating endothelial glycocalyx damage and its correlation with acute kidney injury (AKI). We performed a cohort study in an outbreak of leptospirosis among military personnel. AKI was diagnosed in 14 of 46 (30.4%) patients. Leptospirosis was associated with higher levels of intercellular adhesion molecule-1 (ICAM-1; 483.1 ± 31.7 versus 234.9 ± 24.4 mg/L, P < 0.001) and syndecan-1 (73.7 ± 15.9 versus 21.2 ± 7.9 ng/mL, P < 0.001) compared with exposed controls. Patients with leptospirosis-associated AKI had increased level of syndecan-1 (112.1 ± 45.4 versus 41.5 ± 11.7 ng/mL, P = 0.021) and ICAM-1 (576.9 ± 70.4 versus 434.9 ± 35.3, P = 0.034) compared with leptospirosis patients with no AKI. Association was verified between syndecan-1 and ICAM-1 with serum creatinine elevation and neutrophil gelatinase-associated lipocalin (NGAL) levels. This association remained even after multivariate analysis including other AKI-associated characteristics. Endothelial injury biomarkers are associated with leptospirosis-associated renal damage.
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Affiliation(s)
- Alexandre Braga Libório
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Marcelo Boecker Munoz Braz
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Antonio Carlos Seguro
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Gdayllon C Meneses
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Fernanda Macedo de Oliveira Neves
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Danielle Carvalho Pedrosa
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Luciano Pamplona de Góes Cavalcanti
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Alice Maria Costa Martins
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Elizabeth de Francesco Daher
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
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RETRACTED: ChpK and MazF of the toxin-antitoxin modules are involved in the virulence of Leptospira interrogans during infection. Microbes Infect 2014; 17:34-47. [PMID: 25461800 DOI: 10.1016/j.micinf.2014.10.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 10/27/2014] [Accepted: 10/29/2014] [Indexed: 11/20/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal).
This article has been retracted at the request of the corresponding author and the editorial office of Microbes and Infection. An independent reviewer of the retraction request was also appointed given that one of the authors is the Editor-in- Chief.
For figure 1C, Lanes 1 and 2 appear to share some unexpected similarities, except for the bottom band, which also appear to be the band of interest.
Sections of Figure 2C appear similar to sections of Figure 5D of a paper that had already appeared in Molecular Microbiology, volume 83, issue 5 (2012) 1006-1023. https://doi.org/10.1111/j.1365-2958.2012.07985.x.
In figure 3A, Flow cytograms share identical/similar patterns highlighted in various colours. Peculiarly, some of these patterns can be seen as horizontal rotations of others along the axis that separates different quadrants. (ie red green & purple). Moreover, some quadrants appear to have very high densities of events that are suprisingly limited by quadrant gates (most noticeably quadrants B2 from the second column of panels.
Figure 5A-B it was found that there were duplicated bands were produced.
Figures 5C and 5D, it was found that bands across each individual gel appear identical.
One of the conditions of submission of a paper for publication is that authors declare explicitly that the paper has not been previously published and is not under consideration for publication elsewhere. Re-use of any data should be appropriately cited. As such this article represents a misuse of the scientific publishing system. The scientific community takes a very strong view on this matter and apologies are offered to readers of the journal that this was not detected during the submission process”.
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