1
|
De Meyst A, De Clercq P, Porrez J, Geens T, Braeckman L, Ouburg S, Morré SA, Vanrompay D. Belgian Cross-Sectional Epidemiological Study on Zoonotic Avian Chlamydia spp. in Chickens. Microorganisms 2024; 12:193. [PMID: 38258018 PMCID: PMC10820512 DOI: 10.3390/microorganisms12010193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Chlamydia psittaci, Chlamydia gallinacea, and Chlamydia abortus are the most common Chlamydia spp. in chickens and have a confirmed or suggested zoonotic potential. No recent data are available on their prevalence and impact in the Belgian chicken industry or in the recreational chicken branch. Therefore, a cross-sectional epidemiological study was executed where samples were collected from both factory-farmed and backyard chickens. More specifically, pharyngeal chicken swabs were obtained from 20 chicken farms, 5 chicken abattoirs, and 38 different backyard locations and were analyzed using species-specific Polymerase Chain Reactions (PCRs) for the presence of the three avian Chlamydia spp. To investigate their zoonotic potential, samples were simultaneously collected from 54 backyard chicken caretakes and 37 professional chicken caretakers or abattoir employees and analyzed using species-specific PCRs as well. This study confirmed the presence of DNA of all three Chlamydia species in both the chicken industry and backyard settings. Chlamydia psittaci was the most prevalent in the industry chickens (11.0%), whereas Chlamydia gallinacea was the dominant species in the backyard chickens (14.5%). Chlamydia abortus infections were more common in the commercial chickens (9.0%) compared to the backyard chickens (2.6%). The DNA of all three species was also detected in humans (3.9% Chlamydia psittaci, 2.9% Chlamydia gallinacea, and 1.0% Chlamydia abortus).
Collapse
Affiliation(s)
- Anne De Meyst
- Department of Animal Sciences and Aquatic Ecology, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (A.D.M.); (P.D.C.); (J.P.)
| | - Pieter De Clercq
- Department of Animal Sciences and Aquatic Ecology, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (A.D.M.); (P.D.C.); (J.P.)
| | - Jelmer Porrez
- Department of Animal Sciences and Aquatic Ecology, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (A.D.M.); (P.D.C.); (J.P.)
| | - Tom Geens
- Research and Analytics, Liantis, 8200 Bruges, Belgium;
| | - Lutgart Braeckman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Sander Ouburg
- Research & Development, Microbe&Lab BV, 1105 AG Amsterdam, The Netherlands; (S.O.); (S.A.M.)
| | - Servaas A. Morré
- Research & Development, Microbe&Lab BV, 1105 AG Amsterdam, The Netherlands; (S.O.); (S.A.M.)
- Department of Genetics and Cell Biology, GROW School for Oncology and Reproduction, Maastricht University, 6229 ER Maastricht, The Netherlands
- Dutch Chlamydia trachomatis Reference Laboratory, Department of Medical Microbiology, Faculty of Health, Medicine & Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad 211007, Uttar Pradesh, India
| | - Daisy Vanrompay
- Department of Animal Sciences and Aquatic Ecology, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (A.D.M.); (P.D.C.); (J.P.)
| |
Collapse
|
2
|
Verweij SP, Peters RPH, Catsburg A, de Vries HJC, Ouburg S, Morré SA. Genetic Variation in the MBL2 Gene Is Associated with Chlamydia trachomatis Infection and Host Humoral Response to Chlamydia trachomatis Infection. Int J Mol Sci 2022; 23:ijms23169292. [PMID: 36012556 PMCID: PMC9409028 DOI: 10.3390/ijms23169292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
This study aims to assess the potential association of MBL2 gene single nucleotide polymorphisms (SNPs) to Chlamydia trachomatis infection. We analysed a selected sample of 492 DNA and serum specimens from Dutch Caucasian women. Women were categorized into four groups of infection status based on the results of DNA and antibody tests for C. trachomatis: Ct-DNA+/IgG+, Ct-DNA+/IgG−, Ct-DNA−/IgG+, and Ct-DNA−/IgG−. We compared six MBL2 SNPs (−619G > C (H/L), −290G > C (Y/X), −66C > T (P/Q), +154C > T (A/D), +161A > G (A/B), and +170A > G (A/C)) and their respective haplotypes in relation to these different subgroups. The −619C (L) allele was less present within the Ct-DNA−/IgG+ group compared with the Ct-DNA−/IgG− group (OR = 0.49; 95% CI: 0.28−0.83), while the +170G (C) allele was observed more in the Ct-DNA+/IgG+ group as compared with the Ct-DNA−/IgG− group (OR = 2.4; 95% CI: 1.1−5.4). The HYA/HYA haplotype was more often present in the Ct-DNA−/IgG− group compared with the Ct-DNA+/IgG+ group (OR = 0.37; 95% CI: 0.16−0.87). The +170G (C) allele was associated with increased IgG production (p = 0.048) in C. trachomatis PCR-positive women. This study shows associations for MBL in immune reactions to C. trachomatis. We showed clear associations between MBL2 genotypes, haplotypes, and individuals’ stages of C. trachomatis DNA and IgG positivity.
Collapse
Affiliation(s)
- Stephan P. Verweij
- Department of Respiratory Medicine, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
- Correspondence:
| | - Remco P. H. Peters
- Research Unit, Foundation for Professional Development, East London 5200, South Africa
- Department of Medical Microbiology, University of Pretoria, Pretoria P.O. Box 14679, South Africa
| | | | - Henry J. C. de Vries
- Cluster of Infectious Diseases, Public Health Service Amsterdam, 1018 WT Amsterdam, The Netherlands
- Center for Infection and Immunity Amsterdam (CINIMA), Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), 3720 BA Bilthoven, The Netherlands
| | - Sander Ouburg
- Microbe & Lab B.V., 1105 AG Amsterdam, The Netherlands
| | - Servaas A. Morré
- Department of Genetics and Cell Biology, Faculty of Health, Medicine & Life Sciences, Institute of Public Health Genomics, Research Institute GROW, University of Maastricht, 6216 LK Maastricht, The Netherlands
| |
Collapse
|
3
|
Juliana NCA, Deb S, Juma MH, Poort L, Budding AE, Mbarouk A, Ali SM, Ouburg S, Morré SA, Sazawal S, Ambrosino E. The Vaginal Microbiota Composition and Genital Infections during and after Pregnancy among Women in Pemba Island, Tanzania. Microorganisms 2022; 10:microorganisms10030509. [PMID: 35336085 PMCID: PMC8951098 DOI: 10.3390/microorganisms10030509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/03/2022] [Accepted: 02/21/2022] [Indexed: 01/25/2023] Open
Abstract
We investigated the vaginal microbiota (VMB) composition, prevalence of genital pathogens and their association among pregnant and post-delivery women in Pemba Island, Tanzania. Vaginal swabs were collected from 90 women, at two time points during pregnancy (<20 weeks of gestational age [GA] and ≥20 weeks GA) and once after delivery, when possible. IS-pro assay was used for VMB characterization. Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) and human papillomavirus (HPV) were detected by qPCRs. VMB were mostly Lactobacillus dominant during pregnancy and non-Lactobacillus dominant post-delivery. A significant decrease in VMB richness was observed during pregnancy among paired and unpaired samples. Shannon diversity was significantly lower during pregnancy than post-delivery among unpaired samples. Klebsiella species and Streptococcus anginosus were the most commonly identified pathobionts at all timepoints. A high abundance of pathobionts was mostly seen in women with non-Lactobacillus dominant VMB. At ≥20 weeks GA timepoint during pregnancy, 63.0% of the women carrying one or more genital pathogen (either HPV, CT, TV, or MG) had L. iners dominant VMB. NG was not detected pre-delivery. This study contributes evidence on VMB composition, its changes during pregnancy and post-delivery, and their association with pathobionts and genital pathogens.
Collapse
Affiliation(s)
- Naomi C. A. Juliana
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Reproduction), Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6200 Maastricht, The Netherlands; (N.C.A.J.); (S.A.M.)
| | - Saikat Deb
- Public Health Laboratory—Ivo de Carneri, Chake Chake 74201, Pemba Island, Tanzania; (S.D.); (M.H.J.); (A.M.); (S.M.A.)
- Centre for Public Health Kinetics, New Delhi 110024, India;
| | - Mohamed H. Juma
- Public Health Laboratory—Ivo de Carneri, Chake Chake 74201, Pemba Island, Tanzania; (S.D.); (M.H.J.); (A.M.); (S.M.A.)
| | - Linda Poort
- inBiome, 1098 Amsterdam, The Netherlands; (L.P.); (A.E.B.)
| | | | - Abdalla Mbarouk
- Public Health Laboratory—Ivo de Carneri, Chake Chake 74201, Pemba Island, Tanzania; (S.D.); (M.H.J.); (A.M.); (S.M.A.)
| | - Said M. Ali
- Public Health Laboratory—Ivo de Carneri, Chake Chake 74201, Pemba Island, Tanzania; (S.D.); (M.H.J.); (A.M.); (S.M.A.)
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC, Location AMC, 1105 Amsterdam, The Netherlands;
| | - Servaas A. Morré
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Reproduction), Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6200 Maastricht, The Netherlands; (N.C.A.J.); (S.A.M.)
| | - Sunil Sazawal
- Centre for Public Health Kinetics, New Delhi 110024, India;
| | - Elena Ambrosino
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Reproduction), Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6200 Maastricht, The Netherlands; (N.C.A.J.); (S.A.M.)
- Correspondence: ; Tel.: +31-04-3388-4081
| |
Collapse
|
4
|
Traets MJM, Nijhuis RHT, Morré SA, Ouburg S, Remijn JA, Blok BA, de Laat B, Jong E, Herder GJM, Fiolet ATL, Verweij SP. Association of genetic variations in ACE2, TIRAP and factor X with outcomes in COVID-19. PLoS One 2022; 17:e0260897. [PMID: 34995294 PMCID: PMC8740962 DOI: 10.1371/journal.pone.0260897] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can manifest with varying disease severity and mortality. Genetic predisposition influences the clinical course of infectious diseases. We investigated whether genetic polymorphisms in candidate genes ACE2, TIRAP, and factor X are associated with clinical outcomes in COVID-19. METHODS We conducted a single-centre retrospective cohort study. All patients who visited the emergency department with SARS-CoV-2 infection proven by polymerase chain reaction were included. Single nucleotide polymorphisms in ACE2 (rs2285666), TIRAP (rs8177374) and factor X (rs3211783) were assessed. The outcomes were mortality, respiratory failure and venous thromboembolism. Respiratory failure was defined as the necessity of >5 litres/minute oxygen, high flow nasal oxygen suppletion or mechanical ventilation. RESULTS Between March and April 2020, 116 patients (35% female, median age 65 [inter quartile range 55-75] years) were included and treated according to the then applicable guidelines. Sixteen patients (14%) died, 44 patients (38%) had respiratory failure of whom 23 required endotracheal intubation for mechanical ventilation, and 20 patients (17%) developed venous thromboembolism. The percentage of TIRAP polymorphism carriers in the survivor group was 28% as compared to 0% in the non-survivor group (p = 0.01, Bonferroni corrected p = 0.02). Genotype distribution of ACE2 and factor X did not differ between survivors and non-survivors. CONCLUSION This study shows that carriage of TIRAP polymorphism rs8177374 could be associated with a significantly lower mortality in COVID-19. This TIRAP polymorphism may be an important predictor in the outcome of COVID-19.
Collapse
Affiliation(s)
- Marissa J. M. Traets
- Meander Medical Centre, Department of Internal Medicine, Amersfoort, The Netherlands
| | - Roel H. T. Nijhuis
- Meander Medical Centre, Department of Medical Microbiology and Medical Immunology, Amersfoort, The Netherlands
| | - Servaas A. Morré
- Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Genetics and Cell Biology, Institute for Public Health Genomics, Research Institute GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Sander Ouburg
- Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jasper A. Remijn
- Meander Medical Centre, Department of Clinical Chemistry, Amersfoort, The Netherlands
| | - Bastiaan A. Blok
- Meander Medical Centre, Department of Internal Medicine, Amersfoort, The Netherlands
| | - Bas de Laat
- Synapse Research Institute, Maastricht, The Netherlands
| | - Eefje Jong
- Meander Medical Centre, Department of Internal Medicine, Amersfoort, The Netherlands
| | - Gerarda J. M. Herder
- Meander Medical Centre, Department of Pulmonary Disease, Amersfoort, The Netherlands
| | - Aernoud T. L. Fiolet
- Meander Medical Centre, Department of Internal Medicine, Amersfoort, The Netherlands
| | - Stephan P. Verweij
- Meander Medical Centre, Department of Internal Medicine, Amersfoort, The Netherlands
- Department of Respiratory Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| |
Collapse
|
5
|
Juliana NCA, Juma MH, Heijmans R, Ouburg S, Ali SM, Chauhan AS, Pemba AB, Sazawal S, Morré SA, Deb S, Ambrosino E. Detection of high-risk human papillomavirus (HPV) by the novel AmpFire isothermal HPV assay among pregnant women in Pemba Island, Tanzania. Pan Afr Med J 2020; 37:183. [PMID: 33447338 PMCID: PMC7778224 DOI: 10.11604/pamj.2020.37.183.23367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/12/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction human papillomavirus (HPV) is the most common sexually transmitted virus in the world. Prevalence of infection differs, with highest rates reported in sub-Saharan African, including the country of Tanzania. In pregnancy, the hormonal changes and immune changes seem to facilitate HPV persistence, increasing the cancer risk and the risk of vertical transmission towards the placenta and the fetus. The burden of HPV infection is still high despite multiple screening and detection test available. The AmpFire® HPV assay is a novel nucleic acid isothermal amplification with real-time fluorescence detection assay that can test simultaneously 15 high-risk HPV. This nested cohort study aims to contribute evidence on the prevalence of HPV infection and persistence across two time points among pregnant women in Pemba island, Tanzania. Methods vaginal swabs that were previously collected during pregnancy were stored in eNAT buffer (n1=385 and n2=187) and were tested with AmpFire® screening assay, for simultaneous detection of the HPV 16, 18 and other high-risk HPV genotypes 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66 and 68. Results the AmpFire® HPV assay detected an 11% and 6% high-risk HPV prevalence at the two time points among pregnant women in Pemba island, consecutively. For the 133 women whose samples were tested at both time points, the persistence rate of high-risk HPV was 64%. Conclusion novel isothermal HPV assay, such as the AmpFire®, might be feasible to use in low-income regions.
Collapse
Affiliation(s)
- Naomi Christine Angela Juliana
- Institute of Public Health Genomics, Department of Genetics and Cell Biology, Research School GROW, Maastricht University, Maastricht, The Netherlands
| | - Mohamed Hamad Juma
- Public Health Laboratory, Ivo de Carneri, Chake Chake, Pemba Island, Tanzania
| | - Roel Heijmans
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Said Mohammed Ali
- Public Health Laboratory, Ivo de Carneri, Chake Chake, Pemba Island, Tanzania
| | | | | | - Sunil Sazawal
- Public Health Laboratory, Ivo de Carneri, Chake Chake, Pemba Island, Tanzania.,Centre for Public Health Kinetics, New Delhi, India
| | - Servaas Antonie Morré
- Institute of Public Health Genomics, Department of Genetics and Cell Biology, Research School GROW, Maastricht University, Maastricht, The Netherlands.,Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Saikat Deb
- Public Health Laboratory, Ivo de Carneri, Chake Chake, Pemba Island, Tanzania.,Centre for Public Health Kinetics, New Delhi, India
| | - Elena Ambrosino
- Institute of Public Health Genomics, Department of Genetics and Cell Biology, Research School GROW, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
6
|
Westra WM, Rygiel AM, Mostafavi N, de Wit GMJ, Roes AL, Moons LMG, Peppelenbosch MP, Ouburg S, Morré SA, Jacobs M, Siersema PD, Repping S, Wang KK, Krishnadath KK. The Y-chromosome F haplogroup contributes to the development of Barrett's esophagus-associated esophageal adenocarcinoma in a white male population. Dis Esophagus 2020; 33:5780184. [PMID: 32129453 PMCID: PMC7471775 DOI: 10.1093/dote/doaa011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/11/2022]
Abstract
Barrett's esophagus (BE) is a metaplastic condition of the distal esophagus, resulting from longstanding gastroesophageal reflux disease (GERD). BE predisposes for the highly malignant esophageal adenocarcinoma (EAC). Both BE and EAC have the highest frequencies in white males. Only a subset of patients with GERD develop BE, while <0.5% of BE will progress to EAC. Therefore, it is most likely that the development of BE and EAC is associated with underlying genetic factors. We hypothesized that in white males, Y-chromosomal haplogroups are associated with BE and EAC. To investigate this we conducted a multicenter study studying the frequencies of the Y-chromosomal haplogroups in GERD, BE, and EAC patients. We used genomic analysis by polymerase chain reaction and restriction fragment length polymorphism to determine the frequency of six Y-chromosomal haplogroups (DE, F(xJ,xK), K(xP), J, P(xR1a), and R1a) between GERD, BE, and EAC in a cohort of 1,365 white males, including 612 GERD, 753 BE patients, while 178 of the BE patients also had BE-associated EAC. Univariate logistic regression analysis was used to compare the outcomes. In this study, we found the R1a (6% vs. 9%, P = 0.04) and K (3% vs. 6%, P = 0.035) to be significantly underrepresented in BE patients as compared to GERD patients with an odds ratio (OR) of 0.63 (95% CI 0.42-0.95, P = 0.03) and of 0.56 (95% CI 0.33-0.96, P = 0.03), respectively, while the K haplogroup was protective against EAC (OR 0.30; 95% CI 0.07-0.86, P = 0.05). A significant overrepresentation of the F haplogroup was found in EAC compared to BE and GERD patients (34% vs. 27% and 23%, respectively). The F haplogroup was found to be a risk factor for EAC with an OR of 1.5 (95% CI 1.03-2.19, P = 0.03). We identified the R1a and K haplogroups as protective factors against development of BE. These haplogroups have low frequencies in white male populations. Of importance is that we could link the presence of the predominantly occurring F haplogroup in white males to EAC. It is possible that this F haplogroup is associated to genetic variants that predispose for the EAC development. In future, the haplogroups could be applied to improve stratification of BE and GERD patients with increased risk to develop BE and/or EAC.
Collapse
Affiliation(s)
- W M Westra
- CEMM, Amsterdam UMC-AMC, Amsterdam, The Netherlands,Department of Gastroenterology and Hepatology, Mayo Foundation, Rochester, MN, USA,Department of Gastroenterology and Hepatology, Amsterdam UMC-AMC, Amsterdam, The Netherlands
| | - A M Rygiel
- CEMM, Amsterdam UMC-AMC, Amsterdam, The Netherlands,Department of Medical Genetics, Institute of Mother and Child, Warsaw, Poland
| | - N Mostafavi
- Biostatistical Unit, Department of Gastroenterology, Amsterdam UMC, Amsterdam, The Netherlands
| | - G M J de Wit
- CEMM, Amsterdam UMC-AMC, Amsterdam, The Netherlands
| | - A L Roes
- CEMM, Amsterdam UMC-AMC, Amsterdam, The Netherlands
| | - L M G Moons
- Department of Gastroenterology and Hepatology, UMC Utrecht, The Netherlands
| | - M P Peppelenbosch
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands
| | - S Ouburg
- Department of Medical Microbiology and Infection Control, Amsterdam UMC-VUMC, Amsterdam, The Netherlands
| | - S A Morré
- Department of Medical Microbiology and Infection Control, Amsterdam UMC-VUMC, Amsterdam, The Netherlands,Department of Genetics and Cell Biology, Maastricht University, Maastricht, The Netherlands
| | - M Jacobs
- Department of Gastroenterology and Hepatology, Amsterdam UMC-VUMC, Amsterdam, The Netherlands
| | - P D Siersema
- Department of Gastroenterology and Hepatology, Radboud UMC, Nijmegen, The Netherlands
| | - S Repping
- Department of Reproductive Medicine, Amsterdam UMC-AMC, Amsterdam, The Netherlands
| | - K K Wang
- Department of Gastroenterology and Hepatology, Mayo Foundation, Rochester, MN, USA
| | - K K Krishnadath
- Department of Gastroenterology and Hepatology, Amsterdam UMC-AMC, Amsterdam, The Netherlands,Address correspondence to: Professor Kausilia K. Krishnadath, MD, PhD, Gastroenterology and Hepatology, Amsterdam UMC-AMC, Amsterdam, C2-321, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| |
Collapse
|
7
|
El Tahir O, de Jonge RCJ, Ouburg S, Morré SA, van Furth AM. Study protocol: The Dutch 20|30 Postmeningitis study: a cross-sectional follow-up of two historical childhood bacterial meningitis cohorts on long-term outcomes. BMC Pediatr 2019; 19:519. [PMID: 31888554 PMCID: PMC6936081 DOI: 10.1186/s12887-019-1900-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 12/22/2019] [Indexed: 04/11/2023] Open
Abstract
Background Bacterial meningitis (BM) is a serious, life-threatening infectious disease of the central nervous system that often occurs in young children. The most common severe to moderate sequelae following BM are sensorineural hearing loss, neuromotor disabilities and mental retardation, while subtle sequelae include academic and behavioral disabilities. It is largely unknown whether these more subtle sequelae persist into adolescence and adulthood. Therefore, this study will investigate the very long-term effects of childhood BM in later life. Better understanding of long-term effects and early identification of adverse outcomes after BM are essential for more timely interventions. Additionally, certain single nucleotide polymorphisms (SNPs) are associated with disease severity and might predict adverse sequelae. These include SNPs in genes encoding for pathogen recognition and immune response upon infection. Accordingly, a secondary objective of this study is to investigate the role of genetic variation in BM and use any insights to predict short- and long-term outcomes. Methods In the Dutch 20|30 Postmeningitis study, adolescents and young adults (n = 947) from two historical cohorts with a prior episode of BM during childhood will be enrolled into a cross-sectional follow-up investigation using mainly questionnaires that examine executive and behavioral functioning, health-related quality of life, subjective hearing, mood and sleeping disorders, academic performance, and economic self-sufficiency. The results will be compared to normative data by one-sample t-tests. Multivariable regression analysis will be used to assess for any associations with causative pathogens and severity of BM. Participants that complete the questionnaires will be approached to provide a swab for buccal DNA and subsequent sequencing analyses. Logistic regression models will be used to predict sequelae. Discussion The unique follow-up duration of this cohort will enable us to gain insights into the possible very long-term adverse effects of childhood BM and how these might impact on quality of life. The investigation of host genetic factors will contribute to the development of prediction models which will serve as prognostic tools to identify children who are at high risk of adverse outcome after BM. Trial Registration Dutch Trial Register NTR-6891. Retrospectively registered 28 December 2017.
Collapse
Affiliation(s)
- O El Tahir
- Department of Pediatric Infectious Diseases and Immunology, AI&II, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - R C J de Jonge
- Department of Pediatric Surgery, Erasmus MC Rotterdam - Sophia Children's Hospital Pediatric Intensive Care Unit, Rotterdam, The Netherlands
| | - S Ouburg
- Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics VU University Medical Center, Amsterdam, The Netherlands
| | - S A Morré
- Department of Genetics and Cell Biology, Institute for Public Health Genomics (IPHG), Research School GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - A M van Furth
- Department of Pediatric Infectious Diseases and Immunology, AI&II, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Jansen M, van Ess E, Ouburg S, Gerds M, Morré S, Land J. C-reactive protein as a marker of persistent Chlamydia trachomatis infection is not associated with tubal factor infertility-an independent clinical validation study. Hum Reprod Open 2019; 2019:hoz029. [PMID: 31858023 PMCID: PMC6913217 DOI: 10.1093/hropen/hoz029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/26/2019] [Indexed: 12/05/2022] Open
Abstract
STUDY QUESTION Does C-reactive protein (CRP), as a marker of persisting low-grade inflammation, identify Chlamydia trachomatis IgG antibody test (CAT)-positive women who are at the highest risk for tubal factor infertility (TFI)? SUMMARY ANSWER No association was found between slightly elevated CRP (seCRP) levels and TFI in our CAT-positive patient population. WHAT IS KNOWN ALREADY In the fertility work-up, CAT is used to estimate the risk for TFI and to select high-risk patients for additional invasive diagnostic procedures (e.g. hysterosalpingography and laparoscopy). However, a high number of false positives exist among CAT-positive patients. In a previous study, it has been suggested that women with TFI may be identified more accurately when combining CAT with CRP, a marker for persistent low-grade inflammation. STUDY DESIGN, SIZE, DURATION Our original retrospective cohort consisted of 887 consecutive female patients who visited the fertility clinic of a tertiary care centre between 2007 and 2015. All CAT-positive women who underwent laparoscopy (as the reference test for evaluation of tubal function) and who had not undergone previous pelvic surgery were included in the study. CRP was determined in spare serum samples, and medical data was obtained by chart review. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 101 women (11.4%) were CAT-positive, and 64 of these 101 women (7.2%) met all inclusion criteria. CAT was performed with an ELISA. TFI was assessed by laparoscopy and strictly defined as extensive peri-adnexal adhesions and/or distal occlusion of at least one tube. In spare sera, CRP was performed with a high-sensitivity CRP ELISA, and CRP levels between 3 and 10 mg/L were defined as positive. Analyses were corrected for BMI, endometriosis and smoking. MAIN RESULTS AND THE ROLE OF CHANCE There was no statistically significant association between seCRP level and TFI after adjusting for BMI, endometriosis and smoking (odds ratio 1.0; 95% CI 0.3–3.3; n = 64). LIMITATIONS, REASONS FOR CAUTION Our retrospective study had a small sample size due to a low CAT-positivity rate and a conservative clinical policy with regard to invasive diagnostic testing. Additionally, CRP levels were only measured once, while they may change throughout the menstrual cycle and in time. WIDER IMPLICATIONS OF THE FINDINGS Contrary to previous findings, our results show CRP is not suitable as a marker of persistent low-grade inflammation in CAT-positive women. Other inflammatory markers and immunogenetic host factors should be studied on their clinical validity and utility to improve non-invasive risk assessment for TFI in the fertility work-up. STUDY FUNDING/COMPETING INTEREST(S) This work was partially supported by the European EuroTrans-Bio Grant [Reference number 110012 ETB] and the Eurostars grant (E!9372). S.A.M., a full-time employee of Amsterdam University Medical Centres location VUMC (0.56 fte) and the Maastricht University Medical Center (0.44 fte), is the founder (2011) and CEO of TubaScan Ltd, a spin-off company, Dept. of Medical Microbiology and Infection Prevention, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands. S.O. and E.F.v.E. at the time of conducting this research had a partial appointment at TubaScan Ltd.
Collapse
Affiliation(s)
- Me Jansen
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER, Maastricht, The Netherlands.,Amsterdam UMC, Location VUmc, Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics,1081 HZ, Amsterdam, The Netherlands.,Amsterdam UMC, Location VUmc, Department of Clinical Genetics, Section Community Genetics, Amsterdam Public Health Research Institute, 1081 HV, Amsterdam, The Netherlands
| | - Ef van Ess
- Amsterdam UMC, Location VUmc, Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics,1081 HZ, Amsterdam, The Netherlands
| | - S Ouburg
- Amsterdam UMC, Location VUmc, Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics,1081 HZ, Amsterdam, The Netherlands
| | - Ml Gerds
- Department of Emergency Medicine, Hospital Tjongerschans, 8441 PW Heerenveen, The Netherlands
| | - Sa Morré
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER, Maastricht, The Netherlands.,Amsterdam UMC, Location VUmc, Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics,1081 HZ, Amsterdam, The Netherlands
| | - Ja Land
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER, Maastricht, The Netherlands
| |
Collapse
|
9
|
van Ess EF, Eck-Hauer A, Land JA, Morré SA, Ouburg S. Combining individual Chlamydia trachomatis IgG antibodies MOMP, TARP, CPAF, OMP2, and HSP60 for tubal factor infertility prediction. Am J Reprod Immunol 2019; 81:e13091. [PMID: 30629310 PMCID: PMC6593993 DOI: 10.1111/aji.13091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/30/2018] [Accepted: 01/08/2019] [Indexed: 02/04/2023] Open
Abstract
PROBLEM Tubal factor infertility (TFI) is a severe complication of genital Chlamydia trachomatis infections. In fertility workup, chlamydia antibody test (CAT) is used to predict TFI. The predictive value for TFI of most commonly used CAT is moderate. METHOD OF STUDY A total of 183 infertile Dutch Caucasian women were included in this study. All underwent tubal patency testing (hysterosalpingography [HSG] or laparoscopy). Cases had TFI, and controls had no TFI (ie normal findings during HSG or laparoscopy). TFI was categorized based on severity (TFI 1-TFI 4). This study investigated the predictive values of major outer membrane protein (MOMP), translocated actin-recruiting phosphoprotein (TARP), chlamydial protease-like activity factor (CPAF), heat shock protein-60 (HSP60) and outer membrane protein 2 (OMP2) for TFI. A predictive algorithm is developed to detect TFI with a high certainty based on combinations of antibody titres. Serum was tested with the Mikrogen recomLine immunoblot and quantified with the recomScan. A greedy algorithm that explores all possible antibody combinations was developed. RESULTS Significant differences in the distributions of antigen titres between cases and controls were observed for CPAF (P = 0.0021), HSP60 (P = 0.0061), MOMP (P = 0.0497) and OMP2 (P = 0.0016). Single antibodies could not discriminate between TFI and controls by themselves. The greedy algorithm performs better in specificity, positive predictive value (PPV), accuracy and clinical utility index than the original Mikrogen algorithm. CPAF combined with HSP60 identified 18.2% of TFI cases with 100% certainty. Most of the TFI 4 cases were identified with cut-offs of CPAF > 10.7 or OMP2 > 3.9. CONCLUSION This proof-of-principle study shows that combinations of antibodies in serum are predictive for TFI. A commercially available test can be adapted to predict TFI with a 100% specificity.
Collapse
Affiliation(s)
- Eleanne F van Ess
- Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
| | - Anat Eck-Hauer
- Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jolande A Land
- Department of Genetics and Cell Biology, Faculty of Health, Medicine & Life Sciences, Institute for Public Health Genomics (IPHG), Research Institute GROW, University of Maastricht, Maastricht, The Netherlands
| | - Servaas A Morré
- Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands.,Department of Genetics and Cell Biology, Faculty of Health, Medicine & Life Sciences, Institute for Public Health Genomics (IPHG), Research Institute GROW, University of Maastricht, Maastricht, The Netherlands
| | - Sander Ouburg
- Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
10
|
Singer M, Borg M, Ouburg S, Morré SA. The relation of the vaginal microbiota to early pregnancy development during in vitro fertilization treatment-A meta-analysis. J Gynecol Obstet Hum Reprod 2019; 48:223-229. [PMID: 30685426 DOI: 10.1016/j.jogoh.2019.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/22/2019] [Indexed: 01/06/2023]
Abstract
An abnormal vaginal microbiota composition has been shown to lead to pre-term births, miscarriage, and problems with conceiving. Studies have suggested that dysbiosis reduces successful early pregnancy development during IVF. However, conflicting reports exist. This meta-analysis aims to answer the following question: what is the aggregated effect found by studies investigating the influence of the vaginal microbiota composition on early pregnancy rates after IVF treatment? A systematic review was performed using the Medline and EMBASE databases, using search terms for healthy vaginal microbiota, abnormal vaginal microbiota, fertility and pregnancy. The search resulted in six included articles. Of these, all six were used for further meta-analysis. The main outcome measures were the clinical pregnancy rate, determined through ultrasound proven fetal heartbeat and/or hCG results before 10 weeks gestation, in relation to the vaginal microbiota composition. We found a correlation between abnormal vaginal microbiota and lower rates of early pregnancy development after IVF treatment (OR = 0.70, 95% CI = 0.49 - 0.99). One study showed the reverse correlation. However, heterogeneity between study methodologies in various forms was found. In conclusion, women with an abnormal vaginal microbiota are roughly 1.4 times less likely to have a successful early pregnancy development after IVF treatment when compared to women with normal microbiota.
Collapse
Affiliation(s)
- M Singer
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC: Vrije Universiteit, Amsterdam, the Netherlands; Tubascan, spin-off at the Department of Medical Microbiology and Infection Control, Amsterdam UMC: Vrije Universiteit, Amsterdam, the Netherlands.
| | - M Borg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC: Vrije Universiteit, Amsterdam, the Netherlands; Institute of Public Health Genomics, Department of Genetics and Cell Biology, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, the Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC: Vrije Universiteit, Amsterdam, the Netherlands
| | - S A Morré
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC: Vrije Universiteit, Amsterdam, the Netherlands; Tubascan, spin-off at the Department of Medical Microbiology and Infection Control, Amsterdam UMC: Vrije Universiteit, Amsterdam, the Netherlands; Institute of Public Health Genomics, Department of Genetics and Cell Biology, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, the Netherlands
| |
Collapse
|
11
|
Molenaar MC, Singer M, Ouburg S. The two-sided role of the vaginal microbiome in Chlamydia trachomatis and Mycoplasma genitalium pathogenesis. J Reprod Immunol 2018; 130:11-17. [PMID: 30149363 DOI: 10.1016/j.jri.2018.08.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/13/2018] [Accepted: 08/20/2018] [Indexed: 01/12/2023]
Abstract
Sexually transmitted infections (STI) can have major consequences for the reproductive health of women. Mycoplasma genitalium is a STI that is not as well studied but causes pelvic inflammatory disease (PID) among other complications. Another well-known STI is Chlamydia trachomatis, notorious for its capability to cause infertility. Both C. trachomatis and M. genitalium share some of the same clinical aspects. Parts of the pathogenesis of C. trachomatis and M. genitalium infections are unclear but potential factors are the microbiome and other STIs. The healthy vaginal microbiome is dominated by Lactobacillus spp; these bacteria protect the host against invading bacteria like C. trachomatis and M. genitalium by producing antibacterial compounds and providing a mechanical barrier. A dysbiosis of the vaginal microbiome is characterized by a non-Lactobacillus spp. dominated microbiome, also known as bacterial vaginosis (BV). BV and BV associated bacteria play a role in the pathogenesis of STIs such as C. trachomatis and M. genitalium. The different species of BV associated bacteria have distinct characteristics that could play a role in C. trachomatis and M. genitalium infections. Host factors should also be considered when analysing the interaction of C. trachomatis and M. genitalium and the microbiome. One important factor is the hormonal homeostasis. Oral hormonal contraception influences the vaginal milieu and could influence the infection process of STIs. Overall, this review attempts to give an overview of the pathogenesisof C. trachomatis and M. genitalium infections and the relationship between M. genitalium, C. trachomatis, and the vaginal microbiome.
Collapse
Affiliation(s)
- M C Molenaar
- Laboratory of Immunogenetics, Department Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - M Singer
- Laboratory of Immunogenetics, Department Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands; Tubascan, Spin-Off at the Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.
| | - S Ouburg
- Laboratory of Immunogenetics, Department Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands; Tubascan, Spin-Off at the Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
12
|
van Ess EF, Ouburg S, Spaargaren J, Land JA, Morré SA. Performance of the multitarget Mikrogen Chlamydia trachomatis IgG ELISA in the prediction of tubal factor infertility (TFI) in subfertile women: comparison with the Medac MOMP IgG ELISA plus. Pathog Dis 2018; 75:3883981. [PMID: 28854690 DOI: 10.1093/femspd/ftx067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/20/2017] [Indexed: 12/31/2022] Open
Abstract
There is a need for more accurate Chlamydia trachomatis (CT) IgG antibody tests for tubal factor infertility (TFI) diagnostics. We evaluated the predictive value for TFI of Medac ELISA plus (MOMP) and multitarget Mikrogen ELISA (MOMP-CPAF-TARP). Based on Medac ELISA plus results, 183 subfertile women underwent either hysterosalpingography or laparoscopy to diagnose TFI. TFI was defined as extensive adhesions and/or distal occlusion of at least one tube. Women not fulfilling the definition of TFI served as controls. Serum was subsequently tested with Mikrogen ELISA and results were compared. 48 patients had TFI, 135 were controls. Mikrogen ELISA tested 125 patients positive/borderline of which 32% had TFI. Medac ELISA plus tested 77 patients positive/borderline of which 29.9% had TFI. Mikrogen tested 40 out of 48 TFI patients positive/borderline, Medac 23 out of 48. Kappa value was 0.34. PPV of Mikrogen ELISA and Medac ELISA plus were respectively 32% (95% CI 26%-39%) and 30% (95% CI 24%-37%), and NPV 86% (95% CI 81%-91%) and 76% (95% CI 70%-82%). Both tests were comparable in the prediction of TFI. However, Mikrogen ELISA had a higher NPV and might be more reliable in identifying patients without TFI. Kappa-value showed limited concordance between both tests.
Collapse
Affiliation(s)
- Eleanne F van Ess
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1007 MB Amsterdam, The Netherlands
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1007 MB Amsterdam, The Netherlands
| | - Joke Spaargaren
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1007 MB Amsterdam, The Netherlands
| | - Jolande A Land
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Servaas A Morré
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.,Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine and Life Sciences, University of Maastricht, 6200 MB Maastricht, The Netherlands
| |
Collapse
|
13
|
van Ess EF, Ouburg S, Land JA, Morré SA. Comparison of the Mikrogen multi-target ELISA with the Mikrogen recomLine immunoblot for the detection of Chlamydia trachomatis IgG antibodies in serum in infertile women. J Microbiol Methods 2018; 150:5-8. [PMID: 29746924 DOI: 10.1016/j.mimet.2018.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/13/2018] [Accepted: 05/06/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Chlamydia trachomatis (CT) IgG serology is used in many fertility clinics in order to estimate the risk for tubal factor infertility (TFI) in the fertility work-up. The predictive value for TFI of the currently used mono-target CT serology test should be improved. This study compares the performance of the new multi-target Mikrogen recomWell CT IgG ELISA with the Mikrogen recomLine CT immunoblot and visualizes distribution of individual antibodies in serum with the immunoblot in order to potentially improve the current CT IgG serology test that is clinically used. METHODS Study population consisted of 183 Dutch Caucasian infertile women who underwent laparoscopy and/or hysterosalpingography. 48 women had TFI, 135 were controls. Serum was tested with Mikrogen CT IgG ELISA, which detects 3 CT IgG antibodies in one well, and Mikrogen CT immunoblot, which can individually detect 5 CT IgG antibodies. Tests were compared based on the results in general and in the case and control group also taking the individual antibodies into account. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), Kappa value and distribution of individual antibodies in positive samples were calculated. RESULTS In 183 patients 51% tested positive in the ELISA versus 35% in the immunoblot. 32% versus 65% tested negative. Difference between PPV was not statistically significant (33% and 39% respectively) and NPV in both tests was 81%. Difference in sensitivity and specificity was statistically significant, respectively 65% vs. 52% and 54% vs. 71%. Kappa was only 45%. 64.5% of samples that tested positive with ELISA were positive for at least 4 individual CT antibodies with the immunoblot. CONCLUSION The concordance between CT ELISA and CT immunoblot is moderate. Due to separate criteria for positivity of both tests there is a significant difference in sensitivity and specificity. PPV and NPV, the most relevant characteristics for clinicians, of both tests did not differ significantly. The distribution of individual antibodies and the adjustment of the immunoblot algorithm will be further explored in the future in order to develop a potentially better prediction method for TFI with a higher clinical accuracy.
Collapse
Affiliation(s)
- E F van Ess
- VU University Medical Center, Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, Amsterdam, The Netherlands.
| | - S Ouburg
- VU University Medical Center, Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, Amsterdam, The Netherlands
| | - J A Land
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - S A Morré
- VU University Medical Center, Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, Amsterdam, The Netherlands; Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| |
Collapse
|
14
|
Dubbink JH, Verweij SP, Struthers HE, Ouburg S, McIntyre JA, Morré SA, Peters RP. Genital Chlamydia trachomatis and Neisseria gonorrhoeae infections among women in sub-Saharan Africa: A structured review. Int J STD AIDS 2018; 29:806-824. [PMID: 29486628 DOI: 10.1177/0956462418758224] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chlamydia trachomatis and Neisseria gonorrhoeae constitute major public health problems among women, but the burden of infection in sub-Saharan Africa is poorly documented. We conducted a structured review of the prevalence and incidence of genital, oral and anal C. trachomatis and N. gonorrhoeae infection in women in sub-Saharan Africa. We searched Medline, EMBASE and Web of Science over a 10-year period for studies on epidemiology of genital, oral and anal chlamydial infection and gonorrhoea in women in all countries of sub-Saharan Africa. We assessed geographic and demographic differences in prevalence and incidence of infection; weighted mean prevalence estimates were calculated with a random-effect model. A total of 102 study results were included, with data available for 24/49 of sub-Saharan countries. The weighted prevalence of chlamydial infection was lower among women in community-based studies (3.9%; 95% CI: 2.9-5.1%) than for women recruited at primary healthcare facilities (6.0%; 95% CI: 4.2-8.4%, p < 0.001); the same was observed for gonorrhoea (2.2%; 95% CI: 1.2-4.0% vs. 4.2%; 95% CI: 3.2-5.6%, p < 0.001). Prevalence of Chlamydia among sex workers was 5.5% (95% CI: 4.2-7.3%) and gonorrhoea 7.6% (95% CI: 5.4-11%). Seven studies reported on incidence which varied between 0.75-28 and 2.8-17 per 100 person-years-at-risk for chlamydial infection and gonorrhoea, respectively. Only two studies reported on anal infections and one on oral infection. This overview underscores the considerable incidence and prevalence of genital C. trachomatis and N. gonorrhoeae in women in different settings in sub-Saharan Africa. Better control strategies are warranted to reduce the burden of infection and to prevent long-term complications of these infections.
Collapse
Affiliation(s)
- Jan Henk Dubbink
- 1 Anova Health Institute, Johannesburg, South Africa.,2 Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, the Netherlands.,3 Faculty of Health, Medicine & Life Sciences, Department of Genetics and Cell Biology, Institute for Public Health Genomics (IPHG), Research School GROW (School for Oncology & Developmental Biology), University of Maastricht, Maastricht, the Netherlands
| | - Stephan P Verweij
- 2 Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, the Netherlands
| | - Helen E Struthers
- 1 Anova Health Institute, Johannesburg, South Africa.,4 Division of Infectious Diseases & HIV Medicine, Department of Internal Medicine, University of Cape Town, Cape Town, South Africa
| | - Sander Ouburg
- 2 Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, the Netherlands
| | - James A McIntyre
- 1 Anova Health Institute, Johannesburg, South Africa.,5 School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Servaas A Morré
- 2 Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, the Netherlands.,3 Faculty of Health, Medicine & Life Sciences, Department of Genetics and Cell Biology, Institute for Public Health Genomics (IPHG), Research School GROW (School for Oncology & Developmental Biology), University of Maastricht, Maastricht, the Netherlands
| | - Remco Ph Peters
- 1 Anova Health Institute, Johannesburg, South Africa.,6 Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
15
|
Hoenderboom BM, van Ess EF, van den Broek IVF, van Loo IHM, Hoebe CJPA, Ouburg S, Morré SA. Chlamydia trachomatis antibody detection in home-collected blood samples for use in epidemiological studies. J Microbiol Methods 2017; 144:164-167. [PMID: 29196272 DOI: 10.1016/j.mimet.2017.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/24/2017] [Accepted: 11/26/2017] [Indexed: 11/18/2022]
Abstract
Capillary blood collected in serum tubes was subjected to centrifugation delay while stored at room temperature. Chlamydia trachomatis (CT) IgG concentrations in aliquoted serum of these blood samples remained stable for seven days after collection. CT IgG concentrations can reliably be measured in mailed blood samples in epidemiological studies.
Collapse
Affiliation(s)
- B M Hoenderboom
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Laboratory of Immunogenetics, Department Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.
| | - E F van Ess
- Laboratory of Immunogenetics, Department Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - I V F van den Broek
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - I H M van Loo
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - C J P A Hoebe
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands; Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD South Limburg), Geleen, The Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Department Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - S A Morré
- Laboratory of Immunogenetics, Department Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands; Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| |
Collapse
|
16
|
Abstract
OBJECTIVES Trichomonas vaginalis is thought to be the most common non-viral sexually transmitted infection worldwide. We investigated the prevalence, risk factors and protozoan load of T. vaginalis infection in South African women. METHODS A cross-sectional study of 604 women was conducted at 25 primary healthcare facilities in rural South Africa (Mopani district). T. vaginalis DNA was detected in vaginal and rectal swabs. In univariate and multivariate analyses, the T. vaginalis infection was investigated in relation to demographic characteristics, medical history and behavioural factors. The T. vaginalis load was determined as the logarithm of DNA copies per microlitre sample solution. RESULTS Collected vaginal and rectal swabs were tested for T. vaginalis DNA. Prevalence of vaginal T. vaginalis was 20% (95% CI 17.0% to 23.4%) and rectal 1.2% (95% CI 0.6% to 2.4%). Most women (66%) with a vaginal infection were asymptomatic. Factors associated with T. vaginalis infection were a relationship status of single (OR 2.4; 95% CI 1.5 to 4.0; p<0.001) and HIV positive infection (OR 1.6; 95% CI 1.0 to 2.6; p=0.041). Women with vaginal T. vaginalis infection were more likely to have concurrent Chlamydia trachomatis rectal infection than those without vaginal infection (12%vs3%; p<0.001; OR 4.1). A higher median T. vaginalis load was observed among women with observed vaginal discharge compared with those without vaginal discharge (p=0.025). CONCLUSIONS Vaginal trichomoniasis is highly prevalent in rural South Africa, especially among single women and those with HIV infection, and often presents without symptoms.
Collapse
Affiliation(s)
- Dewi J de Waaij
- Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Genetics and Cell Biology, Faculty of Health, Medicine & Life Sciences, Institute for Public Health Genomics, Research School GROW (School for Oncology & Developmental Biology), University of Maastricht, Maastricht, The Netherlands
| | - Jan Henk Dubbink
- Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Genetics and Cell Biology, Faculty of Health, Medicine & Life Sciences, Institute for Public Health Genomics, Research School GROW (School for Oncology & Developmental Biology), University of Maastricht, Maastricht, The Netherlands
| | - Sander Ouburg
- Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Remco P H Peters
- Anova Health Institute, Johannesburg and Tzaneen, South Africa
- Department of Medical Microbiology, University of Maastricht, Maastricht, The Netherlands
| | - Servaas A Morré
- Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Genetics and Cell Biology, Faculty of Health, Medicine & Life Sciences, Institute for Public Health Genomics, Research School GROW (School for Oncology & Developmental Biology), University of Maastricht, Maastricht, The Netherlands
| |
Collapse
|
17
|
Smelov V, Thomas P, Ouburg S, Morré SA. Prevalence of genital Chlamydia trachomatis infections in Russia: systematic literature review and multicenter study. Pathog Dis 2017; 75:3983168. [PMID: 28830072 DOI: 10.1093/femspd/ftx081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/19/2017] [Indexed: 11/13/2022] Open
Abstract
A reliable overview of data on the prevalence of Chlamydia trachomatis (CT) in Russia is lacking and needed. All the available data on CT prevalence were analyzed in a systematic literature review on CT prevalence in Russia, strengthened with data from the multicenter study among 1263 people in the second-largest Russian megalopolis, St. Petersburg, testing for CT DNA in urethral, anal, cervical and prostate samples. A total of 10 articles met the inclusion criteria. The overall average prevalence of genital CT infections in Russian populations ranged from 2.9% to 33%. Risk factors included being symptomatic (P = 0.004; in men P < 0.001), being younger than 30 years (P = 0.001) and being a man who has sex with men (MSM) (P = 0.0084). Main limitations included the lack of studies in MSM. CT prevalence was higher in the groups where urethral and prostate secretion samples were pooled (5.2%-7.3% vs 3.2% in the urethra only). The data on CT prevalence in a range of Russian populations are analyzed and reported. Prostate secretions represent an additional sampling material for the study of CT infection in men. CT detection in some settings in St. Petersburg yielded levels of reliability comparable with internationally available tests. The initiation of screening programs for Chlamydia infections in Russia should be considered.
Collapse
Affiliation(s)
- Vitaly Smelov
- Institute of Public Health Genomics, Department of Genetics and Cell Biology, Research Institute GROW (School for Oncology and Developmental Biology), Faculty of Health, Medicine and Life Sciences, University of Maastricht, 6200 MD Maastricht, the Netherlands
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1081 HX Amsterdam, the Netherlands
- Prevention and Implementation Group, International Agency for Research on Cancer, World Health Organization, 69372 Lyon, France
- Department of Urology, North-Western State Medical University named after I.I. Mechnikov, 191015 St. Petersburg, Russian Federation
| | - Pierre Thomas
- Institute of Public Health Genomics, Department of Genetics and Cell Biology, Research Institute GROW (School for Oncology and Developmental Biology), Faculty of Health, Medicine and Life Sciences, University of Maastricht, 6200 MD Maastricht, the Netherlands
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1081 HX Amsterdam, the Netherlands
| | - Servaas A Morré
- Institute of Public Health Genomics, Department of Genetics and Cell Biology, Research Institute GROW (School for Oncology and Developmental Biology), Faculty of Health, Medicine and Life Sciences, University of Maastricht, 6200 MD Maastricht, the Netherlands
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1081 HX Amsterdam, the Netherlands
| |
Collapse
|
18
|
Hadfield J, Harris SR, Seth-Smith HMB, Parmar S, Andersson P, Giffard PM, Schachter J, Moncada J, Ellison L, Vaulet MLG, Fermepin MR, Radebe F, Mendoza S, Ouburg S, Morré SA, Sachse K, Puolakkainen M, Korhonen SJ, Sonnex C, Wiggins R, Jalal H, Brunelli T, Casprini P, Pitt R, Ison C, Savicheva A, Shipitsyna E, Hadad R, Kari L, Burton MJ, Mabey D, Solomon AW, Lewis D, Marsh P, Unemo M, Clarke IN, Parkhill J, Thomson NR. Comprehensive global genome dynamics of Chlamydia trachomatis show ancient diversification followed by contemporary mixing and recent lineage expansion. Genome Res 2017; 27:1220-1229. [PMID: 28588068 PMCID: PMC5495073 DOI: 10.1101/gr.212647.116] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 04/27/2017] [Indexed: 01/26/2023]
Abstract
Chlamydia trachomatis is the world's most prevalent bacterial sexually transmitted infection and leading infectious cause of blindness, yet it is one of the least understood human pathogens, in part due to the difficulties of in vitro culturing and the lack of available tools for genetic manipulation. Genome sequencing has reinvigorated this field, shedding light on the contemporary history of this pathogen. Here, we analyze 563 full genomes, 455 of which are novel, to show that the history of the species comprises two phases, and conclude that the currently circulating lineages are the result of evolution in different genomic ecotypes. Temporal analysis indicates these lineages have recently expanded in the space of thousands of years, rather than the millions of years as previously thought, a finding that dramatically changes our understanding of this pathogen's history. Finally, at a time when almost every pathogen is becoming increasingly resistant to antimicrobials, we show that there is no evidence of circulating genomic resistance in C. trachomatis.
Collapse
Affiliation(s)
- James Hadfield
- Pathogen Genomics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, United Kingdom
| | - Simon R Harris
- Pathogen Genomics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, United Kingdom
| | - Helena M B Seth-Smith
- Pathogen Genomics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, United Kingdom
| | - Surendra Parmar
- Public Health England, Public Health Laboratory Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QW, United Kingdom
| | - Patiyan Andersson
- Menzies School of Health Research, Darwin, Northern Territory 0810, Australia
| | - Philip M Giffard
- Menzies School of Health Research, Darwin, Northern Territory 0810, Australia.,School of Psychological and Clinical Sciences, Charles Darwin University, Darwin 0909, Australia
| | - Julius Schachter
- Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California 94110, USA
| | - Jeanne Moncada
- Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California 94110, USA
| | - Louise Ellison
- Pathogen Genomics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, United Kingdom
| | - María Lucía Gallo Vaulet
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica, Microbiología Clínica, Buenos Aires C1113AAD, Argentina
| | - Marcelo Rodríguez Fermepin
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica, Microbiología Clínica, Buenos Aires C1113AAD, Argentina
| | - Frans Radebe
- Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, 2192 Johannesburg, South Africa
| | - Suyapa Mendoza
- Jefe Laboratorio de ITS, Laboratorio Nacional de Vigilancia, FM1100, Honduras
| | - Sander Ouburg
- Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics, VU University Medical Center, 1081 HZ Amsterdam, The Netherlands
| | - Servaas A Morré
- Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics, VU University Medical Center, 1081 HZ Amsterdam, The Netherlands.,Department of Genetics and Cell Biology, Institute of Public Health Genomics, School for Oncology & Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, University of Maastricht, 6229 ER Maastricht, The Netherlands
| | - Konrad Sachse
- Institute of Molecular Pathogenesis, Friedrich-Loeffler-Institut (Federal Research Institute for Animal Health), 07743 Jena, Germany
| | - Mirja Puolakkainen
- Department of Virology, University of Helsinki and Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
| | - Suvi J Korhonen
- Department of Virology, University of Helsinki and Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
| | - Chris Sonnex
- Public Health England, Public Health Laboratory Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QW, United Kingdom
| | - Rebecca Wiggins
- Department of Biology, University of York, York CB2 2QQ, United Kingdom
| | - Hamid Jalal
- Public Health England, Public Health Laboratory Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QW, United Kingdom
| | - Tamara Brunelli
- Clinical Chemistry and Microbiology Laboratory, Santo Stefano Hospital, ASL4, 59100 Prato, Italy
| | - Patrizia Casprini
- Clinical Chemistry and Microbiology Laboratory, Santo Stefano Hospital, ASL4, 59100 Prato, Italy
| | - Rachel Pitt
- Sexually Transmitted Bacteria Reference Unit, Microbiological Services, Public Health England, London NW9 5HT, United Kingdom
| | - Cathy Ison
- Sexually Transmitted Bacteria Reference Unit, Microbiological Services, Public Health England, London NW9 5HT, United Kingdom
| | - Alevtina Savicheva
- Laboratory of Microbiology, D.O. Ott Research Institute of Obstetrics and Gynecology, St. Petersburg, Russia 199034
| | - Elena Shipitsyna
- Laboratory of Microbiology, D.O. Ott Research Institute of Obstetrics and Gynecology, St. Petersburg, Russia 199034.,WHO Collaborating Centre for Gonorrhoea and other STIs, Faculty of Medicine and Health, Örebro University Hospital, SE-701 85 Örebro, Sweden
| | - Ronza Hadad
- WHO Collaborating Centre for Gonorrhoea and other STIs, Faculty of Medicine and Health, Örebro University Hospital, SE-701 85 Örebro, Sweden
| | - Laszlo Kari
- Laboratory of Intracellular Parasites, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana 59840, USA
| | - Matthew J Burton
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - David Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Anthony W Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - David Lewis
- Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, 2192 Johannesburg, South Africa.,Centre for Infectious Diseases and Microbiology and Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Clinical School, University of Sydney, Sydney 2192, Australia
| | - Peter Marsh
- Public Health England, Public Health Laboratory Southampton, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, Faculty of Medicine and Health, Örebro University Hospital, SE-701 85 Örebro, Sweden
| | - Ian N Clarke
- Molecular Microbiology Group, University Medical School, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
| | - Julian Parkhill
- Pathogen Genomics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, United Kingdom
| | - Nicholas R Thomson
- Pathogen Genomics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, United Kingdom.,Department of Pathogen Molecular Biology, The London School of Hygiene and Tropical Medicine, London WC1 7HT, United Kingdom
| |
Collapse
|
19
|
Malogajski J, Jansen ME, Ouburg S, Ambrosino E, Terwee CB, Morré SA. The attitudes of Dutch fertility specialists towards the addition of genetic testing in screening of tubal factor infertility. Sex Reprod Healthc 2017; 12:123-127. [PMID: 28477924 DOI: 10.1016/j.srhc.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 01/31/2017] [Accepted: 04/03/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aims to identify elements perceived by Dutch fertility specialists as barriers and facilitators for the introduction of genetic testing, and their attitudes towards the use of genetic information. The genetic test would be implemented in routine screening for tubal pathology and identifies SNPs relevant for the immune response causing tubal pathology. METHODS Experienced reproductive specialists working in Dutch Academic Hospitals were interviewed. Based on the results of four interviews a questionnaire was developed and used to survey medical doctors in six out of eight Dutch Academic hospitals. RESULTS 60.4% (n=91) stated that the addition of genetic markers to the Chlamydia trachomatis antibody test (CAT) in screening for tubal pathology would increase screening accuracy. 68.2% (n=90) agreed they would require additional training on clinical genetics. Clinical utility (91.2%, n=91) and cost-effectiveness (95.6%, n=91) were recognized by the respondents as important factors in gaining support for the new screening strategy. CONCLUSION In summary, respondents showed a positive attitude towards the implementation of a genetic test combined with CAT for tubal factor infertility (TFI) screening. To gain their support the majority of respondents agreed that clinical utility, specifically cost-effectiveness, is an important factor. Comprehensive research about economic implications and utility regarding the introduction of genomic markers should be the next step in the implementation strategy. Furthermore, education and training would need to be developed and offered to fertility care professionals about genetic markers, their interpretation, and implications for clinical decision-making.
Collapse
Affiliation(s)
- Jelena Malogajski
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Marleen E Jansen
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands.
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - Elena Ambrosino
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Servaas A Morré
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands; Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
20
|
van der Eem L, Dubbink JH, Struthers HE, McIntyre JA, Ouburg S, Morré SA, Kock MM, Peters RPH. Evaluation of syndromic management guidelines for treatment of sexually transmitted infections in South African women. Trop Med Int Health 2016; 21:1138-46. [PMID: 27350659 DOI: 10.1111/tmi.12742] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the performance of three different guidelines for the management of vaginal discharge syndrome (VDS) for women living in a rural setting in South Africa. METHODS We conducted a secondary analysis of data from a cross-sectional study in Mopani District, South Africa. The 2015 and 2008 guidelines of the South African Department of Health (DoH) and the most recent WHO guidelines were evaluated for adequate treatment of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis infection. RESULTS Of the 489 women included in this analysis, 35% presented with VDS according to the DoH and 30% per WHO definition of VDS. Fifty-six per cent of the women with VDS would be treated adequately for these STI when using the 2015 DoH guideline, whereas 76% (P = 0.01) and 64% (P = 0.35) would receive adequate treatment with the 2008 DoH and WHO guidelines, respectively. Of the symptomatic women who tested negative for all four STI, STI treatment would have been indicated for 36% as per 2015 DoH guideline vs. 69% (P < 0.001) per 2008 DoH and 67% (P < 0.001) per WHO guidelines. CONCLUSION A considerable proportion of symptomatic women infected with these common curable STI would receive adequate treatment when using a syndromic management approach, and significant differences exist between the three guidelines. Many symptomatic women without these STI receive broad-spectrum antibiotics, so new approaches are needed to improve syndromic STI control.
Collapse
Affiliation(s)
- Lisette van der Eem
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,African Woman Foundation, Amsterdam, The Netherlands
| | - Jan Henk Dubbink
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,Institute for Public Health Genomics, University of Maastricht, Maastricht, The Netherlands.,Department of Medical Microbiology & Infection Control, VU University Medical Centre, Amsterdam, The Netherlands
| | - Helen E Struthers
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,Department of Internal Medicine, University of Cape Town, Cape Town, South Africa
| | - James A McIntyre
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Sander Ouburg
- Department of Medical Microbiology & Infection Control, VU University Medical Centre, Amsterdam, The Netherlands
| | - Servaas A Morré
- Institute for Public Health Genomics, University of Maastricht, Maastricht, The Netherlands.,Department of Medical Microbiology & Infection Control, VU University Medical Centre, Amsterdam, The Netherlands
| | - Marleen M Kock
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.,Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
| | - Remco P H Peters
- Anova Health Institute, Johannesburg and Tzaneen, South Africa.,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
21
|
Dubbink JH, van der Eem L, McIntyre JA, Mbambazela N, Jobson GA, Ouburg S, Morre SA, Struthers HE, Peters RPH. Sexual behaviour of women in rural South Africa: a descriptive study. BMC Public Health 2016; 16:557. [PMID: 27405338 PMCID: PMC4942904 DOI: 10.1186/s12889-016-3207-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 06/23/2016] [Indexed: 11/24/2022] Open
Abstract
Background Sexual behaviour is a core determinant of the HIV and sexually transmitted infection (STI) epidemics in women living in rural South Africa. Knowledge of sexual behaviour in these areas is limited, but constitutes essential information for a combination prevention approach of behavioural change and biomedical interventions. Methods This descriptive study was conducted in rural Mopani District, South Africa, as part of a larger study on STI. Women of reproductive age (18–49 years) who reported sexual activity were included regardless of the reason for visiting the facility. Questionnaires were administered to 570 women. We report sexual behaviour by age group, ethnic group and self-reported HIV status. Results Young women (<25 years) were more likely to visit bars, practice fellatio, have concurrent sexual partners and report a circumcised partner than older women (>34 years); there was no difference for condom use during last sex act (36 % overall). Sotho women were more likely to report concurrent sexual partners whereas Shangaan women reported more frequent intravaginal cleansing and vaginal scarring practice in our analysis. HIV-infected women were older, had a higher number of lifetime sexual partners, reported more frequent condom use during the last sex act and were more likely to have a known HIV-infected partner than women without HIV infection; hormonal contraceptive use, fellatio, and a circumcised partner were less often reported. Conclusions This study provides insight into women’s sexual behaviour in a rural South African region. There are important differences in sexual behaviour by age group and ethnicity and HIV status; these should be taken into account when designing tailor-made prevention packages.
Collapse
Affiliation(s)
- Jan Henk Dubbink
- Anova Health Institute, Johannesburg, Tzaneen, South Africa.,Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands.,Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Lisette van der Eem
- Anova Health Institute, Johannesburg, Tzaneen, South Africa.,Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, The Netherlands
| | - James A McIntyre
- Anova Health Institute, Johannesburg, Tzaneen, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | - Sander Ouburg
- Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Servaas A Morre
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands.,Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Helen E Struthers
- Anova Health Institute, Johannesburg, Tzaneen, South Africa.,Division of Infectious Diseases & HIV Medicine, Department of Internal Medicine, University of Cape Town, Cape Town, South Africa
| | - Remco P H Peters
- Anova Health Institute, Johannesburg, Tzaneen, South Africa. .,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa. .,Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, The Netherlands. .,Anova Health Institute, PostNet Suite 242, Private Bag X30500, 2041, Houghton, Johannesburg, South Africa.
| |
Collapse
|
22
|
de Waaij DJ, Ouburg S, Dubbink JH, Peters RPH, Morré SA. Evaluation of Presto(plus) assay and LightMix kit Trichomonas vaginalis assay for detection of Trichomonas vaginalis in dry vaginal swabs. J Microbiol Methods 2016; 127:102-104. [PMID: 27268968 DOI: 10.1016/j.mimet.2016.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 11/26/2022]
Abstract
This is an evaluation study of the Presto(plus) Assay for T. vaginalis by comparing to the TIB MOLBIOL LightMix Kit Trichomonas vaginalis Assay using 615 dry collected vaginal and rectal swabs. Discordant samples were analyzed by the Qiagen® Microbial DNA qPCR for TV Assay. Both assays showed comparable performances (McNemar p>0.05).
Collapse
Affiliation(s)
- Dewi J de Waaij
- VU University Medical Centre, Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, Amsterdam, The Netherlands; Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Sander Ouburg
- VU University Medical Centre, Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, Amsterdam, The Netherlands.
| | - Jan Henk Dubbink
- VU University Medical Centre, Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, Amsterdam, The Netherlands; Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Remco P H Peters
- Anova Health Institute, Johannesburg and Tzaneen, South Africa; Department of Medical Microbiology, University of Maastricht, Maastricht, The Netherlands; Department of Microbiology, University of Pretoria, Pretoria, South Africa
| | - Servaas A Morré
- VU University Medical Centre, Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, Amsterdam, The Netherlands; Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| |
Collapse
|
23
|
Singer M, Li W, Morré SA, Ouburg S, Spinola SM. Host Polymorphisms in TLR9 and IL10 Are Associated With the Outcomes of Experimental Haemophilus ducreyi Infection in Human Volunteers. J Infect Dis 2016; 214:489-95. [PMID: 27122592 DOI: 10.1093/infdis/jiw164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/14/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In humans inoculated with Haemophilus ducreyi, there are host effects on the possible clinical outcomes-pustule formation versus spontaneous resolution of infection. However, the immunogenetic factors that influence these outcomes are unknown. Here we examined the role of 14 single-nucleotide polymorphisms (SNPs) in 7 selected pathogen-recognition pathways and cytokine genes on the gradated outcomes of experimental infection. METHODS DNAs from 105 volunteers infected with H. ducreyi at 3 sites were genotyped for SNPs, using real-time polymerase chain reaction. The participants were classified into 2 cohorts, by race, and into 4 groups, based on whether they formed 0, 1, 2, or 3 pustules. χ(2) tests for trend and logistic regression analyses were performed on the data. RESULTS In European Americans, the most significant findings were a protective association of the TLR9 +2848 GG genotype and a risk-enhancing association of the TLR9 TA haplotype with pustule formation; logistic regression showed a trend toward protection for the TLR9 +2848 GG genotype. In African Americans, logistic regression showed a protective effect for the IL10 -2849 AA genotype and a risk-enhancing effect for the IL10 AAC haplotype. CONCLUSIONS Variations in TLR9 and IL10 are associated with the outcome of H. ducreyi infection.
Collapse
Affiliation(s)
- Martin Singer
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam
| | - Wei Li
- Department of Microbiology and Immunology
| | - Servaas A Morré
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam Institute for Public Health Genomics, Department of Genetics and Cell Biology, School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam
| | - Stanley M Spinola
- Department of Microbiology and Immunology Departments of Medicine Pathology and Laboratory Medicine Center for Immunobiology, Indiana University School of Medicine, Indiana University, Indianapolis
| |
Collapse
|
24
|
Lanjouw E, Branković I, Pleijster J, Spaargaren J, Hoebe CJPA, van Kranen HJ, Ouburg S, Morré SA. Specific polymorphisms in the vitamin D metabolism pathway are not associated with susceptibility to Chlamydia trachomatis infection in humans. Pathog Dis 2016; 74:ftw010. [PMID: 26867646 DOI: 10.1093/femspd/ftw010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 01/06/2023] Open
Abstract
Chlamydia trachomatis is the most common sexually transmitted bacterium worldwide. Its often asymptomatic course of infection increases chances of transmission, and increases risk of late complications. Genetic variations in the host immune system are known to impact the course of infections. Recent studies have shown a positive impact of vitamin D on the regulation of the immune system. This study assesses the impact of eight polymorphisms in five genes [VDR (rs1544410 G > A, rs2228570 C > T), CYP27B1 (rs10877012 G > T), DHCR7 (rs7944926 G > A, rs3829251 G > A), GC (rs3755967) and CYP2R1 (rs10741657 G > A, rs2060793 G > A)] on susceptibility to Chlamydia infections in humans. These polymorphisms could influence protein expression or function, and thus influence the immune system. Samples of women visiting the STD outpatient clinic in South Limburg were genotyped using the Roche Lightcycler 480. In this study, we did not observe statistically significant differences between the genotype distributions of these polymorphisms in women with or without a Chlamydia infection. This suggests that VDR, CYP27B1, DHCR7, GC and CYP2R1 do not affect the susceptibility to Chlamydia infections. However, due to its pleiotropic nature in the immune system a role for the vitamin D pathway may not be excluded from the whole clinical course of Chlamydia infections (e.g. late complications), and further research is required.
Collapse
Affiliation(s)
- Esmée Lanjouw
- Department of Dermatology, Erasmus MC, Rotterdam 3015 CA, the Netherlands Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam 1081 BT, the Netherlands
| | - Ivan Branković
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam 1081 BT, the Netherlands Institute for Public Health Genomics, Department of Genetics and Cell Biology, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht 6200 MD, the Netherlands
| | - Jolein Pleijster
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam 1081 BT, the Netherlands
| | - Joke Spaargaren
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam 1081 BT, the Netherlands
| | - Christian J P A Hoebe
- Public Health Service South Limburg, Department of Sexual Health, Infectious Disease and Environmental Health, Geleen 6160 HA, the Netherlands Department of Medical Microbiology, Maastricht University, Maastricht 6200 MD, the Netherlands
| | - Henk J van Kranen
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht 6200 MD, the Netherlands National Institute for Public Health and the Environment, Bilthoven 3721 MA, the Netherlands
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam 1081 BT, the Netherlands
| | - Servaas A Morré
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam 1081 BT, the Netherlands Institute for Public Health Genomics, Department of Genetics and Cell Biology, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht 6200 MD, the Netherlands
| |
Collapse
|
25
|
Singer M, Ouburg S. Effect of cytokine level variations in individuals on the progression and outcome of bacterial urogenital infections--a meta-analysis. Pathog Dis 2016; 74:ftv126. [PMID: 26733496 DOI: 10.1093/femspd/ftv126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 11/12/2022] Open
Abstract
Bacterial urogenital infections such as chlamydia, gonorrhoea and syphilis are widespread inflammatory diseases, which may be accompanied by severe complications. These complications can range from basic inflammation to tubal pathology, infertility and neurological dysfunction, though infections go unnoticed in the majority of cases. Cytokines in the host play a vital role in both the initial and long-term immune response and inflammation. However, levels of cytokine expression vary between individuals. A meta-analysis was performed to evaluate the effect of cytokine expression differences on severity of infections with these pathogens. Studies comparing expression of cytokines in humans with inflammation or inflammation-based complications were identified using NCBI, Google Scholar and Cochrane databases. Only studies into human cytokine expressions were included, and three articles per subject were required to be suitably analysed during meta-analysis. A total of 52 articles were included for meta-analysis. It was shown that differences in IL-1, IL-6, IL-8, IL-10, TNFα and IFNγ affect the clinical outcome of Chlamydia trachomatis infection significantly. Similarly, IL-1 and IL-8 expression during Neisseria gonorrhoeae infection significantly affects the outcome of the disease. For Treponema pallidum infection, it was shown that IFNγ variation in hosts could be linked to severity of disease. However, a lack of studies to use in the meta-analysis and fluctuation in the resulting data depending on the adjustments makes adequate evaluation difficult.
Collapse
Affiliation(s)
- Martin Singer
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, the Netherlands
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
26
|
Jansen ME, Branković I, Spaargaren J, Ouburg S, Morré SA. Potential protective effect of a G>A SNP in the 3'UTR of HLA-A for Chlamydia trachomatis symptomatology and severity of infection. Pathog Dis 2015; 74:ftv116. [PMID: 26656886 DOI: 10.1093/femspd/ftv116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 11/13/2022] Open
Abstract
The interindividual differences in response to Chlamydia trachomatis (CT) infections are for an important part based on the differences in our host genetic make-up. In the past, several genes and pathways have been identified and linked to protection against or risk for CT infection (i.e. susceptibility), and/or the severity of infection, with a major emphasis on the development of tubal pathology, one of the main causes of female infertility. In the current study, we analyzed in Dutch Caucasian women whether the carriage of HLA-A G>A SNP (rs1655900) was related to the susceptibility of CT infection in a STD cohort (n = 329) and to the severity of infection in a subfertility cohort (n = 482). We also investigated if this A-allele was linked to increase in severity of symptoms, from mild symptoms (lower genital infection) to lower abdominal pain (upper genital tract infection) to the most severe late complication of tubal pathology, including double-sided tubal pathology. We showed that the carriage of HLA-A SNP rs1655900 studied is not associated with the susceptibility to CT infection based on the data from the STD cohort, but might be protective to the development of late complications (p = 0.0349), especially tubal pathology could be relevant.
Collapse
Affiliation(s)
- Marleen E Jansen
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD, Maastricht, the Netherlands
| | - Ivan Branković
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD, Maastricht, the Netherlands Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1081 HV, Amsterdam, the Netherlands
| | - Joke Spaargaren
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1081 HV, Amsterdam, the Netherlands
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1081 HV, Amsterdam, the Netherlands
| | - Servaas A Morré
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD, Maastricht, the Netherlands Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1081 HV, Amsterdam, the Netherlands
| |
Collapse
|
27
|
Lanjouw E, Ouburg S, de Vries HJ, Stary A, Radcliffe K, Unemo M. Background review for the '2015 European guideline on the management of Chlamydia trachomatis infections'. Int J STD AIDS 2015:0956462415618838. [PMID: 26608578 DOI: 10.1177/0956462415618838] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
SummaryChlamydia trachomatis infections are major public health concerns globally. Of particular grave concern is that the majority of persons with anogenital Chlamydia trachomatis infections are asymptomatic and accordingly not aware of their infection, and this silent infection can subsequently result in severe reproductive tract complications and sequelae. The current review paper provides all background, evidence base and discussions for the 2015 European guideline on the management of Chlamydia trachomatis infections (Lanjouw E, et al. Int J STD AIDS 2015). Comprehensive information and recommendations are included regarding the diagnosis, treatment and prevention of anogenital, pharyngeal and conjunctival Chlamydia trachomatis infections in European countries. However, Chlamydia trachomatis also causes the eye infection trachoma, which is not a sexually transmitted infection. The 2015 European Chlamydia trachomatis guideline provides up-to-date guidance regarding broader indications for testing and treatment of Chlamydia trachomatis infections; clearer recommendation of using validated nucleic acid amplification tests only for diagnosis; advice on (repeated) Chlamydia trachomatis testing; recommendation of increased testing to reduce the incidence of pelvic inflammatory disease and prevent exposure to infection and recommendations to identify, verify and report Chlamydia trachomatis variants. Improvement of access to testing, test performance, diagnostics, antimicrobial treatment and follow-up of Chlamydia trachomatis patients are crucial to control its spread.
Collapse
Affiliation(s)
- E Lanjouw
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - H J de Vries
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands STI Outpatient Clinic, Infectious Disease Cluster, Health Service Amsterdam, Amsterdam, The Netherlands Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - A Stary
- Outpatients' Centre for Infectious Venereodermatological Diseases, Vienna, Austria
| | - K Radcliffe
- University Hospital Birmingham Foundation NHS Trust, Birmingham, UK
| | - M Unemo
- WHO Collaborating Center for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
28
|
Lanjouw E, Ouburg S, de Vries HJ, Stary A, Radcliffe K, Unemo M. 2015 European guideline on the management of Chlamydia trachomatis infections. Int J STD AIDS 2015; 27:333-48. [PMID: 26608577 DOI: 10.1177/0956462415618837] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 11/01/2015] [Indexed: 12/19/2022]
Abstract
Chlamydia trachomatis infections, which most frequently are asymptomatic, are major public health concerns globally. The 2015 European C. trachomatis guideline provides: up-to-date guidance regarding broader indications for testing and treatment of C. trachomatis infections; a clearer recommendation of using exclusively-validated nucleic acid amplification tests for diagnosis; advice on (repeated) C. trachomatis testing; the recommendation of increased testing to reduce the incidence of pelvic inflammatory disease and prevent exposure to infection; and recommendations to identify, verify and report C. trachomatis variants. Improvement of access to testing, test performance, diagnostics, antimicrobial treatment and follow-up of C. trachomatis patients are crucial to control its spread. For detailed background, evidence base and discussions, see the background review for the present 2015 European guideline on the management of Chlamydia trachomatis infections (Lanjouw E, et al. Int J STD AIDS. 2015).
Collapse
Affiliation(s)
- E Lanjouw
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - H J de Vries
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands STI Outpatient Clinic, Infectious Disease Cluster, Health Service Amsterdam, Amsterdam, The Netherlands Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - A Stary
- Outpatients' Centre for Infectious Venereodermatological Diseases, Vienna, Austria
| | - K Radcliffe
- University Hospital Birmingham Foundation NHS Trust, Birmingham, United Kingdom
| | - M Unemo
- WHO Collaborating Center for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
29
|
Verweij SP, Karimi O, Pleijster J, Lyons JM, de Vries HJC, Land JA, Morré SA, Ouburg S. TLR2, TLR4 and TLR9 genotypes and haplotypes in the susceptibility to and clinical course of Chlamydia trachomatis infections in Dutch women. Pathog Dis 2015; 74:ftv107. [PMID: 26568059 DOI: 10.1093/femspd/ftv107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2015] [Indexed: 01/17/2023] Open
Abstract
Chlamydia trachomatis infections demonstrate remarkable differences in clinical course that are approximately 40% based on host genetic variation. Here, we study the single nucleotide polymorphisms (SNPs) and their haplotypes in TLR2, TLR4 and TLR9 (TLR2 +2477G>A; TLR2 -16934T>A; TLR4+896A>G; TLR9 -1237T>C and TLR9 +2848G>A) in relation to the susceptibility to, and severity of C. trachomatis infections. We analysed the five SNPs in a cohort of 770 Dutch Caucasian women either attending a sexually transmitted diseases outpatient clinic (n = 731) or having complaints of subfertility (n = 39). Haplotype analyses showed a trend for TLR2 haplotype I (-16934T/+2477G) to protect against the development of symptoms and tubal pathology (Ptrend = 0.03) after Chlamydia infection. In the susceptibility cohort, TLR9 haplotype III (-1237C/+2848A) showed a significant decreasing trend in the development of symptoms after C. trachomatis infection (P = 0.02, OR: 0.55, 95%CI: 0.33-0.91). Logistic regression of the TLR2 haplotypes, TLR4+896A>G, and TLR9 haplotypes showed that the TLR2 haplotype combinations AG-TA and AG-TG confer risk (OR 3.4 (P = 0.01) and 1.6 (P = 0.03)), while the TLR9 haplotype combination TG-TA protects against C. trachomatis infections (OR: 0.4, P = 0.004). Our study shows that both TLR2 and TLR9 genes and SNP combinations do influence the clinical course of Chlamydia infections.
Collapse
Affiliation(s)
- Stephan P Verweij
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, 1081 HV, the Netherlands
| | - Ouafae Karimi
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, 1081 HV, the Netherlands Department of Internal Medicine, VU University Medical Center, Amsterdam, 1081 HV, the Netherlands
| | - Jolein Pleijster
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, 1081 HV, the Netherlands
| | - Joseph M Lyons
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, 1081 HV, the Netherlands
| | - Henry J C de Vries
- STI outpatient clinic, Cluster Infectious Diseases, Municipal Health Service Amsterdam, Amsterdam, 1018 WT, the Netherlands Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, 1105 AZ, the Netherlands National Institute for Public Health and the Environment, Bilthoven, 3721 MA, the Netherlands Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, 1105 AZ, the Netherlands
| | - Jolande A Land
- Department of Obstetrics and Gynaecology, UMCG, University of Groningen, Groningen, 9713 GZ, the Netherlands
| | - Servaas A Morré
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, 1081 HV, the Netherlands Institute of Public Health Genomics, Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, 6229 ER, the Netherlands
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, 1081 HV, the Netherlands
| |
Collapse
|
30
|
Verweij SP, Kebbi-Beghdadi C, Land JA, Ouburg S, Morré SA, Greub G. Waddlia chondrophila and Chlamydia trachomatis antibodies in screening infertile women for tubal pathology. Microbes Infect 2015; 17:745-8. [PMID: 26428856 DOI: 10.1016/j.micinf.2015.09.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/14/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
Abstract
Since Waddlia chondrophila is closely related to Chlamydia trachomatis, we hypothesise that W. chondrophila may also be associated with tubal factor infertility (TFI) in women, a major complication of chronic C. trachomatis infection. Five hundred twenty serum samples were tested for anti-Waddlia antibodies by ELISA. Among the 520 investigated women, a total number of 142 (27.3%) has had laparoscopic diagnosis performed, and were either classified TFI positive or negative. Presence of high titres of W. chondrophila antibodies was linked to TFI (p < 0.0001; OR: 7.5; 95% CI: 3.3-17). Moreover, antibody positivity to both W. chondrophila and C. trachomatis-MOMP was strongly associated with TFI (p < 0.0001; OR: 21; 95% CI: 3.8-12E1). This association was much stronger than the statistical association of C. trachomatis-MOMP antibodies only (p < 0.0001; OR: 7.1; 95% CI: 3.7-14), suggesting that co-infection with W. chondrophila and C. trachomatis may lead to more severe reproductive sequelae and immune responses than single infection with either Chlamydiales members.
Collapse
Affiliation(s)
- S P Verweij
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.
| | - C Kebbi-Beghdadi
- Institute of Microbiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - J A Land
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - S A Morré
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands; Institute for Public Health Genomics, Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - G Greub
- Institute of Microbiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland; Infectious Diseases Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
31
|
de Waaij DJ, Dubbink JH, Peters RPH, Ouburg S, Morré SA. Comparison of GMT presto assay and Roche cobas® 4800 CT/NG assay for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in dry swabs. J Microbiol Methods 2015; 118:70-4. [PMID: 26327539 DOI: 10.1016/j.mimet.2015.08.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 08/26/2015] [Accepted: 08/26/2015] [Indexed: 11/25/2022]
Abstract
Urogenital Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most prevalent bacterial STIs worldwide. Molecular tests are the standard for the detection of CT and NG, as these are difficult to culture. The recently introduced CE-IVD marked GMT Presto assay promises to be a valuable addition in CT and NG diagnostics. The advantage of the Presto assay is that it works on many PCR systems and the DNA can be isolated by any system.We compared the Presto assay to the widely used Roche cobas® 4800 CT/NG test for the detection of CT and NG in 612 vaginal and rectal dry collected swabs. Discrepant samples were tested by the TIB MOLBIOL Lightmix Kit 480 HT CT/NG assay. The alloyed gold standard was defined as two concurring Presto and cobas® 4800 results, or, with discrepant Presto and cobas® results, two concurring results of either test together with the Lightmix Kit 480 HT CT/NG assay. For the Presto assay,we observed 77 CT positive (13%) and 22 NG positive (3,6%) vaginal samples, and 41 CT positive (6,7%) and 11 NG positive (1,8%) rectal samples. For the cobas® 4800 assay,we observed 77 CT positive (13%) and 21NG positive (3,4%) vaginal samples, and 39 CT positive (6,4%) and 11 NG positive (1,8%) rectal samples. Ten CT samples were discrepant between Presto and cobas® 4800 CT/NG assays, while two NG samples were discrepant. CT sensitivity in both assays was 100% compared to the alloyed gold standard. The sensitivity was 100% for both vaginal and rectal dry swabs, underlining the suitability of these sample types for detection of CT and NG. The Presto assay is therefore valuable for molecular detection of CT and NG in dry vaginal and rectal swabs.
Collapse
Affiliation(s)
- Dewi J de Waaij
- VU University Medical Centre, Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, Amsterdam, The Netherlands; Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Jan Henk Dubbink
- VU University Medical Centre, Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, Amsterdam, The Netherlands; Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Remco P H Peters
- Anova Health Institute, Johannesburg and Tzaneen, South Africa; Department of Medical Microbiology, University of Maastricht, Maastricht, The Netherlands
| | - Sander Ouburg
- VU University Medical Centre, Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, Amsterdam, The Netherlands.
| | - Servaas A Morré
- VU University Medical Centre, Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, Amsterdam, The Netherlands; Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| |
Collapse
|
32
|
Kelmemi W, Teeuw ME, Bochdanovits Z, Ouburg S, Jonker MA, Alkuraya F, Hashem M, Kayserili H, van Haeringen A, Sheridan E, Masri A, Cobben JM, Rizzu P, Kostense PJ, Dommering CJ, Henneman L, Bouhamed-Chaabouni H, Heutink P, Ten Kate LP, Cornel MC. Determining the genome-wide kinship coefficient seems unhelpful in distinguishing consanguineous couples with a high versus low risk for adverse reproductive outcome. BMC Med Genet 2015; 16:50. [PMID: 26188928 PMCID: PMC4557855 DOI: 10.1186/s12881-015-0191-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 06/17/2015] [Indexed: 11/25/2022]
Abstract
Background Offspring of consanguineous couples are at increased risk of congenital disorders. The risk increases as parents are more closely related. Individuals that have the same degree of relatedness according to their pedigree, show variable genomic kinship coefficients. To investigate whether we can differentiate between couples with high- and low risk for offspring with congenital disorders, we have compared the genomic kinship coefficient of consanguineous parents with a child affected with an autosomal recessive disorder with that of consanguineous parents with only healthy children, corrected for the degree of pedigree relatedness. Methods 151 consanguineous couples (73 cases and 78 controls) from 10 different ethnic backgrounds were genotyped on the Affymetrix platform and passed quality control checks. After pruning SNPs in linkage disequilibrium, 57,358 SNPs remained. Kinship coefficients were calculated using three different toolsets: PLINK, King and IBDelphi, yielding five different estimates (IBDelphi, PLINK (all), PLINK (by population), King robust (all) and King homo (by population)). We performed a one-sided Mann Whitney test to investigate whether the median relative difference regarding observed and expected kinship coefficients is bigger for cases than for controls. Furthermore, we fitted a mixed effects linear model to correct for a possible population effect. Results Although the estimated degrees of genomic relatedness with the different toolsets show substantial variability, correlation measures between the different estimators demonstrated moderate to strong correlations. Controls have higher point estimates for genomic kinship coefficients. The one-sided Mann Whitney test did not show any evidence for a higher median relative difference for cases compared to controls. Neither did the regression analysis exhibit a positive association between case–control status and genomic kinship coefficient. Conclusions In this case–control setting, in which we compared consanguineous couples corrected for degree of pedigree relatedness, a higher degree of genomic relatedness was not significantly associated with a higher likelihood of having an affected child. Further translational research should focus on which parts of the genome and which pathogenic mutations couples are sharing. Looking at relatedness coefficients by determining genome-wide SNPs does not seem to be an effective measure for prospective risk assessment in consanguineous parents. Electronic supplementary material The online version of this article (doi:10.1186/s12881-015-0191-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- W Kelmemi
- Laboratory of Human Genetics, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - M E Teeuw
- Department of Clinical Genetics, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Z Bochdanovits
- Department of Clinical Genetics, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Medical Microbiology and Infection Control, Research School V-ICI, VU University Medical Center, Amsterdam, The Netherlands
| | - M A Jonker
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - F Alkuraya
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - M Hashem
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - H Kayserili
- Medical Genetics Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - A van Haeringen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.,Juliana Children's Hospital, Hague, The Netherlands
| | - E Sheridan
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK.,Department of Genetics, Wellcome Trust Brenner Building, St James's University Hospital, Leeds, UK
| | - A Masri
- Division of Child Neurology, Department of Pediatrics, University of Jordan, Amman, Jordan
| | - J M Cobben
- Department of Pediatric Genetics, AMC University Hospital, Amsterdam, The Netherlands
| | - P Rizzu
- Department of Clinical Genetics, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.,Genome Biology of Neurodegenerative Diseases, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - P J Kostense
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - C J Dommering
- Department of Clinical Genetics, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - L Henneman
- Department of Clinical Genetics, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - H Bouhamed-Chaabouni
- Laboratory of Human Genetics, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - P Heutink
- Department of Clinical Genetics, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.,Genome Biology of Neurodegenerative Diseases, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - L P Ten Kate
- Department of Clinical Genetics, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - M C Cornel
- Department of Clinical Genetics, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,EMGO Institute for Health and Care Research, VU University Medical Center, Mail BS7, D450, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| |
Collapse
|
33
|
Abstract
BACKGROUND Bacterial infections in the genital tract frequently result in morbidity through a variety of inflammation based symptoms. One component of the bacteria that may trigger host inflammatory response is their DNA. CpG motifs in this DNA are known targets for Toll-like receptor 9 (TLR9), which is a pathogen-recognition receptors focusing on CpG DNA. The activation of TLR9 induces the NF-κB inflammatory pathway. This study aims to provide a broad view of the inflammatory potential of CpG DNA motifs in bacteria related to genital diseases: C. trachomatis, E. coli, N. gonorrhoeae, G. vaginalis, H. ducreyi, L. crispatus, L. gasseri, M. hominis, M. genitalium, T. pallidum, and U. urealyticum. METHODS Publicly available genomic sequences of the bacterial species and strains have been analyzed in silico to produce a CpG index number. This CpG index number shows the relative inflammatory potential of the genome and has previously been used in a study by Lundberg et al. (2003). Higher CpG index values suggest a strong CpG induced inflammation potential during infection and vice versa. RESULTS The highest observed CpG index belongs to G. vaginalis with a value of 26,2, suggesting a strong pro-inflammatory potential when in contact with TLR9. The lowest index belongs to N. gonorrhoeae with a value of -79,5, suggesting a strong immunoinhibitory effect on TLR9 contact. Interestingly, Lactobacilli showed a mean CpG index value of 4,2, suggesting a weak inflammatory potential. DISCUSSION Our results show varying CpG index values between bacterial species. Comparison of CpG indices with the clinical course of several pathogens shows the CpG index helps clarify the clinical course of infection. However, we found no links between CpG index values and either obligate pathogenicity or facultative pathogenicity through bacterial vaginosis. Lactobacilli showed relatively low CpG indices which do suggest a lower inflammatory potential from these bacteria. CONCLUSIONS Our results show varying CpG index values between bacterial species, which may help clarify the clinical course of infection, and may help diagnosis.
Collapse
Affiliation(s)
- Martin Singer
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.
| | - Dewi J de Waaij
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.
| | - Servaas A Morré
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands. .,Institute of Public Health Genomics, Department of Genetics and Cell Biology, Research Institutes CAPHRI and GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands.
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.
| |
Collapse
|
34
|
Branković I, van Ess EF, Noz MP, Wiericx WAJ, Spaargaren J, Morré SA, Ouburg S. NOD1 in contrast to NOD2 functional polymorphism influence Chlamydia trachomatis infection and the risk of tubal factor infertility. Pathog Dis 2015; 73:1-9. [PMID: 25854006 DOI: 10.1093/femspd/ftu028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2014] [Indexed: 01/01/2023] Open
Abstract
Intracellular pattern-recognition receptors NOD1 and NOD2 are capable of sensing common structural units of bacterial walls. Recognition triggers specific immune signalling pathways and leads to pro-inflammatory cytokine upregulation and adequate immune response. We investigated whether two functional polymorphisms in NOD1 and NOD2 exert an effect on susceptibility to (STD patients) and severity of (female patients visiting the fertility clinic) Chlamydia trachomatis infection in 807 Dutch Caucasian women. A significant association of the NOD1 +32656 GG insertion variant with protection against infection with C. trachomatis has been detected [p: 0.0057; OR: 0.52]. When comparing C. trachomatis-positive women without symptoms to C. trachomatis-positive women with symptoms, and to C. trachomatis-positive women with TFI, we observed an increasing trend in carriage of the GG allele [Ptrend: 0.0003]. NOD2 1007fs failed to reveal an association. We hypothesize that the underlying mechanism might be a functional effect of the GG insertion on IFN-beta-dependent regulation of immune response in the genital tract. The research is part of an ongoing effort of identifying key polymorphisms that determine the risk of TFI and effectively translating them into the clinical setting for the purpose of optimizing diagnostic management of women at risk for developing TFI.
Collapse
Affiliation(s)
- Ivan Branković
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1081 HV Amsterdam, The Netherlands Institute for Public Health Genomics, Department of Genetics and Cell Biology, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Eleanne F van Ess
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Marlies P Noz
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Wilhelmina Anke J Wiericx
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Joke Spaargaren
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Servaas A Morré
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1081 HV Amsterdam, The Netherlands Institute for Public Health Genomics, Department of Genetics and Cell Biology, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands Dutch Chlamydia trachomatis Reference Laboratory, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
| |
Collapse
|
35
|
de Viron S, Morré SA, Van Oyen H, Brand A, Ouburg S. Genetic similarities between tobacco use disorder and related comorbidities: an exploratory study. BMC Med Genet 2014; 15:85. [PMID: 25060307 PMCID: PMC4119471 DOI: 10.1186/1471-2350-15-85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 06/25/2014] [Indexed: 01/10/2023]
Abstract
Background Tobacco use disorder (TUD), defined as the use of tobacco to the detriment of a person’s health or social functioning, is associated with various disorders. We hypothesized that mutual variation in genes may partly explain this link. The aims of this study were to make a non-exhaustive inventory of the disorders using (partially) the same genetic pathways as TUD, and to describe the genetic similarities between TUD and the selected disorders. Methods We developed a 3 stage approach: (i) selection of genes influencing TUD using Gene2Mesh and Ingenuity Pathway Analysis (IPA), (ii) selection of disorders associated with the selected genes using IPA and (iii) genetic similarities between disorders associated with TUD using Jaccard distance and cluster analyses. Results Fourteen disorders and thirty-two genes met our inclusion criteria. The Jaccard distance between pairs of disorders ranged from 0.00 (e.g. oesophageal cancer and malignant hypertension) to 0.45 (e.g. bladder cancer and addiction). A lower number in the Jaccard distance indicates a higher similarity between the two disorders. Two main clusters of genetically similar disorders were observed, one including coexisting disorders (e.g. addiction and alcoholism) and the other one with the side-effects of smoking (e.g. gastric cancer and malignant hypertension). Conclusions This exploratory study partly explains the potential genetic components linking TUD to other disorders. Two principle clusters of disorders were observed (i) coexisting disorders of TUD and (ii) side-effects of TUD disorders. A further deepening of this observation in a real life study should allow strengthening this hypothesis.
Collapse
Affiliation(s)
- Sylviane de Viron
- Operational Direction Public Health and Surveillance, Scientific Institute of Public Health, J, Wytsmanstraat 14, 1050, Brussels, Belgium.
| | | | | | | | | |
Collapse
|
36
|
Al-Kuhlani M, Rothchild J, Pal S, de la Maza LM, Ouburg S, Morré SA, Dean D, Ojcius DM. TRAIL-R1 is a negative regulator of pro-inflammatory responses and modulates long-term sequelae resulting from Chlamydia trachomatis infections in humans. PLoS One 2014; 9:e93939. [PMID: 24695582 PMCID: PMC3973638 DOI: 10.1371/journal.pone.0093939] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/10/2014] [Indexed: 12/17/2022] Open
Abstract
The immune system eliminates Chlamydia trachomatis infection through inflammation. However, uncontrolled inflammation can enhance pathology. In mice, TNF-related apoptosis-inducing ligand receptor (TRAIL-R), known for its effects on apoptosis, also regulates inflammation. In humans, the four homologues of TRAIL-R had never been investigated for effects on inflammation. Here, we examined whether TRAIL-R regulates inflammation during chlamydial infection. We examined TRAIL-R1 single nucleotide polymorphisms (SNPs) in an Ecuadorian cohort with and without C. trachomatis infections. There was a highly significant association for the TRAIL+626 homozygous mutant GG for infection vs no infection in this population. To confirm the results observed in the human population, primary lung fibroblasts and bone marrow-derived macrophages (BMDMs) were isolated from wildtype (WT) and TRAIL-R-deficient mice, and TRAIL-R1 levels in human cervical epithelial cells were depleted by RNA interference. Infection of BMDMs and primary lung fibroblasts with C. trachomatis strain L2, or the murine pathogen C. muridarum, led to higher levels of MIP2 mRNA expression or IL-1β secretion from TRAIL-R-deficient cells than WT cells. Similarly, depletion of TRAIL-R1 expression in human epithelial cells resulted in a higher level of IL-8 mRNA expression and protein secretion during C. trachomatis infection. We conclude that human TRAIL-R1 SNPs and murine TRAIL-R modulate the innate immune response against chlamydial infection. This is the first evidence that human TRAIL-R1 is a negative regulator of inflammation and plays a role in modulating Chlamydia pathogenesis.
Collapse
Affiliation(s)
- Mufadhal Al-Kuhlani
- Department of Molecular Cell Biology, and Health Sciences Research Institute, University of California Merced, Merced, California, United States of America
| | - James Rothchild
- Center for Immunobiology and Vaccine Development, Children's Hospital Oakland Research Institute, Oakland, California, United States of America
| | - Sukumar Pal
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine, California, United States of America
| | - Luis M. de la Maza
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine, California, United States of America
| | - Sander Ouburg
- Laboratory of Immunogenetics, Medical Microbiology and Infection Prevention, Research School V-ICI, VU University Medical Center, Amsterdam, The Netherlands
| | - Servaas A. Morré
- Laboratory of Immunogenetics, Medical Microbiology and Infection Prevention, Research School V-ICI, VU University Medical Center, Amsterdam, The Netherlands
- Institute of Public Health Genomics, Department of Genetics and Cell Biology, Research School GROW, University of Maastricht, Maastricht, The Netherlands
| | - Deborah Dean
- Center for Immunobiology and Vaccine Development, Children's Hospital Oakland Research Institute, Oakland, California, United States of America
- Graduate Program in Bioengineering, University of California, Berkeley and San Francisco, California, United States of America
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - David M. Ojcius
- Department of Molecular Cell Biology, and Health Sciences Research Institute, University of California Merced, Merced, California, United States of America
- * E-mail:
| |
Collapse
|
37
|
Verweij SP, Lanjouw E, Bax CJ, Quint KD, Oostvogel PM, Dörr PJ, Pleijster J, de Vries HJC, Peters RPH, Ouburg S, Morré SA. Serovar D and E of serogroup B induce highest serological responses in urogenital Chlamydia trachomatis infections. BMC Infect Dis 2014; 14:3. [PMID: 24383586 PMCID: PMC3893429 DOI: 10.1186/1471-2334-14-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 12/11/2013] [Indexed: 12/23/2022] Open
Abstract
Background Chlamydia trachomatis is the most prevalent bacterial sexually transmitted infection (STI) worldwide. A strong link between C. trachomatis serogroup/serovar and serological response has been suggested in a previous preliminary study. The aim of the current study was to confirm and strengthen those findings about serological IgG responses in relation to C. trachomatis serogroups and serovars. Methods The study population (n = 718) consisted of two patient groups with similar characteristics of Dutch STI clinic visitors. We performed genotyping of serovars and used titre based and quantitative commercially available ELISA kits (medac Diagnostika) to determine specific serum IgG levels. Optical density (OD) values generated by both tests were used to calculate the IgG titres (cut-off 1:50). Analyses were conducted stratified by gender. Results We observed very significant differences when comparing the median IgG titres of three serogroups, B, C and I: in women for B vs. C: p < 0.0001 (median titres B 200 vs. C <50); B vs. I: p < 0.0001 (200 vs. 50), and in men for B vs. C: p = 0.0006 (150 vs. <50); B vs. I: p = 0.0001 (150 vs. <50); C vs. I was not significant for both sexes. Serovars D and E of serogroup B had the highest median IgG titres compared to the other serovars in both men and women: 200 and 200 vs. ≤ 100 for women and 100 and 200 vs. ≤ 75 for men, respectively. Conclusions This study shows that B group serovars induce higher serological responses compared to the C and I group serovars in vivo in both men and women.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Servaas A Morré
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.
| |
Collapse
|
38
|
Schuurs TA, Verweij SP, Weel JFL, Ouburg S, Morré SA. Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in an STI population: performances of the Presto CT-NG assay, the Lightmix Kit 480 HT CT/NG and the COBAS Amplicor with urine specimens and urethral/cervicovaginal samples. BMJ Open 2013; 3:e003607. [PMID: 24381252 PMCID: PMC3884618 DOI: 10.1136/bmjopen-2013-003607] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study assessed the performances of the Presto CT-NG assay, the Lightmix Kit 480 HT CT/NG and the COBAS Amplicor for Chlamydia trachomatis and Neisseria gonorrhoeae detection. DESIGN A cross-sectional study design. SETTING Izore, Centre for Diagnosing Infectious Diseases in Friesland, the Netherlands, tested samples sent from regional sexually transmitted infection (STI) outpatient clinics and regional hospitals from the province Friesland, the Netherlands. PARTICIPANTS Samples were collected from 292 men and 835 women. These samples included 560 urine samples and 567 urethral/cervicovaginal samples. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure is C trachomatis infection. No secondary outcome measures are available. RESULTS The sensitivity, specificity, positive predicative value (PPV) and negative predictive value (NPV) for C trachomatis detection in urine samples using the Presto CT-NG assay were 100%, 99.8%, 98.1% and 100%, respectively; for the Lightmix Kit 480 HT CT/NG: 94.2%, 99.8%, 96.1% and 99.4%, respectively; for the COBAS Amplicor: 92.3%, 99.6%, 96% and 99.2%, respectively. The sensitivity, specificity, PPV and NPV for C trachomatis detection in urethral/cervicovaginal swabs using the Presto CT-NG assay and the COBAS Amplicor were 100%, 99.8%, 97.7% and 100%, respectively; for the Lightmix Kit 480 HT CT/NG: 100%, 99.6%, 97.7% and 100%, respectively. Calculations for N gonorrhoeae could not be made due to a low prevalence. CONCLUSIONS All three assays had a high sensitivity, specificity, PPV and NPV for C trachomatis, with best performance for the Presto CT-NG assay.
Collapse
Affiliation(s)
- T A Schuurs
- Izore, Centre for Infectious Diseases Friesland, Leeuwarden, The Netherlands
| | - S P Verweij
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - J F L Weel
- Izore, Centre for Infectious Diseases Friesland, Leeuwarden, The Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - S A Morré
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
- Faculty of Health, Medicine & Life Sciences, Department of Genetics and Cell Biology, Research Institute GROW, Institute of Public Health Genomics, University of Maastricht, Maastricht, The Netherlands
| |
Collapse
|
39
|
Sanders MS, de Jonge RCJ, Terwee CB, Heymans MW, Koomen I, Ouburg S, Spanjaard L, Morré SA, van Furth AM. Addition of host genetic variants in a prediction rule for post meningitis hearing loss in childhood: a model updating study. BMC Infect Dis 2013; 13:340. [PMID: 23879305 PMCID: PMC3726293 DOI: 10.1186/1471-2334-13-340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 07/16/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Sensorineural hearing loss is the most common sequela in survivors of bacterial meningitis (BM). In the past we developed a validated prediction model to identify children at risk for post-meningitis hearing loss. It is known that host genetic variations, besides clinical factors, contribute to severity and outcome of BM. In this study it was determined whether host genetic risk factors improve the predictive abilities of an existing model regarding hearing loss after childhood BM. METHODS Four hundred and seventy-one Dutch Caucasian childhood BM were genotyped for 11 single nucleotide polymorphisms (SNPs) in seven different genes involved in pathogen recognition. Genetic data were added to the original clinical prediction model and performance of new models was compared to the original model by likelihood ratio tests and the area under the curve (AUC) of the receiver operating characteristic curves. RESULTS Addition of TLR9-1237 SNPs and the combination of TLR2 + 2477 and TLR4 + 896 SNPs improved the clinical prediction model, but not significantly (increase of AUC's from 0.856 to 0.861 and from 0.856 to 0.875 (p = 0.570 and 0.335, respectively). Other SNPs analysed were not linked to hearing loss. CONCLUSIONS Although addition of genetic risk factors did not significantly improve the clinical prediction model for post-meningitis hearing loss, AUC's of the pre-existing model remain high after addition of genetic factors. Future studies should evaluate whether more combinations of SNPs in larger cohorts has an additional value to the existing prediction model for post meningitis hearing loss.
Collapse
Affiliation(s)
- Marieke S Sanders
- Department of Pediatric Infectious Diseases - Immunology, and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Smelov V, Novikov A, Brown LJ, Eklund C, Strokova L, Ouburg S, Morre SA, Dillner J. False-positive prostate cancer markers in a man with symptomatic urethral Chlamydia trachomatis infection. Int J STD AIDS 2013; 24:501-2. [DOI: 10.1177/0956462412472805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Summary Symptomatic male urethral Chlamydia trachomatis infection resulted in inflammation of the prostate, with associated increases in both prostate-specific (PSA) and prostate cancer-specific (PCA3) markers with prostate biopsies showing no evidence of malignancy.
Collapse
Affiliation(s)
- V Smelov
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Urology and Andrology, North-Western State Medical University named after I.I. Mechnikov, St Petersburg, Russia
| | - A Novikov
- Department of Urology and Andrology, North-Western State Medical University named after I.I. Mechnikov, St Petersburg, Russia
| | | | - C Eklund
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - L Strokova
- Department of Urology and Andrology, North-Western State Medical University named after I.I. Mechnikov, St Petersburg, Russia
| | - S Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam
| | - S A Morre
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam
- Institute of Public Health Genomics, Department of Genetics and Cell Biology, Research Institutes CAPHRI (School for Public Health and Primary Care) and GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - J Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
41
|
Waaij DJD, Dubbink J, Eem LVD, Bos MLA, Ouburg S, Lewis DA, Struthers H, McIntyre JA, Morré SA, Peters RPH. P3.011 Dry Swab Evaluation by Roche 4800 CT/NG and the Presto-Plus: Cross-Sectional Study of Genital, Rectal and Pharyngeal Chlamydia and Gonorrhoea Infection in Women in Rural South Africa. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
42
|
Verweij SP, Lanjouw E, Bax CJ, Oostvogel PM, Dörr JP, Pleijster J, Vries HJCD, Peters RPH, Ouburg S, Morré SA. P1.004 Serovar D and E of Serogroup B Induce Highest Serological Responses in Urogenital Chlamydia Trachomatis Infections. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
43
|
Lal JA, Malogajski J, Verweij SP, de Boer P, Ambrosino E, Brand A, Ouburg S, Morré SA. Chlamydia trachomatis infections and subfertility: opportunities to translate host pathogen genomic data into public health. Public Health Genomics 2013; 16:50-61. [PMID: 23548718 DOI: 10.1159/000346207] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Chlamydia trachomatis (CT) infections in women can result in tubal pathology (TP). Worldwide 10-15% of all couples are subfertile, meaning they did not get pregnant after 1 year. Part of the routine subfertility diagnostics is the Chlamydia Antibody Test (CAT) to decide for laparoscopy or not in order to diagnose TP. The CAT positive and negative predictive value is such that many unneeded laparoscopies are done and many TP cases are missed. Addition of host genetic markers related to infection susceptibility and severity could potentially improve the clinical management of couples who suffer from subfertility. In the present study, the potential translational and clinical value of adding diagnostic host genetic marker profiles on the basis of infection and inflammation to the current clinical management of subfertility was investigated. This review provides an overview of the current state of the art of host genetic markers in relation to CT infection, proposes a new clinical diagnostic approach, and investigates how the Learning-Adapting-Leveling model (LAL, a public health genomic (PHG) model) can be of value and provide insight to see whether these host genetic markers can be translated into public health. This review shows that the preliminary basis of adding host genetic marker profiles to the current diagnostic procedures of subfertility is present but has to be further developed before implementation into health care can be achieved. CT infection is an example in the field of PHG with potential diagnostic to be taken up in the future in the field of subfertility diagnosis with a time line for integration to be dependent on enhanced participation of many stakeholders in the field of PHG which could be advanced through the LAL model.
Collapse
Affiliation(s)
- J A Lal
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Jiang J, Karimi O, Ouburg S, Champion CI, Khurana A, Liu G, Freed A, Pleijster J, Rozengurt N, Land JA, Surcel HM, Tiitinen A, Paavonen J, Kronenberg M, Morré SA, Kelly KA. Interruption of CXCL13-CXCR5 axis increases upper genital tract pathology and activation of NKT cells following chlamydial genital infection. PLoS One 2012; 7:e47487. [PMID: 23189125 PMCID: PMC3506621 DOI: 10.1371/journal.pone.0047487] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 09/12/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Regulation of immune responses is critical for controlling inflammation and disruption of this process can lead to tissue damage. We reported that CXCL13 was induced in fallopian tube tissue following C. trachomatis infection. Here, we examined the influence of the CXCL13-CXCR5 axis in chlamydial genital infection. METHODOLOGY AND PRINCIPAL FINDINGS Disruption of the CXCL13-CXCR5 axis by injecting anti-CXCL13 Ab to BALB/c mice or using Cxcr5-/- mice increased chronic inflammation in the upper genital tract (UGT; uterine horns and oviducts) after Chlamydia muridarum genital infection (GT). Further studies in Cxcr5-/- mice showed an elevation in bacterial burden in the GT and increased numbers of neutrophils, activated DCs and activated NKT cells early after infection. After resolution, we noted increased fibrosis and the accumulation of a variety of T cells subsets (CD4-IFNγ, CD4-IL-17, CD4-IL-10 & CD8-TNFα) in the oviducts. NKT cell depletion in vitro reduced IL-17α and various cytokines and chemokines, suggesting that activated NKT cells modulate neutrophils and DCs through cytokine/chemokine secretion. Further, chlamydial glycolipids directly activated two distinct types of NKT cell hybridomas in a cell-free CD1d presentation assay and genital infection of Cd1d-/- mice showed reduced oviduct inflammation compared to WT mice. CXCR5 involvement in pathology was also noted using single-nucleotide polymorphism analysis in C. trachomatis infected women attending a sub-fertility clinic. Women who developed tubal pathology after a C. trachomatis infection had a decrease in the frequency of CXCR5 SNP +10950 T>C (rs3922). CONCLUSIONS/SIGNIFICANCE These experiments indicate that disruption of the CXCL13-CXCR5 axis permits increased activation of NKT cells by type I and type II glycolipids of Chlamydia muridarum and results in UGT pathology potentially through increased numbers of neutrophils and T cell subsets associated with UGT pathology. In addition, CXCR5 appears to contribute to inter-individual differences in human tubal pathology following C. trachomatis infection.
Collapse
Affiliation(s)
- Janina Jiang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Ouafae Karimi
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - Cheryl I. Champion
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Archana Khurana
- La Jolla Institute for Allergy and Immunology, La Jolla, California, United States of America
| | - Guangchao Liu
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Amanda Freed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Jolein Pleijster
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Nora Rozengurt
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- CURE DDRC Morphology and Images Core, University of California Los Angeles, Los Angeles, California, United States of America
| | - Jolande A. Land
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Helja-Marja Surcel
- National Institute for Health and Welfare, Kastelli Research Centre, Oulu, Finland
| | - Aila' Tiitinen
- Department of Obstetrics and Gynecology, University Hospital, University of Helsinki, Helsinki, Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, University Hospital, University of Helsinki, Helsinki, Finland
| | - Mitchell Kronenberg
- La Jolla Institute for Allergy and Immunology, La Jolla, California, United States of America
| | - Servaas A. Morré
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
- Institute of Public Health Genomics, Department of Genetics and Cell Biology, Research Institutes, School of Public Health and Primary Care (CAPHRI) and Growth and Development (GROW), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Kathleen A. Kelly
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- California NanoSystems, University of California Los Angeles, Los Angeles, California, United States of America
| |
Collapse
|
45
|
van Well GTJ, Sanders MS, Ouburg S, van Furth AM, Morré SA. Polymorphisms in Toll-like receptors 2, 4, and 9 are highly associated with hearing loss in survivors of bacterial meningitis. PLoS One 2012; 7:e35837. [PMID: 22662111 PMCID: PMC3360733 DOI: 10.1371/journal.pone.0035837] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 03/23/2012] [Indexed: 12/20/2022] Open
Abstract
Genetic variation in innate immune response genes contributes to inter-individual differences in disease manifestation and degree of complications upon infection. We recently described an association of single nucleotide polymorphisms (SNPs) in TLR9 with susceptibility to meningococcal meningitis (MM). In this study, we investigate the association of SNPs in multiple pathogen recognition and immune response genes with clinical features that determine severity and outcome (especially hearing loss) of childhood MM and pneumococcal meningitis (PM). Eleven SNPs in seven genes (TLR2, TLR4, TLR9, NOD1, NOD2, CASP1, and TRAIL) were genotyped in 393 survivors of childhood bacterial meningitis (BM) (327 MM patients and 66 PM patients). Genotype distributions of single SNPs and combination of SNPs were compared between thirteen clinical characteristics associated with severity of BM. After correction for multiple testing, TLR4+896 mutant alleles were highly associated with post-meningitis hearing loss, especially MM (p= 0.001, OR 4.0 for BM, p= 0.0004, OR 6.2 for MM). In a multigene analysis, combined carriership of the TLR2+2477 wild type (WT) with TLR4+896 mutant alleles increases the risk of hearing loss (p<0.0001, OR 5.7 in BM and p= 0.0001, OR 7.6 in MM). Carriage of one or both mutant alleles in TLR4+896 and TLR9 -1237 increases the risk for hearing loss (p = 0.0006, OR 4.1 in BM). SNPs in immune response genes contribute to differences in clinical severity and outcome of BM. The TLR system seems to play an important role in the immune response to BM and subsequent neuronal damage as well as in cochlear inflammation. Genetic markers may be used for identification of high-risk patients by creating prediction rules for post-meningitis hearing loss and other sequelae, and provide more insight in the complex immune response in the CNS possibly resulting in new therapeutic interventions.
Collapse
Affiliation(s)
- Gijs Th J. van Well
- Department of Pediatric Infectious Diseases, Immunology and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marieke S. Sanders
- Department of Pediatric Infectious Diseases, Immunology and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
- Laboratory of Immunogenetics, Department of Medical Microbiology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Surgery, Antonius Hospital, Nieuwegein, The Netherlands
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology, VU University Medical Center, Amsterdam, The Netherlands
| | - A. Marceline van Furth
- Department of Pediatric Infectious Diseases, Immunology and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Servaas A. Morré
- Laboratory of Immunogenetics, Department of Medical Microbiology, VU University Medical Center, Amsterdam, The Netherlands
- Institute of Public Health Genomics, Department of Genetics and Cell Biology, Research Institutes CAPHRI (School for Public Health and Primary Care) and GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| |
Collapse
|
46
|
Sanders MS, van Well GTJ, Ouburg S, Morré SA, van Furth AM. Toll-like receptor 9 polymorphisms are associated with severity variables in a cohort of meningococcal meningitis survivors. BMC Infect Dis 2012; 12:112. [PMID: 22577991 PMCID: PMC3443431 DOI: 10.1186/1471-2334-12-112] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 05/11/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Genetic variation in immune response genes is associated with susceptibility and severity of infectious diseases. Toll-like receptor (TLR) 9 polymorphisms are associated with susceptibility to develop meningococcal meningitis (MM). The aim of this study is to compare genotype distributions of two TLR9 polymorphisms between clinical severity variables in MM survivors. METHODS We used DNA samples of a cohort of 390 children who survived MM. Next, we determined the genotype frequencies of TLR9 -1237 and TLR9 +2848 polymorphisms and compared these between thirteen clinical variables associated with prognostic factors predicting adverse outcome of bacterial meningitis in children. RESULTS The TLR9 -1237 TC and CC genotypes were associated with a decreased incidence of a positive blood culture for Neisseria (N.) meningitidis (p = 0.014, odds ratio (OR) 0.5. 95% confidence interval (CI) 0.3 - 0.9). The TLR9 +2848 AA mutant was associated with a decreased incidence of a positive blood culture for N. meningitidis (p = 0.017, OR 0.6, 95% CI 0.3 - 0.9). Cerebrospinal fluid (CSF) leukocytes per μL were higher in patients carrying the TLR9 -1237 TC or CC genotypes compared to carriers of the TT wild type (WT) (p = 0.024, medians: 2117, interquartile range (IQR) 4987 versus 955, IQR 3938). CSF blood/glucose ratios were lower in TLR9 -1237 TC or CC carriers than in carriers of the TT WT (p = 0.017, medians: 0.20, IQR 0.4 versus 0.35, IQR 0.5). CSF leukocytes/μL were higher in patients carrying the TLR9 +2848 AA mutant compared to carriers of GG or GA (p = 0.0067, medians: 1907, IQR 5221 versus 891, IQR 3952). CONCLUSIONS We identified TLR9 genotypes associated with protection against meningococcemia and enhanced local inflammatory responses inside the central nervous system, important steps in MM pathogenesis and defense.
Collapse
Affiliation(s)
- Marieke S Sanders
- Laboratory for Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, 1007 MB, The Netherlands
- Department of Pediatric Infectious Diseases, Immunology and Rheumatology, VU University Medical Center, Amsterdam, 1007 MB, The Netherlands
- Department in Surgery, Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Gijs TJ van Well
- Department of Pediatric Infectious Diseases, Immunology and Rheumatology, VU University Medical Center, Amsterdam, 1007 MB, The Netherlands
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), Maastricht, 6202 AZ, The Netherlands
| | - Sander Ouburg
- Laboratory for Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, 1007 MB, The Netherlands
| | - Servaas A Morré
- Laboratory for Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, 1007 MB, The Netherlands
| | - A Marceline van Furth
- Department of Pediatric Infectious Diseases, Immunology and Rheumatology, VU University Medical Center, Amsterdam, 1007 MB, The Netherlands
| |
Collapse
|
47
|
Verweij SP, Ouburg S, de Vries H, Morré SA, van Ginkel CJW, Bos H, Sebens FW. The first case record of a female patient with bubonic lymphogranuloma venereum (LGV), serovariant L2b. Sex Transm Infect 2012; 88:346-7. [DOI: 10.1136/sextrans-2011-050298] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
48
|
Verweij SP, Catsburg A, Ouburg S, Lombardi A, Heijmans R, Dutly F, Frei R, Morré SA, Goldenberger D. Lymphogranuloma venereum variant L2b-specific polymerase chain reaction: insertion used to close an epidemiological gap. Clin Microbiol Infect 2011; 17:1727-30. [PMID: 21895856 DOI: 10.1111/j.1469-0691.2011.03481.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The management of the ongoing lymphogranuloma venereum epidemic in industrialized Western countries caused by Chlamydia trachomatis variant L2b still needs improvements in diagnosis, therapy and prevention. We therefore developed the first rapid C. trachomatis variant L2b-specific polymerase chain reaction to circumvent laborious ompA gene sequencing.
Collapse
Affiliation(s)
- S P Verweij
- Laboratory of Immunogenetics, Department of Pathology, University Hospital L. Sacco, Milano, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Bax CJ, Quint KD, Peters RPH, Ouburg S, Oostvogel PM, Mutsaers JAEM, Dörr PJ, Schmidt S, Jansen C, van Leeuwen AP, Quint WGV, Trimbos JB, Meijer CJLM, Morré SA. Analyses of multiple-site and concurrent Chlamydia trachomatis serovar infections, and serovar tissue tropism for urogenital versus rectal specimens in male and female patients. Sex Transm Infect 2011; 87:503-7. [PMID: 21856696 DOI: 10.1136/sti.2010.048173] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aims of this study were: to determine the incidence of concurrent infections on a serovar level; to determine the incidence of multiple anatomical infected sites on a detection and genotyping level and analyse site-specific serovar distribution; to identify tissue tropism in urogenital versus rectal specimens. METHODS Chlamydia trachomatis-infected patients in two populations were analysed: 75 visiting the outpatient department of obstetrics and gynaecology of the MC Haaglanden, and 358 visiting the outpatient sexually transmitted disease clinic, The Hague, The Netherlands. The PACE 2 assay (Gen-Probe) was used to detect C trachomatis from urethral, cervical, vaginal, oropharyngeal and anorectal swabs. C trachomatis genotyping was performed on all C trachomatis positive samples, using the CT-DT genotyping assay. RESULTS Samples from 433 patients (256 female and 177 male) with confirmed C trachomatis infection were analysed. In 11 patients (2.6%), concurrent serovars in one anatomical sample site were present. In 62 (34.1%) female and four (9.3%) male patients, multiple sample site infections were found. A substantial percentage of women tested at the cervical/vaginal and rectal site were found to be positive at both sites (36.1%, 22/61). In men, D/Da and G/Ga serovars were more prevalent in rectal than urogenital specimens (p=0.0081 and p=0.0033, respectively), while serovar E was more prevalent in urogenital specimens (p=0.0012). CONCLUSIONS The prevalence of multiple serovar infections is relatively low. Significant differences in serovar distribution are found in rectal specimens from men, with serovar G/Ga being the most prominent, suggesting tissue tropism.
Collapse
Affiliation(s)
- C J Bax
- Department of Obstetrics and Gynaecology, MC Haaglanden, The Hague, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Peters RPH, Verweij SP, Nijsten N, Ouburg S, Mutsaers J, Jansen CL, van Leeuwen AP, Morré SA. Evaluation of sexual history-based screening of anatomic sites for chlamydia trachomatis and neisseria gonorrhoeae infection in men having sex with men in routine practice. BMC Infect Dis 2011; 11:203. [PMID: 21791061 PMCID: PMC3162902 DOI: 10.1186/1471-2334-11-203] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 07/26/2011] [Indexed: 11/28/2022] Open
Abstract
Background Sexually transmitted infection (STI) screening programmes are implemented in many countries to decrease burden of STI and to improve sexual health. Screening for Chlamydia trachomatis and Neisseria gonorrhoeae has a prominent role in these protocols. Most of the screening programmes concerning men having sex with men (MSM) are based on opportunistic urethral testing. In The Netherlands, a history-based approach is used. The aim of this study is to evaluate the protocol of screening anatomic sites for C. trachomatis and N. gonorrhoeae infection based on sexual history in MSM in routine practice in The Netherlands. Methods All MSM visiting the clinic for STI in The Hague are routinely asked about their sexual practice during consulting. As per protocol, tests for urogenital, oropharyngeal and anorectal infection are obtained based on reported site(s) of sexual contact. All consultations are entered into a database as part of the national STI monitoring system. Data of an 18 months period were retrieved from this database and analysed. Results A total of 1455 consultations in MSM were registered during the study period. The prevalence of C. trachomatis and N. gonorrhoeae per anatomic site was: urethral infection 4.0% respectively and 2.8%, oropharynx 1.5% and 4.2%, and anorectum 8.2% and 6.0%. The majority of chlamydia cases (72%) involved a single anatomic site, which was especially manifest for anorectal infections (79%), while 42% of gonorrhoea cases were single site. Twenty-six percent of MSM with anorectal chlamydia and 17% with anorectal gonorrhoea reported symptoms of proctitis; none of the oropharyngeal infections were symptomatic. Most cases of anorectal infection (83%) and oropharyngeal infection (100%) would have remained undiagnosed with a symptom-based protocol. Conclusions The current strategy of sexual-history based screening of multiple anatomic sites for chlamydia and gonorrhoea in MSM is a useful and valid guideline which is to be preferred over a symptom-based screening protocol.
Collapse
Affiliation(s)
- Remco P H Peters
- The Hague Municipal Health Services, STI clinic, The Hague, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|