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Study of the Adsorption of Bacillus subtilis and Bacillus cereus Bacteria on Enterosorbent Obtained from Apricot Kernels. Mol Vis 2022. [DOI: 10.3390/c8030038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This paper presents the results of scientific research on the structural parameters and the adsorption capacity of activated carbon obtained from apricot kernels (AC-A) in a fluidized layer. The obtained results highlight the fact that the described procedure allows obtaining a mesoporous carbon adsorbent with increased adsorption capacities (SBET = 1424 m2/g) and with quality indices corresponding to the requirements of the carbon enterosorbents imposed by the European Pharmacopoeia Monograph. Adsorption kinetics studies of the bacteria Bacillus subtilis and Bacillus cereus have shown that the time to establish the adsorption equilibrium is 75–90 min. The adsorption of the mentioned bacteria on the carbon enterosorbent AC-A was studied depending on the temperature (26 and 36 °C) and pH of the solution (1.97–4.05). Scanning Electron Microscopy (SEM) showed that the immobilization of bacteria takes place on the outer surface of the carbon adsorbent due to the fact that the geometric dimensions of the bacteria are often larger than the macro diameter of the activated carbon pores. FTIR investigations also indicated the presence of bacteria on the surface of the activated carbon.
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Yamashita M, Ohta R, Mouri N, Takizawa S, Sano C. Herpes Simplex Virus Pneumonia Mimicking Legionella Pneumonia in an Elderly Patient With Heart and Liver Failure. Cureus 2022; 14:e21938. [PMID: 35273879 PMCID: PMC8900970 DOI: 10.7759/cureus.21938] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 12/15/2022] Open
Abstract
The diagnosis of viral pneumonia is often difficult because of its varied presentations. Regarding the serological diagnosis of viral infections, it is difficult to perform a viral DNA test in general medical facilities, especially in rural settings. Among viral pneumonia cases, herpes simplex virus (HSV) pneumonia can occur in immunocompromised hosts. However, when the clinical course of HSV pneumonia is acute, and the features of pneumonia are not distinct, the diagnosis can be challenging. We report the case of a 69-year-old man who visited the hospital with complaints of dyspnea and cough for two days. Although the patient had no fever and the urine was negative for Legionella antigen, we suspected Legionella pneumonia based on the clinical course, Gram stain of sputum, and CT findings. After undergoing treatment with antibiotics, his condition worsened, with dyspnea and an increase in the demand for oxygen at 5 L. The patient also had complications related to the heart and liver. The sputum culture was negative, and the HSV serum test revealed that HSV IgM level was elevated to 1.16 (reference value: ≤0.80) and IgG level at admission and at follow-up 21 days later was elevated to 28.1 and 60.0 respectively (reference value: ≤2.0); accordingly, the patient was diagnosed with HSV pneumonia. In cases of pneumonia with atypical courses, the coexistence of multiple diseases, and immunosuppression, HSV pneumonia should be included in the differential diagnosis. In rural settings, viral pneumonia should be investigated using antibodies against viruses due to the limited availability of other medical resources. When a patient is judged to be immunosuppressed in the treatment of pneumonia of unknown cause, it is important to consider the possibility of HSV infection and take prompt action. Furthermore, it is essential to consider the possibility of multi-organ failure secondary to HSV infection, which requires systemic management.
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Ramesh P, Nagendrappa JH, Shivashankara SKH. Comparative analysis of Rosetta stone events in Klebsiella pneumoniae and Streptococcus pneumoniae for drug target identification. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2021. [DOI: 10.1186/s43088-021-00126-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Drug target identification is a fast-growing field of research in many human diseases. Many strategies have been devised in the post-genomic era to identify new drug targets for infectious diseases. Analysis of protein sequences from different organisms often reveals cases of exon/ORF shuffling in a genome. This results in the fusion of proteins/domains, either in the same genome or that of some other organism, and is termed Rosetta stone sequences. They help link disparate proteins together describing local and global relationships among proteomes. The functional role of proteins is determined mainly by domain-domain interactions and leading to the corresponding signaling mechanism. Putative proteins can be identified as drug targets by re-annotating their functional role through domain-based strategies.
Results
This study has utilized a bioinformatics approach to identify the putative proteins that are ideal drug targets for pneumonia infection by re-annotating the proteins through position-specific iterations. The putative proteome of two pneumonia-causing pathogens was analyzed to identify protein domain abundance and versatility among them. Common domains found in both pathogens were identified, and putative proteins containing these domains were re-annotated. Among many druggable protein targets, the re-annotation of EJJ83173 (which contains the GFO_IDH_MocA domain) showed that its probable function is glucose-fructose oxidoreduction. This protein was found to have sufficient interactor proteins and homolog in both pathogens but no homolog in the host (human), indicating it as an ideal drug target. 3D modeling of the protein showed promising model parameters. The model was utilized for virtual screening which revealed several ligands with inhibitory activity. These ligands included molecules documented in traditional Chinese medicine and currently marketed drugs.
Conclusions
This novel strategy of drug target identification through domain-based putative protein re-annotation presents a prospect to validate the proposed drug target to confer its utility as a typical protein targeting both pneumonia-causing species studied herewith.
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Eticha EM, Gemechu WD. Adherence to Guidelines for Assessment and Empiric Antibiotics Recommendations for Community-Acquired Pneumonia at Ambo University Referral Hospital: Prospective Observational Study. Patient Prefer Adherence 2021; 15:467-473. [PMID: 33658770 PMCID: PMC7920623 DOI: 10.2147/ppa.s295118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/16/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The high incidence and substantial morbidity and mortality associated with community-acquired pneumonia necessitate an accurate assessment and appropriate management of patients. This observational prospective study aimed to evaluate the physicians' adherence to the Ethiopian Standard Treatment Guideline for assessment and an empiric antibiotic selection for Community-acquired pneumonia. RESULTS The study indicated that the pneumonia severity assessment tool, CURB-65 score, was never used. Of 141 patients referred to an admitting diagnosis of severe community-acquired pneumonia, only 50 were subsequently found to satisfy the guideline criteria, over-diagnosis of 41.9%. Large proportions of the participants (130, 60%) were prescribed antibiotics in the last three months. The most commonly prescribed single antibiotic was Ceftriaxone (47, 21.7%), while ceftriaxone plus azithromycin was the most common combination, 110 (50.7%). In general, the extent of non-adherence to the national guideline for the use of antibiotics was 36.4%. In conclusion, the use of CRB65 scores was uncommon in the study setting. Poor adherence to Ethiopian Standard Treatment Guideline regarding the decision of hospital admission (41.9%) and the antimicrobial selection (36.4%) was determined.
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Affiliation(s)
- Endalkachew Mekonnen Eticha
- Ambo University, College of Medicine and Health Science, School of Pharmacy, Ambo, Ethiopia
- Correspondence: Endalkachew Mekonnen Eticha Email
| | - Workineh Diriba Gemechu
- Jigjiga University, College of Medicine and Health Science, School of Medicine, Jigjiga, Ethiopia
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Schirm S, Ahnert P, Berger S, Nouailles G, Wienhold SM, Müller-Redetzky H, Suttorp N, Loeffler M, Witzenrath M, Scholz M. A biomathematical model of immune response and barrier function in mice with pneumococcal lung infection. PLoS One 2020; 15:e0243147. [PMID: 33270742 PMCID: PMC7714238 DOI: 10.1371/journal.pone.0243147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022] Open
Abstract
Pneumonia is one of the leading causes of death worldwide. The course of the disease is often highly dynamic with unforeseen critical deterioration within hours in a relevant proportion of patients. Besides antibiotic treatment, novel adjunctive therapies are under development. Their additive value needs to be explored in preclinical and clinical studies and corresponding therapy schedules require optimization prior to introduction into clinical practice. Biomathematical modeling of the underlying disease and therapy processes might be a useful aid to support these processes. We here propose a biomathematical model of murine immune response during infection with Streptococcus pneumoniae aiming at predicting the outcome of different treatment schedules. The model consists of a number of non-linear ordinary differential equations describing the dynamics and interactions of the pulmonal pneumococcal population and relevant cells of the innate immune response, namely alveolar- and inflammatory macrophages and neutrophils. The cytokines IL-6 and IL-10 and the chemokines CCL2, CXCL1 and CXCL5 are considered as major mediators of the immune response. We also model the invasion of peripheral blood monocytes, their differentiation into macrophages and bacterial penetration through the epithelial barrier causing blood stream infections. We impose therapy effects on this system by modelling antibiotic therapy and treatment with the novel C5a-inactivator NOX-D19. All equations are derived by translating known biological mechanisms into equations and assuming appropriate response kinetics. Unknown model parameters were determined by fitting the predictions of the model to time series data derived from mice experiments with close-meshed time series of state parameters. Parameter fittings resulted in a good agreement of model and data for the experimental scenarios. The model can be used to predict the performance of alternative schedules of combined antibiotic and NOX-D19 treatment. We conclude that we established a comprehensive biomathematical model of pneumococcal lung infection, immune response and barrier function in mice allowing simulations of new treatment schedules. We aim to validate the model on the basis of further experimental data. We also plan the inclusion of further novel therapy principles and the translation of the model to the human situation in the near future.
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Affiliation(s)
- Sibylle Schirm
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Peter Ahnert
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Sarah Berger
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Geraldine Nouailles
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sandra-Maria Wienhold
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Holger Müller-Redetzky
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Norbert Suttorp
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Martin Witzenrath
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
- LIFE Research Center of Civilization Diseases, University of Leipzig, Leipzig, Germany
- * E-mail:
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Abstract
Community-acquired pneumonia (CAP) is one of the respiratory infectious diseases caused by not only bacteria, but also viruses. Antibiotic agents are needed to treat only bacterial but not viral CAP. In addition, there are some non-infectious respiratory diseases in the differential diagnosis of CAP, such as malignant diseases, interstitial lung diseases, pulmonary edema, and pulmonary hemorrhage. We usually diagnose patients having CAP by comprehensive evaluation of symptoms, vital signs, laboratory examinations, and radiographic examinations. However, symptoms and vital signs are not specific for the diagnosis of CAP; therefore, we also use inflammatory biomarkers for differentiating bacterial from viral CAP and non-infectious respiratory diseases. We have used the white blood cell count, C-reactive protein (CRP), and erythrocyte sedimentation rate as common inflammatory biomarkers, but they are not specific for bacterial infection because they could be increased by malignant diseases and collagen diseases. Recently, some inflammatory biomarkers such as procalcitonin (PCT), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), pro-adrenomedullin (proADM), and presepsin have been developed as relatively specific biomarkers for bacterial infection. Many reports have evaluated the usefulness of PCT for diagnosing CAP. In this review, the characteristics of each biomarker are discussed based on previous studies.
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Affiliation(s)
- Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
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Purba AK, Ascobat P, Muchtar A, Wulandari L, Rosyid AN, Purwono PB, van der Werf TS, Friedrich AW, Postma MJ. Multidrug-Resistant Infections Among Hospitalized Adults With Community-Acquired Pneumonia In An Indonesian Tertiary Referral Hospital. Infect Drug Resist 2019; 12:3663-3675. [PMID: 31819549 PMCID: PMC6883944 DOI: 10.2147/idr.s217842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/12/2019] [Indexed: 01/12/2023] Open
Abstract
Objectives To evaluate the clinical and microbiological appearance among hospitalized pneumonia patients focusing on resistance and risk factors for mortality in a referral hospital. Patients and methods The study was an observational retrospective study on patients with CAP from 2014 to 2016 at Dr Soetomo referral hospital of Surabaya, Indonesia. All positive cultures with antimicrobial susceptibility results from blood and respiratory specimens were included. Patients infected with drug-susceptible pathogens and MDR organisms were also assessed in terms of clinical characteristics, day-3 clinical improvement, and 14-day mortality. Results Of 202 isolates, 181 possessed antimicrobial susceptibility data. S. pneumoniae was the most prevalent pathogen causing CAP (18.3%). Most patients were empirically treated with ceftriaxone (n=75; 41.4%). Among beta-lactam antibiotics, the susceptibility to the third-generation cephalosporins remained relatively high, between 67.4% and 82.3%, compared with the other beta-lactams such as amoxicillin/clavulanate and ampicillin/sulbactam (a sensitivity rate of 36.5% and 47.5, respectively). For carbapenem antibiotics, imipenem and meropenem susceptibility was 69.6% and 82.3% respectively. Approximately 22% of isolates were identified as MDR that showed significant differences in clinical outcomes of 14-day mortality rates (p<0.001). Notably, patients with day-3 improvement had a lower risk of mortality (OR= 0.06; 95% CI= 0.02–0.19). Conclusion One-fifth of causative agents among hospitalized CAP cases were identified as MDR organisms. The pathogens of MDR and non-MDR CAP remain susceptible to the third-generation cephalosporins. Together with additional consideration of culture findings and Pneumonia Severity Index (PSI) assessment, a 3-day clinical assessment is essential to predict the prognosis of 14-day mortality. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/QzMqf278Mac
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Affiliation(s)
- Abdul Kr Purba
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo Hospital, Surabaya, Indonesia.,Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Unit of PharmacoTherapy, Epidemiology and -economics (PTE2), Department of Pharmacy, Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Purwantyastuti Ascobat
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Armen Muchtar
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Laksmi Wulandari
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Alfian Nur Rosyid
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Priyo Budi Purwono
- Department of Microbiology, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Tjip S van der Werf
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alex W Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo Hospital, Surabaya, Indonesia.,Unit of PharmacoTherapy, Epidemiology and -economics (PTE2), Department of Pharmacy, Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands.,Department of Economics, Econometrics and Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
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8
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Heo JY, Song JY. Disease Burden and Etiologic Distribution of Community-Acquired Pneumonia in Adults: Evolving Epidemiology in the Era of Pneumococcal Conjugate Vaccines. Infect Chemother 2018; 50:287-300. [PMID: 30600652 PMCID: PMC6312904 DOI: 10.3947/ic.2018.50.4.287] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Indexed: 12/23/2022] Open
Abstract
Pneumonia is the leading cause of morbidity and mortality, particularly in old adults. The incidence and etiologic distribution of community-acquired pneumonia is variable both geographically and temporally, and epidemiology might evolve with the change of population characteristics and vaccine uptake rates. With the increasing prevalence of chronic medical conditions, a wide spectrum of healthcare-associated pneumonia could also affect the epidemiology of community-acquired pneumonia. Here, we provide an overview of the epidemiological changes associated with community-acquired pneumonia over the decades since pneumococcal conjugate vaccine introduction.
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Affiliation(s)
- Jung Yeon Heo
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Asian Pacific Influenza Institute, Korea University College of Medicine, Seoul, Korea.
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Parlak ES, Alisik M, Hezer H, Karalezli A, Hasanoglu HC, Erel O. Evaluation of dynamic thiol/disulfide redox state in community-acquired pneumonia. Saudi Med J 2018; 39:495-499. [PMID: 29738010 PMCID: PMC6118170 DOI: 10.15537/smj.2018.5.22111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives To compare dynamic thiol/disulfide homeostasis between patients with community-acquired pneumonia (CAP) and healthy controls. Methods This prospective, case-control study was conducted in the Department of Pulmonary Diseases, Ankara Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey, between August 2016 and August 2017. In total, 50 hospitalized patients with CAP and 35 healthy individuals were enrolled. Patients with comorbidities and smokers were excluded. The thiol/disulfide state was evaluated in each group. Thiol levels (native/total) and % polymorhonuclear leukocytes and C-reactive protein levels association were evaluated in patients with CAP. Results There was no significant difference between the CAP and control groups in age or gender (both, p>0.05). The disulfide (SS) levels were similar between the 2 groups (p=0.148). The total thiol (TT) and native thiol (SH) levels were significantly lower (all, p=0.001) and the SS/TT levels were significantly higher (p=0.019) in the CAP group compared with the controls. Conclusions This study showed that the oxidant/antioxidant ratio was shifted to the oxidative side in CAP patients. An abnormal thiol/disulfide state may be an important factor in the pathogenesis and monitoring the treatment response. The thiol resources may use for treatment in CAP and may positively affect the prognosis.
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Affiliation(s)
- Ebru S Parlak
- Department of Pulmonary Diseases, Ankara Ataturk Training and Research Hospital, Ankara, Turkey. E-mail.
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Rashwan R, Varano della Vergiliana JF, Lansley SM, Cheah HM, Popowicz N, Paton JC, Waterer GW, Townsend T, Kay I, Brown JS, Lee YCG. Streptococcus pneumoniae potently induces cell death in mesothelial cells. PLoS One 2018; 13:e0201530. [PMID: 30059559 PMCID: PMC6066251 DOI: 10.1371/journal.pone.0201530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 07/17/2018] [Indexed: 01/22/2023] Open
Abstract
Pleural infection/empyema is common and its incidence continues to rise. Streptococcus pneumoniae is the commonest bacterial cause of empyema in children and among the commonest in adults. The mesothelium represents the first line of defense against invading microorganisms, but mesothelial cell responses to common empyema pathogens, including S. pneumoniae, have seldom been studied. We assessed mesothelial cell viability in vitro following exposure to common empyema pathogens. Clinical isolates of S. pneumoniae from 25 patients with invasive pneumococcal disease and three reference strains were tested. All potently induced death of cultured mesothelial cells (MeT-5A) in a dose- and time-dependent manner (>90% at 107 CFU/mL after 24 hours). No significant mesothelial cell killing was observed when cells were co-cultured with Staphylococcus aureus, Streptococcus sanguinis and Streptococcus milleri group bacteria. S. pneumoniae induced mesothelial cell death via secretory product(s) as cytotoxicity could be: i) reproduced using conditioned media derived from S. pneumoniae and ii) in transwell studies when the bacteria and mesothelial cells were separated. No excess cell death was seen when heat-killed S. pneumoniae were used. Pneumolysin, a cytolytic S. pneumoniae toxin, induced cell death in a time- and dose-dependent manner. S. pneumoniae lacking the pneumolysin gene (D39 ΔPLY strain) failed to kill mesothelial cells compared to wild type (D39) controls, confirming the necessity of pneumolysin in D39-induced mesothelial cell death. However, pneumolysin gene mutation in other S. pneumoniae strains (TIGR4, ST3 and ST23F) only partly abolished their cytotoxic effects, suggesting different strains may induce cell death via different mechanisms.
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Affiliation(s)
- Rabab Rashwan
- Centre for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
- Department of Microbiology and Immunology, Faculty of Medicine, Minia University, Minya, Egypt
| | - Julius F. Varano della Vergiliana
- Centre for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine & Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Sally M. Lansley
- Centre for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine & Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Hui Min Cheah
- Centre for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine & Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Natalia Popowicz
- Centre for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine & Pharmacology, University of Western Australia, Perth, Western Australia, Australia
- Department of Pharmacy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - James C. Paton
- Research Centre for Infectious Diseases, Department of Molecular and Cellular Biology, University of Adelaide, Adelaide, South Australia, Australia
| | - Grant W. Waterer
- Respiratory Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Tiffany Townsend
- Dept of Microbiology & Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ian Kay
- Dept of Microbiology & Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jeremy S. Brown
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, United Kingdom
| | - Y. C. Gary Lee
- Centre for Respiratory Health, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine & Pharmacology, University of Western Australia, Perth, Western Australia, Australia
- Dept of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- * E-mail:
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11
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Aulin LBS, Valitalo PA, Rizk ML, Visser SAG, Rao G, van der Graaf PH, van Hasselt JGC. Validation of a Model Predicting Anti-infective Lung Penetration in the Epithelial Lining Fluid of Humans. Pharm Res 2018; 35:26. [PMID: 29368211 PMCID: PMC5783989 DOI: 10.1007/s11095-017-2336-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Linda B S Aulin
- Leiden Academic Centre for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, Netherlands
| | | | | | | | - Gauri Rao
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Piet H van der Graaf
- Leiden Academic Centre for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, Netherlands.,Certara, Canterbury, UK
| | - J G Coen van Hasselt
- Leiden Academic Centre for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, Netherlands.
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12
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Chang TM, Mou CH, Shen TC, Yang CL, Yang MH, Wu FY, Sung FC. Retrospective cohort evaluation on risk of pneumonia in patients with pulmonary tuberculosis. Medicine (Baltimore) 2016; 95:e4000. [PMID: 27368009 PMCID: PMC4937923 DOI: 10.1097/md.0000000000004000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Pulmonary tuberculosis (PTb) and pneumonia are diseases that may exist concomitantly. Population study investigating the subsequent pneumonia development in PTb patients is limited. This study compares the risk of pneumonia between cohorts with and without PTb.We used the claims data of the Taiwan National Health Insurance to identify a cohort with PTb (N = 3417) newly diagnosed in 2000-2006 without pneumonia history, and a randomly selected comparison cohort (N = 6834) free of PTb and pneumonia, frequency matched by propensity score. Incidence rates and hazard ratios of pneumonia were calculated by sex, age, and comorbidity starting in the 7th month after the cohorts being established until the end of 2011.We found the incidence of pneumonia to be 1.9-fold higher in the PTb cohort than in the PTb free cohort (51.6 vs 27.0 per 1000 person-years). The PTb cohort had a Cox method estimated adjusted hazard ratio of 2.14 (95% confidence interval = 1.96-2.32). We also found that the risk was greater for men than for women, but lower for young adults aged 20-39 years. Comorbidity interacted with PTb by aggravating the pneumonia risk, particularly for those with asthma. For PTb patients comorbid with asthma, the pneumonia incidence was 2.5-fold higher than for PTb patients free of comorbidities (75.9 vs 29.3 per 1000 person-years).Our results display that PTb patients have an elevated risk of developing pneumonia. Adequate follow-up should be provided to the PTb patients, especially those with comorbidity.
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Affiliation(s)
- Tsui-Ming Chang
- Department of Public Health, China Medical University
- Department of Nursing, Central Taiwan University of Science and Technology
| | - Chih-Hsin Mou
- Management Office for Health Data, China Medical University Hospital
| | - Te-Chun Shen
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung
| | - Chien-Lung Yang
- Department of Laboratory Medicine, Hsin-Chu Mackay Memorial Hospital
| | - Min-Hui Yang
- Department of Public Health, China Medical University
- Department of Laboratory Medicine, Catholic Mercy Hospital, Catholic Mercy Medical Foundation, HsinChu
| | - Fang-Yang Wu
- Department of Public Health, China Medical University
- Correspondence: Fung-Chang Sung, Department of Health Services Administration, China Medical University, 91 Hseuh Shih Road, Taichung 404, Taiwan (e-mail: )
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Mahidol University Faculty of Public Health, Bangkok, Thailand
- Correspondence: Fung-Chang Sung, Department of Health Services Administration, China Medical University, 91 Hseuh Shih Road, Taichung 404, Taiwan (e-mail: )
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13
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Zahlten J, Herta T, Kabus C, Steinfeldt M, Kershaw O, García P, Hocke AC, Gruber AD, Hübner RH, Steinicke R, Doehn JM, Suttorp N, Hippenstiel S. Role of Pneumococcal Autolysin for KLF4 Expression and Chemokine Secretion in Lung Epithelium. Am J Respir Cell Mol Biol 2015; 53:544-54. [PMID: 25756955 DOI: 10.1165/rcmb.2014-0024oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In severe pneumococcal pneumonia, the delicate balance between a robust inflammatory response necessary to kill bacteria and the loss of organ function determines the outcome of disease. In this study, we tested the hypothesis that Krueppel-like factor (KLF) 4 may counter-regulate Streptococcus pneumoniae-related human lung epithelial cell activation using the potent proinflammatory chemokine IL-8 as a model molecule. Pneumococci induced KLF4 expression in human lung, in primary human bronchial epithelial cells, and in the lung epithelial cell line BEAS-2B. Whereas proinflammatory cell activation depends mainly on the classical Toll-like receptor 2-mitogen-activated protein kinase or phosphatidylinositide 3-kinase and NF-κB pathways, the induction of KLF4 occurred independently of these molecules but relied, in general, on tyrosine kinase activation and, in part, on the src kinase family member yamaguchi sarcoma viral oncogene homolog (yes) 1. The up-regulation of KLF4 depended on the activity of the main pneumococcal autolysin LytA. KLF4 overexpression suppressed S. pneumoniae-induced NF-κB and IL-8 reporter gene activation and release, whereas small interfering RNA-mediated silencing of KLF4 or yes1 kinase led to an increase in IL-8 release. The KLF4-dependent down-regulation of NF-κB luciferase activity could be rescued by the overexpression of the histone acetylase p300/cAMP response element-binding protein-associated factor. In conclusion, KLF4 acts as a counter-regulatory transcription factor in pneumococci-related proinflammatory activation of lung epithelial cells, thereby potentially preventing lung hyperinflammation and subsequent organ failure.
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Affiliation(s)
- Janine Zahlten
- 1 Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Toni Herta
- 1 Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christin Kabus
- 1 Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Magdalena Steinfeldt
- 1 Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Olivia Kershaw
- 2 Department of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Pedro García
- 3 Departamento de Microbiología Molecular, Centro de Investigaciones Biologicas, Consejo Superior de Investigaciones Científicas, Madrid, Spain; and.,4 CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Andreas C Hocke
- 1 Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Achim D Gruber
- 2 Department of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Ralf-Harto Hübner
- 1 Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Steinicke
- 1 Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan-Moritz Doehn
- 1 Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Norbert Suttorp
- 1 Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Hippenstiel
- 1 Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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14
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Reveles KR, Mortensen EM, Attridge RT, Frei CR. Comparative-effectiveness of vancomycin and linezolid as part of guideline-recommended empiric therapy for healthcare-associated pneumonia. BMC Res Notes 2015; 8:450. [PMID: 26382940 PMCID: PMC4573683 DOI: 10.1186/s13104-015-1396-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 08/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Linezolid has been directly compared to vancomycin in pneumonia; however, most clinical trials have not compared outcomes specifically in the healthcare-associated pneumonia (HCAP) population. The objective of this study was to compare the effectiveness of vancomycin and linezolid in a national cohort of hospitalized veterans with HCAP. METHODS This was a retrospective cohort study of Veterans Health Administration patients admitted to >150 hospitals across the United States between 2002 and 2007. Patients were included if they were at least 65 years old, had an ICD-9-CM code for pneumonia, had one or more HCAP risk factors, and received guideline-concordant antibiotic therapy with linezolid or vancomycin within 48 h of admission. Critically ill patients were excluded. Multivariable logistic regression models and propensity scores were used to examine the association between linezolid or vancomycin therapy and 30-day mortality. RESULTS A total of 1211 patients met study criteria; 946 received vancomycin and 265 received linezolid. Thirty-day mortality was higher in patients treated with vancomycin (n = 243; 25.7 %) as compared to linezolid (n = 33; 12.5 %) (adjusted OR 2.56; 95 % CI 1.67-4.04). Vancomycin use (n = 945) was also predictive of 30-day mortality compared to linezolid use (n = 264) in the propensity score analysis (adjusted OR 2.55; 95 % CI 1.66-4.02). CONCLUSION Linezolid was associated with decreased patient mortality compared to vancomycin in a national cohort of non-critically ill, hospitalized veterans with HCAP.
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Affiliation(s)
- Kelly R Reveles
- College of Pharmacy, The University of Texas at Austin, San Antonio, TX, USA.
- Pharmacotherapy Education and Research Center (PERC), School of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., MSC-6220, San Antonio, TX, 78229-3900, USA.
| | - Eric M Mortensen
- The VA North Texas Health Care System, Dallas, TX, USA.
- School of Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines, Boulevard, Dallas, TX, USA.
| | - Russell T Attridge
- Feik School of Pharmacy, University of the Incarnate Word, 4301 Broadway, CPO #99, San Antonio, TX, USA.
| | - Christopher R Frei
- College of Pharmacy, The University of Texas at Austin, San Antonio, TX, USA.
- Pharmacotherapy Education and Research Center (PERC), School of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., MSC-6220, San Antonio, TX, 78229-3900, USA.
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15
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Roach DJ, Burton JN, Lee C, Stackhouse B, Butler-Wu SM, Cookson BT, Shendure J, Salipante SJ. A Year of Infection in the Intensive Care Unit: Prospective Whole Genome Sequencing of Bacterial Clinical Isolates Reveals Cryptic Transmissions and Novel Microbiota. PLoS Genet 2015; 11:e1005413. [PMID: 26230489 PMCID: PMC4521703 DOI: 10.1371/journal.pgen.1005413] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/02/2015] [Indexed: 01/05/2023] Open
Abstract
Bacterial whole genome sequencing holds promise as a disruptive technology in clinical microbiology, but it has not yet been applied systematically or comprehensively within a clinical context. Here, over the course of one year, we performed prospective collection and whole genome sequencing of nearly all bacterial isolates obtained from a tertiary care hospital's intensive care units (ICUs). This unbiased collection of 1,229 bacterial genomes from 391 patients enables detailed exploration of several features of clinical pathogens. A sizable fraction of isolates identified as clinically relevant corresponded to previously undescribed species: 12% of isolates assigned a species-level classification by conventional methods actually qualified as distinct, novel genomospecies on the basis of genomic similarity. Pan-genome analysis of the most frequently encountered pathogens in the collection revealed substantial variation in pan-genome size (1,420 to 20,432 genes) and the rate of gene discovery (1 to 152 genes per isolate sequenced). Surprisingly, although potential nosocomial transmission of actively surveilled pathogens was rare, 8.7% of isolates belonged to genomically related clonal lineages that were present among multiple patients, usually with overlapping hospital admissions, and were associated with clinically significant infection in 62% of patients from which they were recovered. Multi-patient clonal lineages were particularly evident in the neonatal care unit, where seven separate Staphylococcus epidermidis clonal lineages were identified, including one lineage associated with bacteremia in 5/9 neonates. Our study highlights key differences in the information made available by conventional microbiological practices versus whole genome sequencing, and motivates the further integration of microbial genome sequencing into routine clinical care.
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Affiliation(s)
- David J. Roach
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Joshua N. Burton
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Choli Lee
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Bethany Stackhouse
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Susan M. Butler-Wu
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
| | - Brad T. Cookson
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Microbiology, University of Washington, Seattle, Washington, United States of America
| | - Jay Shendure
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Stephen J. Salipante
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
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16
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Adler N, Weber H, Gunadasa I, Hughes A, Friedman N. Adherence to therapeutic guidelines for patients with community-acquired pneumonia in Australian hospitals. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2014; 8:17-20. [PMID: 25249765 PMCID: PMC4167314 DOI: 10.4137/ccrpm.s17978] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/09/2014] [Accepted: 08/16/2014] [Indexed: 01/11/2023]
Abstract
Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality, particularly in elderly patients, and is associated with a considerable economic burden on the healthcare system. The combination of high incidence and substantial financial costs necessitate accurate diagnosis and appropriate management of patients admitted with CAP. This article will discuss the rates of adherence to clinical guidelines, the use of severity scoring tools and the appropriateness of antimicrobial prescribing for patients diagnosed with CAP. The authors maintain that awareness of national and hospital guidelines is imperative to complement the physicians’ clinical judgment with evidence-based recommendations. Increased use of pneumonia severity assessment tools and greater adherence to therapeutic guidelines will enhance concordant antimicrobial prescribing for patients with CAP. A robust and multifaceted educational intervention, in combination with antimicrobial stewardship programs, may enhance compliance of CAP guidelines in clinical practice in Australia.
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Affiliation(s)
- Nr Adler
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Hm Weber
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - I Gunadasa
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Aj Hughes
- Departments of General Medicine and Infectious Diseases, Barwon Health, Geelong, Victoria, Australia
| | - Nd Friedman
- Departments of General Medicine and Infectious Diseases, Barwon Health, Geelong, Victoria, Australia
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17
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Ruiz-González A, Esquerda A, Porcel JM, Bielsa S, Valencia H, Cao G, Falguera M. A pilot study on the diagnostic accuracy of proadrenomedullin and proatrial natriuretic Peptide in lower respiratory tract infections. Open Respir Med J 2014; 8:22-7. [PMID: 25071872 PMCID: PMC4110395 DOI: 10.2174/1874306401408010022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 06/12/2014] [Accepted: 06/25/2014] [Indexed: 11/22/2022] Open
Abstract
Background : Pneumonia is the leading cause of death among infectious diseases in developed countries. However, the severity of pneumonia requiring hospitalization often makes the initial diagnosis difficult because of an equivocal clinical picture or interpretation of the chest film. The objective of the present study was to assess the usefulness of the plasma levels of mid-regional proadrenomedullin (MR-proADM) and mid-regional proatrial natriuretic peptide (MR-proANP) in differentiating pneumonia from other lower respiratory tract infections (LRTIs). Methods : A retrospective study was conducted. The plasma levels of MR-proADM and MR-proANP were measured in 85 patients hospitalized for LRTIs, 56 of whom with diagnosis of pneumonia and 29 with other LRTIs. Results : The patients with pneumonia had increased MR-proADM levels (median 1.46 nmol/L [IQR 25-75, 0.82-2.02 nmol/L]) compared with the patients with other LRTIs (median 0.88 nmol/mL [0.71-1.39 nmol/L]) (p= 0.04). However, the MR-proANP levels did not show differences between the groups. The optimal threshold of MR-proADM to predict pneumonia was 1.5 nmol/L, which yielded a sensitivity of 51.7% (95% CI, 38.0-65.3), a 79.3% specificity (95% CI, 60.3-92.0), and an odds ratio of 6.64 (95% CI, 1.32-32.85). The combination of this parameter with C-reactive protein in an “and” rule increased the specificity for detecting pneumonia significantly. Conclusion : MR-proADM levels (but not MR-proANP levels) are increased in patients with pneumonia although its discriminatory power is moderate.
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Affiliation(s)
- Agustín Ruiz-González
- Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain
| | - Aureli Esquerda
- Department of Laboratory Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain
| | - José M Porcel
- Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain
| | - Silvia Bielsa
- Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain
| | - Horacio Valencia
- Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain
| | - Gonzalo Cao
- Department of Laboratory Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain
| | - Miquel Falguera
- Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain
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18
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Szaba FM, Kummer LW, Duso DK, Koroleva EP, Tumanov AV, Cooper AM, Bliska JB, Smiley ST, Lin JS. TNFα and IFNγ but not perforin are critical for CD8 T cell-mediated protection against pulmonary Yersinia pestis infection. PLoS Pathog 2014; 10:e1004142. [PMID: 24854422 PMCID: PMC4031182 DOI: 10.1371/journal.ppat.1004142] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/07/2014] [Indexed: 11/18/2022] Open
Abstract
Septic pneumonias resulting from bacterial infections of the lung are a leading cause of human death worldwide. Little is known about the capacity of CD8 T cell-mediated immunity to combat these infections and the types of effector functions that may be most effective. Pneumonic plague is an acutely lethal septic pneumonia caused by the Gram-negative bacterium Yersinia pestis. We recently identified a dominant and protective Y. pestis antigen, YopE69-77, recognized by CD8 T cells in C57BL/6 mice. Here, we use gene-deficient mice, Ab-mediated depletion, cell transfers, and bone marrow chimeric mice to investigate the effector functions of YopE69-77-specific CD8 T cells and their relative contributions during pulmonary Y. pestis infection. We demonstrate that YopE69-77-specific CD8 T cells exhibit perforin-dependent cytotoxicity in vivo; however, perforin is dispensable for YopE69-77-mediated protection. In contrast, YopE69-77-mediated protection is severely impaired when production of TNFα and IFNγ by CD8 T cells is simultaneously ablated. Interestingly, TNFα is absolutely required at the time of challenge infection and can be provided by either T cells or non-T cells, whereas IFNγ provided by T cells prior to challenge appears to facilitate the differentiation of optimally protective CD8 T cells. We conclude that cytokine production, not cytotoxicity, is essential for CD8 T cell-mediated control of pulmonary Y. pestis infection and we suggest that assays detecting Ag-specific TNFα production in addition to antibody titers may be useful correlates of vaccine efficacy against plague and other acutely lethal septic bacterial pneumonias.
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Affiliation(s)
- Frank M. Szaba
- Trudeau Institute, Saranac Lake, New York, United States of America
| | | | - Debra K. Duso
- Trudeau Institute, Saranac Lake, New York, United States of America
| | | | | | - Andrea M. Cooper
- Trudeau Institute, Saranac Lake, New York, United States of America
| | - James B. Bliska
- Center for Infectious Diseases and Department of Molecular Genetics and Microbiology, Stony Brook University, Stony Brook, New York, United States of America
| | | | - Jr-Shiuan Lin
- Trudeau Institute, Saranac Lake, New York, United States of America
- * E-mail:
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19
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Song JY, Eun BW, Nahm MH. Diagnosis of pneumococcal pneumonia: current pitfalls and the way forward. Infect Chemother 2013; 45:351-66. [PMID: 24475349 PMCID: PMC3902818 DOI: 10.3947/ic.2013.45.4.351] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Indexed: 02/02/2023] Open
Abstract
Streptococcus pneumoniae is the most common cause of community-acquired pneumonia. However, it can also asymptomatically colonize the upper respiratory tract. Because of the need to distinguish between S. pneumoniae that is simply colonizing the upper respiratory tract and S. pneumoniae that is causing pneumonia, accurate diagnosis of pneumococcal pneumonia is a challenging issue that still needs to be solved. Sputum Gram stains and culture are the first diagnostic step for identifying pneumococcal pneumonia and provide information on antibiotic susceptibility. However, these conventional methods are relatively slow and insensitive and show limited specificity. In the past decade, new diagnostic tools have been developed, particularly antigen (teichoic acid and capsular polysaccharides) and nucleic acid (ply, lytA, and Spn9802) detection assays. Use of the pneumococcal antigen detection methods along with biomarkers (C-reactive protein and procalcitonin) may enhance the specificity of diagnosis for pneumococcal pneumonia. This article provides an overview of current methods of diagnosing pneumococcal pneumonia and discusses new and future test methods that may provide the way forward for improving its diagnosis.
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Affiliation(s)
- Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Byung Wook Eun
- Department of Pediatrics, Eulji General Hospital, Seoul, Korea
| | - Moon H Nahm
- Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. ; Department of Microbiology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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20
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Zhu J, Bean HD, Jiménez-Díaz J, Hill JE. Secondary electrospray ionization-mass spectrometry (SESI-MS) breathprinting of multiple bacterial lung pathogens, a mouse model study. J Appl Physiol (1985) 2013; 114:1544-9. [PMID: 23519230 DOI: 10.1152/japplphysiol.00099.2013] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Bacterial pneumonia is one of the leading causes of disease-related morbidity and mortality in the world, in part because the diagnostic tools for pneumonia are slow and ineffective. To improve the diagnosis success rates and treatment outcomes for bacterial lung infections, we are exploring the use of secondary electrospray ionization-mass spectrometry (SESI-MS) breath analysis as a rapid, noninvasive method for determining the etiology of lung infections in situ. Using a murine lung infection model, we demonstrate that SESI-MS breathprints can be used to distinguish mice that are infected with one of seven lung pathogens: Haemophilus influenzae, Klebsiella pneumoniae, Legionella pneumophila, Moraxella catarrhalis, Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus pneumoniae, representing the primary causes of bacterial pneumonia worldwide. After applying principal components analysis, we observed that with the first three principal components (primarily comprised of data from 14 peaks), all infections were separable via SESI-MS breathprinting (P < 0.0001). Therefore, we have shown the potential of this SESI-MS approach for rapidly detecting and identifying acute bacterial lung infections in situ via breath analysis.
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Affiliation(s)
- Jiangjiang Zhu
- School of Engineering, University of Vermont, Burlington, Vermont 05405, USA
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21
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Rapid identification of microorganisms isolated from throat swab specimens of community-acquired pneumonia patients by two MALDI-TOF MS systems. Diagn Microbiol Infect Dis 2012; 73:301-7. [DOI: 10.1016/j.diagmicrobio.2012.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 04/05/2012] [Accepted: 04/16/2012] [Indexed: 11/18/2022]
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22
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Etiologic diagnosis of lower respiratory tract bacterial infections using sputum samples and quantitative loop-mediated isothermal amplification. PLoS One 2012; 7:e38743. [PMID: 22719933 PMCID: PMC3375278 DOI: 10.1371/journal.pone.0038743] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 05/10/2012] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED Etiologic diagnoses of lower respiratory tract infections (LRTI) have been relying primarily on bacterial cultures that often fail to return useful results in time. Although DNA-based assays are more sensitive than bacterial cultures in detecting pathogens, the molecular results are often inconsistent and challenged by doubts on false positives, such as those due to system- and environment-derived contaminations. Here we report a nationwide cohort study on 2986 suspected LRTI patients across P. R. China. We compared the performance of a DNA-based assay qLAMP (quantitative Loop-mediated isothermal AMPlification) with that of standard bacterial cultures in detecting a panel of eight common respiratory bacterial pathogens from sputum samples. Our qLAMP assay detects the panel of pathogens in 1047(69.28%) patients from 1533 qualified patients at the end. We found that the bacterial titer quantified based on qLAMP is a predictor of probability that the bacterium in the sample can be detected in culture assay. The relatedness of the two assays fits a logistic regression curve. We used a piecewise linear function to define breakpoints where latent pathogen abruptly change its competitive relationship with others in the panel. These breakpoints, where pathogens start to propagate abnormally, are used as cutoffs to eliminate the influence of contaminations from normal flora. With help of the cutoffs derived from statistical analysis, we are able to identify causative pathogens in 750 (48.92%) patients from qualified patients. In conclusion, qLAMP is a reliable method in quantifying bacterial titer. Despite the fact that there are always latent bacteria contaminated in sputum samples, we can identify causative pathogens based on cutoffs derived from statistical analysis of competitive relationship. TRIAL REGISTRATION ClinicalTrials.gov NCT00567827.
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23
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Lippi G, Meschi T, Cervellin G. Inflammatory biomarkers for the diagnosis, monitoring and follow-up of community-acquired pneumonia: clinical evidence and perspectives. Eur J Intern Med 2011; 22:460-5. [PMID: 21925053 DOI: 10.1016/j.ejim.2011.02.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 02/13/2011] [Accepted: 02/25/2011] [Indexed: 02/07/2023]
Abstract
Community-acquired pneumonia (CAP) is defined as an infection of the alveolar or gas-exchanging portions of the lungs occurring outside the hospital, with clinical symptoms accompanied by the presence of an infiltrate in the chest radiograph. Due to the high prevalence and the large demand of healthcare resources, an accurate clinical and therapeutic decision making is crucial in patients with CAP. As such, there is increasing interest on the use of traditional and innovative biomarkers such as procalcitonin (PCT) and C-reactive protein (CRP). At variance with other traditional inflammatory and innovative biomarkers, PCT might help limiting unnecessary antibiotic use, reduce bacterial resistance and decrease medical costs and drug-related adverse events. PCT however carries some additional advantages over CRP, such as the greater specificity for infections and a more narrow range of normal concentrations.
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Affiliation(s)
- Giuseppe Lippi
- U.O. Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
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24
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Lin JS, Szaba FM, Kummer LW, Chromy BA, Smiley ST. Yersinia pestis YopE contains a dominant CD8 T cell epitope that confers protection in a mouse model of pneumonic plague. THE JOURNAL OF IMMUNOLOGY 2011; 187:897-904. [PMID: 21653834 DOI: 10.4049/jimmunol.1100174] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Septic bacterial pneumonias are a major cause of death worldwide. Several of the highest priority bioterror concerns, including anthrax, tularemia, and plague, are caused by bacteria that acutely infect the lung. Bacterial resistance to multiple antibiotics is increasingly common. Although vaccines may be our best defense against antibiotic-resistant bacteria, there has been little progress in the development of safe and effective vaccines for pulmonary bacterial pathogens. The Gram-negative bacterium Yersinia pestis causes pneumonic plague, an acutely lethal septic pneumonia. Historic pandemics of plague caused millions of deaths, and the plague bacilli's potential for weaponization sustains an ongoing quest for effective countermeasures. Subunit vaccines have failed, to date, to fully protect nonhuman primates. In mice, they induce the production of Abs that act in concert with type 1 cytokines to deliver high-level protection; however, the Y. pestis Ags recognized by cytokine-producing T cells have yet to be defined. In this study, we report that Y. pestis YopE is a dominant Ag recognized by CD8 T cells in C57BL/6 mice. After vaccinating with live attenuated Y. pestis and challenging intranasally with virulent plague, nearly 20% of pulmonary CD8 T cells recognize this single, highly conserved Ag. Moreover, immunizing mice with a single peptide, YopE(69-77), suffices to confer significant protection from lethal pulmonary challenge. These findings suggest YopE could be a valuable addition to subunit plague vaccines and provide a new animal model in which sensitive, pathogen-specific assays can be used to study CD8 T cell-mediated defense against acutely lethal bacterial infections of the lung.
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