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Sanz MB, Pasteran F, de Mendieta JM, Brunetti F, Albornoz E, Rapoport M, Lucero C, Errecalde L, Nuñez MR, Monge R, Pennini M, Power P, Corso A, Gomez SA. KPC-2 allelic variants in Klebsiella pneumoniae isolates resistant to ceftazidime-avibactam from Argentina: blaKPC-80, blaKPC-81, blaKPC-96 and blaKPC-97. Microbiol Spectr 2024; 12:e0411123. [PMID: 38319084 PMCID: PMC10913460 DOI: 10.1128/spectrum.04111-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024] Open
Abstract
Ceftazidime-avibactam (CZA) therapy has significantly improved survival rates for patients infected by carbapenem-resistant bacteria, including KPC producers. However, resistance to CZA is a growing concern, attributed to multiple mechanisms. In this study, we characterized four clinical CZA-resistant Klebsiella pneumoniae isolates obtained between July 2019 and December 2020. These isolates expressed novel allelic variants of blaKPC-2 resulting from changes in hotspots of the mature protein, particularly in loops surrounding the active site of KPC. Notably, KPC-80 had an K269_D270insPNK mutation near the Lys270-loop, KPC-81 had a del_I173 mutation within the Ω-loop, KPC-96 showed a Y241N substitution within the Val240-loop and KPC-97 had an V277_I278insNSEAV mutation within the Lys270-loop. Three of the four isolates exhibited low-level resistance to imipenem (4 µg/mL), while all remained susceptible to meropenem. Avibactam and relebactam effectively restored carbapenem susceptibility in resistant isolates. Cloning mutant blaKPC genes into pMBLe increased imipenem MICs in recipient Escherichia coli TOP10 for blaKPC-80, blaKPC-96, and blaKPC-97 by two dilutions; again, these MICs were restored by avibactam and relebactam. Frameshift mutations disrupted ompK35 in three isolates. Additional resistance genes, including blaTEM-1, blaOXA-18 and blaOXA-1, were also identified. Interestingly, three isolates belonged to clonal complex 11 (ST258 and ST11) and one to ST629. This study highlights the emergence of CZA resistance including unique allelic variants of blaKPC-2 and impermeability. Comprehensive epidemiological surveillance and in-depth molecular studies are imperative for understanding and monitoring these complex resistance mechanisms, crucial for effective antimicrobial treatment strategies. IMPORTANCE The emergence of ceftazidime-avibactam (CZA) resistance poses a significant threat to the efficacy of this life-saving therapy against carbapenem-resistant bacteria, particularly Klebsiella pneumoniae-producing KPC enzymes. This study investigates four clinical isolates exhibiting resistance to CZA, revealing novel allelic variants of the key resistance gene, blaKPC-2. The mutations identified in hotspots surrounding the active site of KPC, such as K269_D270insPNK, del_I173, Y241N and V277_I278insNSEAV, prove the adaptability of these pathogens. Intriguingly, low-level resistance to imipenem and disruptions in porin genes were observed, emphasizing the complexity of the resistance mechanisms. Interestingly, three of four isolates belonged to clonal complex 11. This research not only sheds light on the clinical significance of CZA resistance but also shows the urgency for comprehensive surveillance and molecular studies to inform effective antimicrobial treatment strategies in the face of evolving bacterial resistance.
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Affiliation(s)
- María Belén Sanz
- National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR)-INEI-ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina
| | - Fernando Pasteran
- National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR)-INEI-ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina
| | - Juan Manuel de Mendieta
- National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR)-INEI-ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina
| | - Florencia Brunetti
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Ezequiel Albornoz
- National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR)-INEI-ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina
| | - Melina Rapoport
- National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR)-INEI-ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina
| | - Celeste Lucero
- National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR)-INEI-ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina
| | | | - Maria Rosa Nuñez
- Hospital Provincial Neuquén Dr. Castro Rendón, Neuquén, Argentina
| | | | | | - Pablo Power
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Alejandra Corso
- National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR)-INEI-ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina
| | - Sonia A. Gomez
- National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR)-INEI-ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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De Belder D, Martino F, Tijet N, Melano RG, Faccone D, De Mendieta JM, Rapoport M, Albornoz E, Petroni A, Tuduri E, Derdoy L, Cogut S, Errecalde L, Pasteran F, Corso A, Gomez SA. Co-integrate Col3m bla NDM-1-harboring plasmids in clinical Providencia rettgeri isolates from Argentina. Microbiol Spectr 2023; 11:e0165123. [PMID: 37732774 PMCID: PMC10581215 DOI: 10.1128/spectrum.01651-23] [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: 05/02/2023] [Accepted: 08/01/2023] [Indexed: 09/22/2023] Open
Abstract
The first cases of bla NDM in Argentina were detected in three Providencia rettgeri (Pre) recovered from two hospitals in Buenos Aires city in 2013. The isolates were genetically related, but the plasmid profile was different. Here, we characterized the bla NDM-1-harboring plasmids of the first three cases detected in Argentina. Hybrid assembly obtained from short- and long-read sequencing rendered bla NDM-1 in Col3M plasmids of ca. 320 kb (p15268A_320) in isolate PreM15268, 210 kb (p15758B_210) in PreM15758, and 225 kb (p15973A_225) in PreM15973. In addition, PreM15758 harbored a 98-kb circular plasmid (p15758C_98) flanked by a putative recombination site (hin-TnAs2), with 100% nucleotide ID and coverage with p15628A_320. Analysis of PFGE/S1-nuclease gel, Southern hybridization with bla NDM-1 probe, hybrid assembly of short and long reads suggests that pM15758C_98 can integrate by homologous recombination. The three bla NDM-1-plasmids were non-conjugative in vitro. Moreover, tra genes were incomplete, and oriT was not found in the three bla NDM-1-plasmids. In two isolates, blaNDM-1 was embedded in a partially conserved structure flanked by two ISKox2. In addition, all plasmids harbored aph(3')-Ia, aph(3')-VI, and qnrD1 genes and aac(6´)Ib-cr, bla OXA-1, catB3, and arr3 as part of a class 1 integron. Also, p15268A_320 and p15973A_225 harbored bla PER-2. To the best of our knowledge, this is the first report of clinical P. rettgeri harboring blaNDM-1 in an atypical genetic environment and located in unusual chimeric Col3M plasmids. The study and continuous surveillance of these pathogens are crucial to tracking the evolution of these resistant plasmids and finding solutions to tackle their dissemination. IMPORTANCE Infections caused by carbapenem hydrolyzing enzymes like NDM (New Delhi metallo-beta-lactamase) represent a serious problem worldwide because they restrict available treatment options and increase morbidity and mortality, and treatment failure prolongs hospital stays. The first three cases of NDM in Argentina were caused by genetically related P. rettgeri recovered in two hospitals. In this work, we studied the genetic structure of the plasmids encoding bla NDM in those index cases and revealed the enormous plasticity of these genetic elements. In particular, we found a small plasmid that was also found inserted in the larger plasmids by homologous recombination as a co-integrate element. We also found that the bla NDM plasmids were not able to transfer or move to other hosts, suggesting their role as reservoir elements for the acquisition of resistance genes. It is necessary to unravel the dissemination strategies and the evolution of these resistant plasmids to find solutions to tackle their spread.
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Affiliation(s)
- Denise De Belder
- Antimicrobial Agents Division, National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), National Institute of Infectious Diseases–ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
- National Council on Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | - Florencia Martino
- Antimicrobial Agents Division, National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), National Institute of Infectious Diseases–ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
| | - Nathalie Tijet
- Public Health Ontario Laboratory, Toronto, Ontario, Canada
| | - Roberto G. Melano
- Public Health Ontario Laboratory, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Diego Faccone
- Antimicrobial Agents Division, National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), National Institute of Infectious Diseases–ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
- National Council on Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | - Juan Manuel De Mendieta
- Antimicrobial Agents Division, National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), National Institute of Infectious Diseases–ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
| | - Melina Rapoport
- Antimicrobial Agents Division, National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), National Institute of Infectious Diseases–ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
| | - Ezequiel Albornoz
- Antimicrobial Agents Division, National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), National Institute of Infectious Diseases–ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
| | - Alejandro Petroni
- Antimicrobial Agents Division, National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), National Institute of Infectious Diseases–ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
| | - Ezequiel Tuduri
- Antimicrobial Agents Division, National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), National Institute of Infectious Diseases–ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
| | - Laura Derdoy
- Hospital General de Agudos José María Ramos Mejía, Buenos Aires, Argentina
| | - Sandra Cogut
- Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires, Argentina
| | - Laura Errecalde
- Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires, Argentina
| | - Fernando Pasteran
- Antimicrobial Agents Division, National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), National Institute of Infectious Diseases–ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
| | - Alejandra Corso
- Antimicrobial Agents Division, National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), National Institute of Infectious Diseases–ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
| | - Sonia A. Gomez
- Antimicrobial Agents Division, National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), National Institute of Infectious Diseases–ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
- National Council on Scientific and Technical Research (CONICET), Buenos Aires, Argentina
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Gomez SA, Sanz MB, Rapoport M, Sucin G, Corallo TA, Poklepovich T, Campos J, Ceriana P, de Mendieta JM, Prieto M, Pasteran F, Corso A. Novel Metallo-β-Lactamase blaCVI-1 Isolated from a Chromobaterium violaceum Clinical Strain Resistant to Colistin. Pathogens 2023; 12:961. [PMID: 37513808 PMCID: PMC10385785 DOI: 10.3390/pathogens12070961] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/13/2023] [Revised: 07/08/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE We aimed to describe a colistin (COL)-resistant (R) Chromobacterium violaceum (Cvi) isolate from a septic patient in Argentina expressing a previously unknown gene, blaCVI-1. METHODS In 2019, a 12 year old child was injured with a thorn in a lagoon. The child was hospitalized due to sepsis and multiple abscesses. Cvi was isolated from skin and soft tissue and tracheal aspirate. The patient was successfully treated with imipenem (IMI) plus amikacin. Antimicrobial susceptibility was assessed by disk diffusion, broth microdilution, and the E-test. Carbapenemase activity was assayed by double-disk synergy and microbiological tests. Resistance, virulence, and additional gene searches were performed by in silico analysis of sequences obtained by whole-genome sequencing (WGS). A maximum likelihood phylogenetic tree was built with public Cvi genomes. RESULTS R was seen for IMI and COL. Expression of a metallo-β-lactamase was confirmed. Genome analysis revealed blaCVI-1, a subclass B2 metallo-β-lactamase with 62.66% ID with CphA from A. hydrophila (WP081086394). R to COL could be attributed to the arnC and arnT genes. Virulence factors required for invasion and toxicity were also found. No plasmids were detected. The phylogeny tree showed two main clades with geographical distinction, and the isolate studied here stands alone in a branch closely related to two clinical isolates from the USA. CONCLUSIONS This is the second report of infection by Cvi in Argentina. This pathogen carried a new gene, blaCVI-1, a metallo-β-lactamase that can be detected by routine methods. Prompt suspicion of C. violaceum infection is crucial to treating this rare pathogen rapidly and properly.
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Affiliation(s)
- Sonia A Gomez
- Servicio Antimicrobianos, INEI-ANLIS "Dr. Carlos G. Malbrán", National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), Buenos Aires C1282AFF, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires C1425FQB, Argentina
| | - María Belén Sanz
- Servicio Antimicrobianos, INEI-ANLIS "Dr. Carlos G. Malbrán", National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), Buenos Aires C1282AFF, Argentina
| | - Melina Rapoport
- Servicio Antimicrobianos, INEI-ANLIS "Dr. Carlos G. Malbrán", National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), Buenos Aires C1282AFF, Argentina
| | - Graciela Sucin
- Sector de Bacteriología, Hosp. Pediátrico "Dr. Avelino Castelán", Resistencia H3508, Argentina
| | - Teresa A Corallo
- Sector de Bacteriología, Hosp. Pediátrico "Dr. Avelino Castelán", Resistencia H3508, Argentina
| | - Tomás Poklepovich
- Plataforma de Genómica y Bioinformática, INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires CP1281, Argentina
| | - Josefina Campos
- Plataforma de Genómica y Bioinformática, INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires CP1281, Argentina
| | - Paola Ceriana
- Servicio Antimicrobianos, INEI-ANLIS "Dr. Carlos G. Malbrán", National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), Buenos Aires C1282AFF, Argentina
| | - Juan Manuel de Mendieta
- Servicio Antimicrobianos, INEI-ANLIS "Dr. Carlos G. Malbrán", National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), Buenos Aires C1282AFF, Argentina
| | - Mónica Prieto
- Servicio Bacteriología Especial INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires CP1281, Argentina
| | - Fernando Pasteran
- Servicio Antimicrobianos, INEI-ANLIS "Dr. Carlos G. Malbrán", National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), Buenos Aires C1282AFF, Argentina
| | - Alejandra Corso
- Servicio Antimicrobianos, INEI-ANLIS "Dr. Carlos G. Malbrán", National and Regional Reference Laboratory in Antimicrobial Resistance (NRRLAR), Buenos Aires C1282AFF, Argentina
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Faccone D, Gomez SA, de Mendieta JM, Sanz MB, Echegorry M, Albornoz E, Lucero C, Ceriana P, Menocal A, Martino F, De Belder D, Corso A, Pasterán F. Emergence of Hyper-Epidemic Clones of Enterobacterales Clinical Isolates Co-Producing KPC and Metallo-Beta-Lactamases during the COVID-19 Pandemic. Pathogens 2023; 12:pathogens12030479. [PMID: 36986401 PMCID: PMC10052147 DOI: 10.3390/pathogens12030479] [Citation(s) in RCA: 3] [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] [Received: 02/23/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The global spread of carbapenemase-producing Enterobacterales has become an epidemiological risk for healthcare systems by limiting available antimicrobial treatments. The COVID-19 pandemic worsened this scenario, prompting the emergence of extremely resistant microorganisms. METHODS Between March 2020 and September 2021, the NRL confirmed 82 clinical Enterobacterales isolates harboring a combination of blaKPC and MBL genes. Molecular typing was analyzed by PFGE and MLST. Modified double-disk synergy (MDDS) tests were used for phenotypic studies. RESULTS Isolates were submitted from 28 hospitals located in seven provinces and Buenos Aires City, including 77 K. pneumoniae, 2 K. oxytoca, 2 C. freundii, and 1 E. coli. Almost half of K. pneumoniae isolates (n = 38; 49.4%), detected in 15 hospitals, belong to the CC307 clone. CC11 was the second clone, including 29 (37.7%) isolates (22, ST11 and 7, ST258) from five cities and 12 hospitals. Three isolates belonging to CC45 were also detected. The carbapenemase combinations observed were as follows: 55% blaKPC-2 plus blaNDM-5; 32.5% blaKPC-2 plus blaNDM-1; 5% blaKPC-3 plus blaNDM-1; 5% blaKPC-2 plus blaIMP-8; and 2.5% strain with blaKPC-2 plus blaNDM-5 plus blaOXA-163. Aztreonam/avibactam and aztreonam/relebactam were the most active combinations (100% and 91% susceptible, respectively), followed by fosfomycin (89%) and tigecycline (84%). CONCLUSIONS The MDDS tests using ceftazidime-avibactam/EDTA and aztreonam/boronic acid disks improved phenotypic classification as dual producers. The successful high-risk clones of K. pneumoniae, such as hyper-epidemic CC307 and CC11 clones, drove the dissemination of double carbapenemase-producing isolates during the COVID-19 pandemic.
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Affiliation(s)
- Diego Faccone
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz, Buenos Aires City 2290 (C1425FQB), Argentina
| | - Sonia A Gomez
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz, Buenos Aires City 2290 (C1425FQB), Argentina
| | - Juan Manuel de Mendieta
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - María Belén Sanz
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - Mariano Echegorry
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - Ezequiel Albornoz
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - Celeste Lucero
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - Paola Ceriana
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - Alejandra Menocal
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - Florencia Martino
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz, Buenos Aires City 2290 (C1425FQB), Argentina
| | - Denise De Belder
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - Alejandra Corso
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - Fernando Pasterán
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
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5
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Sanz MB, De Belder D, de Mendieta JM, Faccone D, Poklepovich T, Lucero C, Rapoport M, Campos J, Tuduri E, Saavedra MO, Van der Ploeg C, Rogé A, Pasteran F, Corso A, Rosato AE, Gomez SA. Carbapenemase-Producing Extraintestinal Pathogenic Escherichia coli From Argentina: Clonal Diversity and Predominance of Hyperepidemic Clones CC10 and CC131. Front Microbiol 2022; 13:830209. [PMID: 35369469 PMCID: PMC8971848 DOI: 10.3389/fmicb.2022.830209] [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: 12/06/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Extraintestinal pathogenic Escherichia coli (ExPEC) causes infections outside the intestine. Particular ExPEC clones, such as clonal complex (CC)/sequence type (ST)131, have been known to sequentially accumulate antimicrobial resistance that starts with chromosomal mutations against fluoroquinolones, followed with the acquisition of blaCTX–M–15 and, more recently, carbapenemases. Here we aimed to investigate the distribution of global epidemic clones of carbapenemase-producing ExPEC from Argentina in representative clinical isolates recovered between July 2008 and March 2017. Carbapenemase-producing ExPEC (n = 160) were referred to the Argentinean reference laboratory. Of these, 71 were selected for genome sequencing. Phenotypic and microbiological studies confirmed the presence of carbapenemases confirmed as KPC-2 (n = 52), NDM-1 (n = 16), IMP-8 (n = 2), and VIM-1 (n = 1) producers. The isolates had been recovered mainly from urine, blood, and abdominal fluids among others, and some were from screening samples. After analyzing the virulence gene content, 76% of the isolates were considered ExPEC, although non-ExPEC isolates were also obtained from extraintestinal sites. Pan-genome phylogeny and clonal analysis showed great clonal diversity, although the first phylogroup in abundance was phylogroup A, harboring CC10 isolates, followed by phylogroup B2 with CC/ST131, mostly H30Rx, the subclone co-producing CTX-M-15. Phylogroups D, B1, C, F, and E were also detected with fewer strains. CC10 and CC/ST131 were found throughout the country. In addition, CC10 nucleated most metalloenzymes, such as NDM-1. Other relevant international clones were identified, such as CC/ST38, CC155, CC14/ST1193, and CC23. Two isolates co-produced KPC-2 and OXA-163 or OXA-439, a point mutation variant of OXA-163, and three isolates co-produced MCR-1 among other resistance genes. To conclude, in this work, we described the molecular epidemiology of carbapenemase-producing ExPEC in Argentina. Further studies are necessary to determine the plasmid families disseminating carbapenemases in ExPEC in this region.
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Affiliation(s)
- María Belén Sanz
- Servicio Antimicrobianos, Laboratorio Nacional de Referencia en Resistencia a los Antimicrobianos (LNRRA), INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Denise De Belder
- Servicio Antimicrobianos, Laboratorio Nacional de Referencia en Resistencia a los Antimicrobianos (LNRRA), INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina.,Plataforma Genómica y Bioinformática (PLABIO), INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - J M de Mendieta
- Servicio Antimicrobianos, Laboratorio Nacional de Referencia en Resistencia a los Antimicrobianos (LNRRA), INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Diego Faccone
- Servicio Antimicrobianos, Laboratorio Nacional de Referencia en Resistencia a los Antimicrobianos (LNRRA), INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Tomás Poklepovich
- Plataforma Genómica y Bioinformática (PLABIO), INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Celeste Lucero
- Servicio Antimicrobianos, Laboratorio Nacional de Referencia en Resistencia a los Antimicrobianos (LNRRA), INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Melina Rapoport
- Servicio Antimicrobianos, Laboratorio Nacional de Referencia en Resistencia a los Antimicrobianos (LNRRA), INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Josefina Campos
- Plataforma Genómica y Bioinformática (PLABIO), INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Ezequiel Tuduri
- Servicio Antimicrobianos, Laboratorio Nacional de Referencia en Resistencia a los Antimicrobianos (LNRRA), INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina.,Plataforma Genómica y Bioinformática (PLABIO), INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Mathew O Saavedra
- Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Hospital, Houston Methodist Research Institute, Houston, TX, United States
| | - Claudia Van der Ploeg
- Servicio de Antígenos y Antisueros, INPB-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Ariel Rogé
- Servicio de Antígenos y Antisueros, INPB-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | | | - Fernando Pasteran
- Servicio Antimicrobianos, Laboratorio Nacional de Referencia en Resistencia a los Antimicrobianos (LNRRA), INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Alejandra Corso
- Servicio Antimicrobianos, Laboratorio Nacional de Referencia en Resistencia a los Antimicrobianos (LNRRA), INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Adriana E Rosato
- Department of Pathology and Molecular Microbiology Diagnostics-Research, Riverside University Health System, Moreno Valley, CA, United States.,School of Medicine, University of California, Riverside, Riverside, CA, United States
| | - Sonia A Gomez
- Servicio Antimicrobianos, Laboratorio Nacional de Referencia en Resistencia a los Antimicrobianos (LNRRA), INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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De Belder D, Ghiglione B, Pasteran F, de Mendieta JM, Corso A, Curto L, Di Bella A, Gutkind G, Gomez SA, Power P. Comparative Kinetic Analysis of OXA-438 with Related OXA-48-Type Carbapenem-Hydrolyzing Class D β-Lactamases. ACS Infect Dis 2020; 6:3026-3033. [PMID: 32970406 DOI: 10.1021/acsinfecdis.0c00537] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Novel variants of OXA-48-type enzymes with the ability to hydrolyze oxyimino-cephalosporins and carbapenems are increasingly reported. Since its first report in 2011, OXA-163 is now extensively spread throughout Argentina, and several variants like OXA-247 have emerged. Here, we characterized a new blaOXA-48-like variant, OXA-438, and we performed a comparative kinetic analysis with the local variants OXA-247 and OXA-163 and the internationally disseminated OXA-48. blaOXA-163, blaOXA-247, and blaOXA-438 were located in a 70 kb IncN2 conjugative plasmid. OXA-438 presented mutations in the vicinity of conserved KTG (214-216), with a 2-aa deletion (R220-I221) and a D224E shift (as in OXA-163) compared to OXA-48. Despite Kpn163 (OXA-163), Kpn247 (OXA-247) and Eco438 (OXA-438) were resistant to meropenem and ertapenem, and the transconjugants (TC) remained susceptible (however, the carbapenems minimum inhibitory concentrations were ≥3 times 2-fold dilutions higher than the acceptor strain). TC163 and Eco48 were resistant to oxyimino-cephalosporins, unlike TC247 and TC438. kcat/Km values for cefotaxime in OXA-163 were slightly higher than the rest of the variants that were accompanied by a lower Km for carbapenems. For OXA-163, OXA-247, and OXA-438, the addition of NaHCO3 improved kcat values for both cefotaxime and ceftazidime; carbapenems kcat/Km values were higher than for oxyimino-cephalosporins. Mutations occurring near the conserved KTG in OXA-247 and OXA-438 are probably responsible for the improved carbapenems hydrolysis and decreased inactivation of oxyimino-cephalosporins compared to OXA-163. Dichroism results suggest that deletions at the β5-β6 loop seem to impact the structural stability of OXA-48 variants. Finally, additional mechanisms are probably involved in the resistance pattern observed in the clinical isolates.
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Affiliation(s)
- Denise De Belder
- Servicio Antimicrobianos - National Reference Laboratory in Antimicrobial Resistance (NRLAR), Instituto Nacional de Enfermedades Infecciosas-ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires 1282, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires 1452, Argentina
| | - Barbara Ghiglione
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires 1452, Argentina
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Departamento de Microbiología, Inmunología, Biotecnología y Genética, Laboratorio de Resistencia Bacteriana, Universidad de Buenos Aires, Buenos Aires 1113, Argentina
| | - Fernando Pasteran
- Servicio Antimicrobianos - National Reference Laboratory in Antimicrobial Resistance (NRLAR), Instituto Nacional de Enfermedades Infecciosas-ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires 1282, Argentina
| | - Juan Manuel de Mendieta
- Servicio Antimicrobianos - National Reference Laboratory in Antimicrobial Resistance (NRLAR), Instituto Nacional de Enfermedades Infecciosas-ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires 1282, Argentina
| | - Alejandra Corso
- Servicio Antimicrobianos - National Reference Laboratory in Antimicrobial Resistance (NRLAR), Instituto Nacional de Enfermedades Infecciosas-ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires 1282, Argentina
| | - Lucrecia Curto
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires 1452, Argentina
- IQUIFIB, Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Buenos Aires 1113, Argentina
| | - Adriana Di Bella
- Hospital Nacional “Profesor Alejandro Posadas”, El Palomar, Buenos Aires 1684, Argentina
| | - Gabriel Gutkind
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires 1452, Argentina
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Departamento de Microbiología, Inmunología, Biotecnología y Genética, Laboratorio de Resistencia Bacteriana, Universidad de Buenos Aires, Buenos Aires 1113, Argentina
| | - Sonia A. Gomez
- Servicio Antimicrobianos - National Reference Laboratory in Antimicrobial Resistance (NRLAR), Instituto Nacional de Enfermedades Infecciosas-ANLIS “Dr. Carlos G. Malbrán”, Buenos Aires 1282, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires 1452, Argentina
| | - Pablo Power
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires 1452, Argentina
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Departamento de Microbiología, Inmunología, Biotecnología y Genética, Laboratorio de Resistencia Bacteriana, Universidad de Buenos Aires, Buenos Aires 1113, Argentina
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7
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Martino F, Tijet N, Melano R, Petroni A, Heinz E, De Belder D, Faccone D, Rapoport M, Biondi E, Rodrigo V, Vazquez M, Pasteran F, Thomson NR, Corso A, Gomez SA. Correction: Isolation of five Enterobacteriaceae species harbouring blaNDM-1 and mcr-1 plasmids from a single paediatric patient. PLoS One 2019; 14:e0224937. [PMID: 31671170 PMCID: PMC6822747 DOI: 10.1371/journal.pone.0224937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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8
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Gomez SA, Chapman LAC, Dilger E, Courtenay O, Picado A. Correction: Estimating the efficacy of community-wide use of systemic insecticides in dogs to control zoonotic visceral leishmaniasis: A modelling study in a Brazilian scenario. PLoS Negl Trop Dis 2019; 13:e0007452. [PMID: 31136590 PMCID: PMC6538138 DOI: 10.1371/journal.pntd.0007452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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9
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Castillo LA, Birnberg-Weiss F, Rodriguez-Rodrigues N, Martire-Greco D, Bigi F, Landoni VI, Gomez SA, Fernandez GC. Klebsiella pneumoniae ST258 Negatively Regulates the Oxidative Burst in Human Neutrophils. Front Immunol 2019; 10:929. [PMID: 31105712 PMCID: PMC6497972 DOI: 10.3389/fimmu.2019.00929] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/30/2019] [Accepted: 04/11/2019] [Indexed: 11/13/2022] Open
Abstract
The epidemic clone of Klebsiella pneumoniae (Kpn), sequence type 258 (ST258), carbapenamase producer (KPC), commonly infects hospitalized patients that are left with scarce therapeutic option since carbapenems are last resort antibiotics for life-threatening bacterial infections. To improve prevention and treatment, we should better understand the biology of Kpn KPC ST258 infections. Our hypothesis was that Kpn KPC ST258 evade the first line of defense of innate immunity, the polymorphonuclear neutrophil (PMN), by decreasing its functional response. Therefore, our aim was to evaluate how the ST258 Kpn clone affects PMN responses, focusing on the respiratory burst, compared to another opportunistic pathogen, Escherichia coli (Eco). We found that Kpn KPC ST258 was unable to trigger bactericidal responses as reactive oxygen species (ROS) generation and NETosis, compared to the high induction observed with Eco, but both bacterial strains were similarly phagocytized and cause increases in cell size and CD11b expression. The absence of ROS induction was also observed with other Kpn ST258 strains negative for KPC. These results reflect certain selectivity in terms of the functions that are triggered in PMN by Kpn, which seems to evade specifically those responses critical for bacterial survival. In this sense, bactericidal mechanisms evasion was associated with a higher survival of Kpn KPC ST258 compared to Eco. To investigate the mechanisms and molecules involved in ROS inhibition, we used bacterial extracts (BE) and found that BE were able to inhibit ROS generation triggered by the well-known ROS inducer, fMLP. A sequence of experiments led us to elucidate that the polysaccharide part of LPS was responsible for this inhibition, whereas lipid A mediated the other responses that were not affected by bacteria, such as cell size increase and CD11b up-regulation. In conclusion, we unraveled a mechanism of immune evasion of Kpn KPC ST258, which may contribute to design more effective strategies for the treatment of these multi-resistant bacterial infections.
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Affiliation(s)
- Luis A Castillo
- Laboratorio de Fisiología de los Procesos Inflamatorios, Instituto de Medicina Experimental (IMEX)- Consejo Nacional de investigaciones Científicas y Tecnológicas (CONICET)/Academia Nacional de Medicina de Buenos Aires, Buenos Aires, Argentina
| | - Federico Birnberg-Weiss
- Laboratorio de Fisiología de los Procesos Inflamatorios, Instituto de Medicina Experimental (IMEX)- Consejo Nacional de investigaciones Científicas y Tecnológicas (CONICET)/Academia Nacional de Medicina de Buenos Aires, Buenos Aires, Argentina
| | - Nahuel Rodriguez-Rodrigues
- Laboratorio de Fisiología de los Procesos Inflamatorios, Instituto de Medicina Experimental (IMEX)- Consejo Nacional de investigaciones Científicas y Tecnológicas (CONICET)/Academia Nacional de Medicina de Buenos Aires, Buenos Aires, Argentina
| | - Daiana Martire-Greco
- Laboratorio de Fisiología de los Procesos Inflamatorios, Instituto de Medicina Experimental (IMEX)- Consejo Nacional de investigaciones Científicas y Tecnológicas (CONICET)/Academia Nacional de Medicina de Buenos Aires, Buenos Aires, Argentina
| | - Fabiana Bigi
- Instituto de Agrobiotecnología y Biología Molecular (IABIMO), Instituto Nacional de Tecnología Agropecuaria (INTA), Consejo Nacional de investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
| | - Veronica I Landoni
- Laboratorio de Fisiología de los Procesos Inflamatorios, Instituto de Medicina Experimental (IMEX)- Consejo Nacional de investigaciones Científicas y Tecnológicas (CONICET)/Academia Nacional de Medicina de Buenos Aires, Buenos Aires, Argentina
| | - Sonia A Gomez
- Servicio de Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas Dr. Carlos G. Malbrán (INEI), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS), Buenos Aires, Argentina
| | - Gabriela C Fernandez
- Laboratorio de Fisiología de los Procesos Inflamatorios, Instituto de Medicina Experimental (IMEX)- Consejo Nacional de investigaciones Científicas y Tecnológicas (CONICET)/Academia Nacional de Medicina de Buenos Aires, Buenos Aires, Argentina
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10
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Gomez SA, Chapman LAC, Dilger E, Courtenay O, Picado A. Estimating the efficacy of community-wide use of systemic insecticides in dogs to control zoonotic visceral leishmaniasis: A modelling study in a Brazilian scenario. PLoS Negl Trop Dis 2018; 12:e0006797. [PMID: 30222756 PMCID: PMC6160230 DOI: 10.1371/journal.pntd.0006797] [Citation(s) in RCA: 8] [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: 05/08/2018] [Revised: 09/27/2018] [Accepted: 08/28/2018] [Indexed: 12/31/2022] Open
Abstract
Systemic insecticides in dogs have been suggested as a public health intervention to prevent human cases of Zoonotic Visceral Leishmaniasis (ZVL). But, currently there are no systemic insecticides for dogs registered against zoo-anthropophilic pool blood feeding phlebotomine flies. We predict the impact of community-wide use of systemic insecticide in dog populations as a public health measure to control transmission of Leishmania infantum to humans using a mathematical model. We developed a Susceptible-Exposed-Infected (SEI) compartmental model to describe L. infantum transmission dynamics in dogs, with a vectorial capacity term to represent transmission between L. infantum-hosting dogs via phlebotomine flies. For Infected (I) dogs two levels of infectiousness were modelled, high infectiousness and low infectiousness. Human incidence was estimated through its relationship to infection in the dog population. We evaluated outcomes from a wide range of scenarios comprising different combinations of initial insecticide efficacy, duration of insecticide efficacy over time, and proportion of the dog population treated (60%, 70% & 80%). The same reduction in human infection incidence can be achieved via different combinations of insecticide efficacy, duration and dog coverage. For example, a systemic insecticide with an initial efficacy of 80% and 6 months above 65% efficacy would require treating at least 70% of the dogs to reduce the human infection incidence by 50%. Sensitivity analysis showed that the model outcome was most sensitive to baseline values of phlebotomine fly daily survival rate and insecticide coverage. Community-wide use of systemic insecticides applied to the “L. infantum canine reservoir” can significantly reduce human incidence of L. infantum infection. The results of this mathematical model can help defining the insecticide target product profile and how the insecticide should be applied to maximise effectiveness. Zoonotic visceral leishmaniasis (ZVL) is a potentially deadly disease in humans caused by Leishmania infantum. This leishmania species can be delivered by pool blood feeding zoo-anthropophilic phlebotomine flies to several mammals, the dog population being recognized as the main reservoir. Transmission from infected dogs to humans is through the bite of female phlebotomine sand flies. The disease is endemic in several countries and Brazil has a high prevalence of cases with over 3000 ZVL cases reported per year. The main, inefficient and highly controversial, control measure in Brazil has been culling sero-positive dogs. The community-wide use of systemic insecticides in dogs could be an alternative to control L. infantum transmission from phlebotomine flies to humans. The rationale is that phlebotomine flies which sampled their blood meals from dogs treated with systemic insecticides would die reducing the risk of L. infantum transmission. To reduce the number of ZVL cases, a large proportion of dogs in the community should be treated and the systemic insecticide used should be effective in killing phlebotomine flies acting as vectors of L. infantum parasites for a significant amount of time. We used a mathematical model mimicking L. infantum transmission to show that this novel vector control strategy could be effective. We identified the combination of different key parameters (e.g. insecticide efficacy, duration and proportion of dogs treated) that could lead to a significant reduction of the risk of L. infantum infection in humans.
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Affiliation(s)
- Sonia A. Gomez
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- * E-mail: (AP); (SAG)
| | - Lloyd A. C. Chapman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Life Sciences, University of Warwick, Gibbet Hill Campus, Coventry, United Kingdom
| | - Erin Dilger
- School of Life Sciences, University of Warwick, Gibbet Hill Campus, Coventry, United Kingdom
| | - Orin Courtenay
- School of Life Sciences, University of Warwick, Gibbet Hill Campus, Coventry, United Kingdom
| | - Albert Picado
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- * E-mail: (AP); (SAG)
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11
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De Belder D, Lucero C, Rapoport M, Rosato A, Faccone D, Petroni A, Pasteran F, Albornoz E, Corso A, Gomez SA. Genetic Diversity of KPC-Producing Escherichia coli, Klebsiella oxytoca, Serratia marcescens, and Citrobacter freundii Isolates from Argentina. Microb Drug Resist 2017; 24:958-965. [PMID: 29236574 DOI: 10.1089/mdr.2017.0213] [Citation(s) in RCA: 19] [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: 11/13/2022] Open
Abstract
The predominance of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae was caused by the spread of ST258 clone. In Latin America, KPC was reported in 2006, with the isolation of genetically unrelated K. pneumoniae in Colombia. Since then, the expansion of blaKPC in either K. pneumoniae ST258 or other Enterobacteriaceae (ETB) species was increasingly reported. In this study, we characterized 89 KPC-producing Escherichia coli, Klebsiella oxytoca, Serratia marcescens, and Citrobacter freundii that were received between 2010 and 2014. The results revealed that all isolates harbored blaKPC-2. Moreover, the dissemination of KPC by non-K. pneumoniae was mainly caused by the dispersion of ETB mostly genetically unrelated. E. coli is a community pathogen that may serve as the vehicle for the spread of KPC into community settings. Recently, KPC was detected in E. coli ST131, an international epidemic and multidrug-resistant clone. We found that 5/29 KPC-producing E. coli belonged to ST131 and four were blaCTXM-15 producers. The detection of blaKPC in ST131 should be closely monitored to prevent further dissemination. The blaKPC is generally located within Tn4401 transposon capable of mobilization through transposition found in plasmids in ST258. Less is known about the diversity of blaKPC genetic elements that disseminate horizontally among other species of ETB. We found that 16/29 E. coli and 2/18 S. marcescens harbored blaKPC-2 in Tn4401a. In 71 isolates, blaKPC-2 was located amidst diverse Tn3-derived genetic elements bearing non-Tn4401 structure. Further studies on the plasmids that encode blaKPC-2 in these clinical isolates may provide additional insight into its transmission mechanisms.
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Affiliation(s)
- Denise De Belder
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina .,2 Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina.
| | - Celeste Lucero
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina
| | - Melina Rapoport
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina
| | - Adriana Rosato
- 3 Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, Texas
| | - Diego Faccone
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina .,2 Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina.
| | - Alejandro Petroni
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina
| | - Fernando Pasteran
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina
| | - Ezequiel Albornoz
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina
| | - Alejandra Corso
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina
| | - Sonia A Gomez
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina .,2 Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina.
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Loza A, Talaga A, Herbas G, Canaviri RJ, Cahuasiri T, Luck L, Guibarra A, Goncalves R, Pereira JA, Gomez SA, Picado A, Messenger LA, Bern C, Courtenay O. Systemic insecticide treatment of the canine reservoir of Trypanosoma cruzi induces high levels of lethality in Triatoma infestans, a principal vector of Chagas disease. Parasit Vectors 2017; 10:344. [PMID: 28724448 PMCID: PMC5518140 DOI: 10.1186/s13071-017-2278-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 04/22/2017] [Accepted: 07/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite large-scale reductions in Chagas disease prevalence across Central and South America, Trypanosoma cruzi infection remains a considerable public health problem in the Gran Chaco region where vector-borne transmission persists. In these communities, peridomestic animals are major blood-meal sources for triatomines, and household presence of infected dogs increases T. cruzi transmission risk for humans. To address the pressing need for field-friendly, complementary methods to reduce triatomine infestation and interrupt T. cruzi transmission, this study evaluated the systemic activity of three commercial, oral, single dose insecticides Fluralaner (Bravecto®), Afoxolaner (NexGard®) and Spinosad (Comfortis®) in canine feed-through assays against Triatoma infestans, the principal domestic vector species in the Southern Cone of South America. METHODS Twelve healthy, outbred dogs were recruited from the Zoonosis Surveillance and Control Program in Santa Cruz, Bolivia, and randomized to three treatment groups, each containing one control and three treated dogs. Following oral drug administration, colony-reared second and third stage T. infestans instars were offered to feed on dogs for 30 min at 2, 7, 21, 34 and 51 days post-treatment. RESULTS Eighty-five per cent (768/907) of T. infestans successfully blood-fed during bioassays, with significantly higher proportions of bugs becoming fully-engorged when exposed to Bravecto® treated dogs (P < 0.001) for reasons unknown. Exposure to Bravecto® or NexGard® induced 100% triatomine mortality in fully- or semi-engorged bugs within 5 days of feeding for the entire follow-up period. The lethality effect for Comfortis® was much lower (50-70%) and declined almost entirely after 51 days. Instead Comfortis® treatment resulted in substantial morbidity; of these, 30% fully recovered whereas 53% remained morbid after 120 h, the latter subsequently unable to feed 30 days later. CONCLUSIONS A single oral dose of Fluralaner or Afoxolaner was safe and well tolerated, producing complete triatomine mortality on treated dogs over 7.3 weeks. While both drugs were highly efficacious, more bugs exposed to Fluralaner took complete blood-meals, and experienced rapid knock-down. Coupled with its longer residual activity, Fluralaner represents an ideal insecticide for development into a complementary, operationally-feasible, community-level method of reducing triatomine infestation and potentially controlling T. cruzi transmission, in the Gran Chaco region.
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Affiliation(s)
- Ariel Loza
- Facultad de Ciencias Veterinarias, Universidad Autonóma Gabriel René Moreno (UAGRM), Santa Cruz, Bolivia
| | - Adrianna Talaga
- University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Gladys Herbas
- Facultad de Ciencias Veterinarias, Universidad Autonóma Gabriel René Moreno (UAGRM), Santa Cruz, Bolivia
| | - Ruben Jair Canaviri
- Facultad de Ciencias Veterinarias, Universidad Autonóma Gabriel René Moreno (UAGRM), Santa Cruz, Bolivia
| | - Thalia Cahuasiri
- Facultad de Ciencias Veterinarias, Universidad Autonóma Gabriel René Moreno (UAGRM), Santa Cruz, Bolivia
| | - Laura Luck
- Facultad de Ciencias Veterinarias, Universidad Autonóma Gabriel René Moreno (UAGRM), Santa Cruz, Bolivia
| | - Alvaro Guibarra
- Facultad de Ciencias Veterinarias, Universidad Autonóma Gabriel René Moreno (UAGRM), Santa Cruz, Bolivia
| | - Raquel Goncalves
- University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Juan Antonio Pereira
- Facultad de Ciencias Veterinarias, Universidad Autonóma Gabriel René Moreno (UAGRM), Santa Cruz, Bolivia
| | - Sonia A Gomez
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clinic - Universitat de Barcelona, Rosello 132, 08036, Barcelona, Spain
| | - Albert Picado
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clinic - Universitat de Barcelona, Rosello 132, 08036, Barcelona, Spain
| | | | - Caryn Bern
- University of California-San Francisco, 550 16th St, 94158, San Francisco, CA, USA
| | - Orin Courtenay
- University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
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Gomez SA, Kulow M, Anklam KS, Park D, Kaspar CW, Ivanek R, Döpfer D. Gene markers of generic Escherichia coli associated with colonization and persistence of Escherichia coli O157 in cattle. Prev Vet Med 2014; 117:140-8. [PMID: 25112682 DOI: 10.1016/j.prevetmed.2014.07.009] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 07/07/2014] [Accepted: 07/13/2014] [Indexed: 10/25/2022]
Abstract
Enterohemorrhagic Escherichia coli (EHEC) O157 are important foodborne pathogens whose major reservoir are asymptomatic cattle. There is evidence suggesting that nonpathogenic E. coli and bacteriophages in the gastro-intestinal tract can influence the pathogenicity of EHEC O157. The factors contributing to the onset and persistence of shedding EHEC O157 in cattle are not completely elucidated. This study used Bayesian network analysis to identify genetic markers of generic E. coli associated with shedding of EHEC O157 in cattle from data generated during an oral experimental challenge study in 4 groups of 6 steers inoculated with three different EHEC O157 strains. The quantification of these associations was accomplished using mixed effects logistic regression. The results showed that the concurrent presence of generic E. coli carrying the prophage marker R4-N and the virulence marker stx2 increased the odds of the onset of EHEC O157 shedding. The presence of prophage markers z2322 and X011C increased, while C1.N decreased the odds of shedding EHEC O157 two days later. A significant antagonist interaction effect between the presence of the virulence marker stx2 on the day of shedding EHEC O157 and two days before shedding was also found. In terms of the persistence of EHEC O157 shedding, the presence of prophage marker R4-N (OR=16, and 95% confidence interval (CI): 1.1, 252) was found to increase the odds of stopping EHEC O157 shedding, whereas prophage marker C1.N (OR=0.16, CI: 0.03, 0.7) and the enterohemolysin gene hly (OR=0.03, CI: 0.001, 0.8) were found to significantly decrease the odds of stopping EHEC O157 shedding. In conclusion, the study found that the presence of certain genetic markers in the generic E. coli genome can influence the pathogenicity of EHEC O157.
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Affiliation(s)
- Sonia A Gomez
- Department of Statistics, UW-Madison, 1220 Medical Sciences Center, 1300 University Avenue, Madison, WI 53706, USA
| | - Megan Kulow
- Department of Medical Sciences, School of Veterinary Medicine, UW-Madison, 2015 Linden Drive, Madison, WI 53706, USA
| | - Kelly S Anklam
- Department of Medical Sciences, School of Veterinary Medicine, UW-Madison, 2015 Linden Drive, Madison, WI 53706, USA
| | - Donjin Park
- Department of Bacteriology, UW-Madison, 1550 Linden Drive, Madison, WI 53706, USA
| | - Charles W Kaspar
- Department of Bacteriology, UW-Madison, 1550 Linden Drive, Madison, WI 53706, USA
| | - Renata Ivanek
- Veterinary Integrative Biosciences, 4458 Texas A&M University, College Station, TX 77843, USA
| | - Dörte Döpfer
- Department of Medical Sciences, School of Veterinary Medicine, UW-Madison, 2015 Linden Drive, Madison, WI 53706, USA.
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14
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Gomez SA, Abrey-Recalde MJ, Panek CA, Ferrarotti NF, Repetto MG, Mejías MP, Fernández GC, Vanzulli S, Isturiz MA, Palermo MS. The oxidative stress induced in vivo by Shiga toxin-2 contributes to the pathogenicity of haemolytic uraemic syndrome. Clin Exp Immunol 2013; 173:463-72. [PMID: 23607458 DOI: 10.1111/cei.12124] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2013] [Indexed: 12/19/2022] Open
Abstract
Typical haemolytic uraemic syndrome (HUS) is caused by Shiga toxin (Stx)-producing Escherichia coli infections and is characterized by thrombotic microangiopathy that leads to haemolytic anaemia, thrombocytopenia and acute renal failure. Renal or neurological sequelae are consequences of irreversible tissue damage during the acute phase. Stx toxicity and the acute inflammatory response raised by the host determine the development of HUS. At present there is no specific therapy to control Stx damage. The pathogenic role of reactive oxygen species (ROS) on endothelial injury has been largely documented. In this study, we investigated the in-vivo effects of Stx on the oxidative balance and its contribution to the development of HUS in mice. In addition, we analysed the effect of anti-oxidant agents as therapeutic tools to counteract Stx toxicity. We demonstrated that Stx induced an oxidative imbalance, evidenced by renal glutathione depletion and increased lipid membrane peroxidation. The increased ROS production by neutrophils may be one of the major sources of oxidative stress during Stx intoxication. All these parameters were ameliorated by anti-oxidants reducing platelet activation, renal damage and increasing survival. To conclude, Stx generates a pro-oxidative state that contributes to kidney failure, and exogenous anti-oxidants could be beneficial to counteract this pathogenic pathway.
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Affiliation(s)
- S A Gomez
- Servicio de Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, ANLIS 'Dr Carlos G. Malbrán', Buenos Aires, Argentina
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15
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Gomez SA, Pasteran FG, Faccone D, Tijet N, Rapoport M, Lucero C, Lastovetska O, Albornoz E, Galas M, Melano RG, Corso A, Petroni A. Clonal dissemination of Klebsiella pneumoniae ST258 harbouring KPC-2 in Argentina. Clin Microbiol Infect 2011; 17:1520-4. [PMID: 21851480 DOI: 10.1111/j.1469-0691.2011.03600.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [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 present work describes the abrupt emergence of Klebsiella pneumoniae carbapenemase (KPC) and characterizes the first 79 KPC-producing enterobacteria from Argentina (isolated from 2006 to 2010). The emergence of bla(KPC-2) was characterized by two patterns of dispersion: the first was the sporadic occurrence in diverse enterobacteria from distant geographical regions, harbouring plasmids of different incompatibility groups and bla(KPC-2) in an unusual genetic environment flanked by ISKpn8-Δbla(TEM-1) and ISKpn6-like. bla(KPC-2) was associated with IncL/M transferable plasmids; the second was the abrupt clonal spread of K. pneumoniae ST258 harbouring bla(KPC-2) in Tn4401a.
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Affiliation(s)
- S A Gomez
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas (INEI)-ANLIS Dr Carlos G. Malbrán, Ciudad Autónoma de Buenos Aires, Argentina.
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16
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Rancé F, Deschildre A, Villard-Truc F, Gomez SA, Paty E, Santos C, Couderc L, Fauquert JL, De Blic J, Bidat E, Dupont C, Eigenmann P, Lack G, Scheinmann P. Oral food challenge in children: an expert review. Eur Ann Allergy Clin Immunol 2009; 41:35-49. [PMID: 19585859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Oral food challenges are indicated for the diagnosis of food allergy and the double-blind, placebo-controlled oral food challenge is considered the gold standard diagnostic method in children with suspected food allergy. This practice parameter for oral food challenges in children was prepared by a workgroup at the request of the French Society for Allergology and Clinical Immunology (SFAIC) and the French Paediatric Society for Allergology and Pulmonology (SP2A). We aimed to develop practical guidelines for oral food challenges in children for the diagnosis of suspected food allergy or the evaluation of food tolerance. We also considered the safety measures to be implemented during testing and management of the potentially serious allergic reactions that may arise during the test. The strength of the recommendations was established, using the GRADE evidence-based approach. We considered four issues: (1) the selection of children for oral food challenges (indications and contraindications); (2) the procedure used (material, where the test should be carried out, technique and management of reactions); (3) interpretation of the test and (4) consequences of the test.
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Affiliation(s)
- F Rancé
- Allergologie-Pneumologie, Hôpital des Enfants, Toulouse, France
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17
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Gomez SA, Argüelles CL, Guerrieri D, Tateosian NL, Amiano NO, Slimovich R, Maffia PC, Abbate E, Musella RM, Garcia VE, Chuluyan HE. Secretory leukocyte protease inhibitor: a secreted pattern recognition receptor for mycobacteria. Am J Respir Crit Care Med 2008; 179:247-53. [PMID: 19011154 DOI: 10.1164/rccm.200804-615oc] [Citation(s) in RCA: 30] [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: 01/23/2023] Open
Abstract
RATIONALE Human secretory leukocyte protease inhibitor (SLPI) displays bactericidal activity against pathogens such as Escherichia coli and Streptococcus. Furthermore, it has been reported that murine SLPI shows potent antimycobacterial activity. OBJECTIVES The aim of the present study was to investigate whether human recombinant SLPI not only kills mycobacteria but also acts as a pattern recognition receptor for the host immune system. METHODS For the in vivo experiment, BALB/c mice were infected by intranasal instillation with Mycobacterium bovis BCG and viable BCG load in lung homogenates was later determined. For the in vitro experiments, SLPI was incubated overnight with a suspension of M. bovis BCG or the virulent strain Mycobacterium tuberculosis H37Rv, and the percentage survival as well as the binding of SLPI to mycobacteria was determined. Furthermore, bacteria phagocytosis was also determined by flow cytometry. MEASUREMENTS AND MAIN RESULTS Intranasal SLPI treatment decreased the number of colony-forming units recovered from lung homogenates, indicating that SLPI interfered with M. bovis BCG infection. Moreover, SLPI decreased the viability of both M. bovis BCG and H37Rv. We demonstrated that SLPI attached to the surface of the mycobacteria by binding to pathogen-associated molecular pattern mannan-capped lipoarabinomannans and phosphatidylinositol mannoside. Furthermore, we found that in the sputum of patients with tuberculosis, mycobacteria were coated with endogenous SLPI. Finally, we showed that phagocytosis of SLPI-coated mycobacteria was faster than that of uncoated bacteria. CONCLUSIONS The present results demonstrate for the first time that human SLPI kills mycobacteria and is a new pattern recognition receptor for them.
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Affiliation(s)
- Sonia A Gomez
- Department of Pharmacology, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
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18
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Fernandez GC, Gomez SA, Ramos MV, Bentancor LV, Fernandez-Brando RJ, Landoni VI, Lopez L, Ramirez F, Diaz M, Alduncin M, Grimoldi I, Exeni R, Isturiz MA, Palermo MS. The functional state of neutrophils correlates with the severity of renal dysfunction in children with hemolytic uremic syndrome. Pediatr Res 2007; 61:123-8. [PMID: 17211153 DOI: 10.1203/01.pdr.0000250037.47169.55] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hemolytic Uremic Syndrome (HUS) is the main cause of acute renal failure in children. The high percentage of patients who develop long-term sequelae constitutes an important medical concern. The identification of parameters that correlate with the degree of renal failure may be useful to plan the best treatment soon after hospitalization. Here, we investigated the functional state of neutrophils (PMN) from HUS patients on admission, before dialysis and/or transfusion, in relation to the severity of renal impairment reached during the acute period (AP). We found that all PMN activation parameters measured in severe cases of HUS (HUS AP3) were statistically lower comparing to children with mild cases of HUS (HUS AP1). As HUS PMN phenotype and dysfunction is compatible with that of cells undergoing cell death, we also studied spontaneous apoptosis. Not only were HUS PMN not apoptotic, but HUS AP3 PMN showed an increased survival. Almost all phenotypic and functional parameters measured on PMN correlated with severity. Our results revealed a marked deactivation of PMN in severe cases of HUS, and suggest that studying the functional state of PMN could be of prognostic value.
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Affiliation(s)
- Gabriela C Fernandez
- Division of Immunology, Institute of Hematological Investigations, National Academy of Medicine, C1425AUM Buenos Aires, Argentine.
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19
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Fernandez GC, Lopez MF, Gomez SA, Ramos MV, Bentancor LV, Fernandez-Brando RJ, Landoni VI, Dran GI, Meiss R, Isturiz MA, Palermo MS. Relevance of neutrophils in the murine model of haemolytic uraemic syndrome: mechanisms involved in Shiga toxin type 2-induced neutrophilia. Clin Exp Immunol 2006; 146:76-84. [PMID: 16968401 PMCID: PMC1809733 DOI: 10.1111/j.1365-2249.2006.03155.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
It has been demonstrated that infections due to Shiga toxins (Stx) producing Escherichia coli are the main cause of the haemolytic uraemic syndrome (HUS). However, the contribution of the inflammatory response in the pathogenesis of the disease has also been well established. Neutrophils (PMN) represent a central component of inflammation during infections, and patients with high peripheral PMN counts at presentation have a poor prognosis. The mouse model of HUS, by intravenous injection of pure Stx type 2 (Stx2), reproduces human neutrophilia and allows the study of early events in the course of Stx2-induced pathophysiological mechanisms. The aim of this study was to address the contribution of PMN on Stx2 toxicity in a murine model of HUS, by evaluating the survival and renal damage in mice in which the granulocytic population was depleted. We found that the absence of PMN reduced Stx2-induced lethal effects and renal damage. We also investigated the mechanisms underlying Stx2-induced neutrophilia, studying the influence of Stx2 on myelopoyesis, on the emergence of cells from the bone marrow and on the in vivo migration into tissues. Stx2 administration led to an accelerated release of bone marrow cells, which egress at an earlier stage of maturation, together with an increase in the proliferation of myeloid progenitors. Moreover, Stx2-treated mice exhibited a lower migratory capacity to a local inflammatory site. In conclusion, PMN are essential in the pathogenesis of HUS and neutrophilia is not merely an epiphenomenon, but contributes to Stx2-damaging mechanism by potentiating Stx2 toxicity.
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Affiliation(s)
- G C Fernandez
- Departamento de Inmunología, Instituto de Investigaciones Hematologicas, Buenos Aires, Argentina.
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20
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Johnson LC, Freeman CR, Spinweber CL, Gomez SA. Subjective and objective measures of sleepiness: effect of benzodiazepine and caffeine on their relationship. Psychophysiology 1991; 28:65-71. [PMID: 1679563 DOI: 10.1111/j.1469-8986.1991.tb03388.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
As part of a larger project on the effects of benzodiazepine and caffeine on daytime sleepiness, performance and mood, this study examined the relationship among the Multiple Sleep Latency Test, lapses during a tapping task, a Visual Analog Scale, and the Stanford Sleepiness scale. Subjects were 80 male, adult nonsmokers aged 20.3 +/- 2.7 years. The Multiple Sleep Latency Test, Stanford Sleepiness Scale, and the Visual Analog Scale were obtained at two-hour intervals beginning at 0700 h and ending at 1700 h. The tapping task (lapses) was administered each day at 0600 h, 1000 h, and 1400 h. A lapse was a 3-s or greater pause between taps. Correlations between the Multiple Sleep Latency Test and subjective (Visual Analog Scale and the Stanford Sleepiness Scale) measures were significant at 0600 h, but became nonsignificant as the day progressed. Correlations between lapses and the two subjective measures were generally nonsignificant. The two objective measures were significantly correlated in the total group but not in all treatment groups. The subjective measures were significantly correlated in the total sample and in each treatment group. This study reaffirms the importance of time of day when measuring sleepiness, and suggests that subjective and objective measures may measure different aspects of sleepiness.
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Affiliation(s)
- L C Johnson
- Naval Health Research Center, San Diego, CA 92186-5122
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21
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Johnson LC, Spinweber CL, Gomez SA, Matteson LT. Daytime sleepiness, performance, mood, nocturnal sleep: the effect of benzodiazepine and caffeine on their relationship. Sleep 1990; 13:121-35. [PMID: 2184488 DOI: 10.1093/sleep/13.2.121] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The present study was part of a larger 3-day, 2-night double-blind parallel group design in which 80 young adult men were divided into eight treatment groups to examine the effects of benzodiazepines and caffeine on nocturnal sleep and daytime sleepiness, performance, and mood. The present study was done to examine further the relationship among daytime sleepiness, performance, mood, and nocturnal sleep and to determine if and how these relationships were affected by the nighttime use of benzodiazepine and the ingestion of caffeine in the morning. Subjects received 15 or 30 mg of flurazepam, 0.25 or 0.50 mg of triazolam, or placebo at bedtime and 250 mg of caffeine or placebo in the morning for two treatment days. Two objective (Multiple Sleep Latency Test and lapses) and two subjective (Stanford Sleepiness Scale and Visual Analog Scale) measures of sleepiness, five performance tests, and two mood measures (Profile of Mood Scale and Visual Analog Scale) were administered repeatedly on both days. Electroencephalogram sleep was recorded on both nights. Objective sleep measures of daytime sleepiness were not significantly related to either performance or mood, but subjects with greater daytime sleepiness had significantly longer and more efficient nocturnal sleep. Neither benzodiazepine or caffeine influenced these relationships. In contrast, higher estimates of subjective sleepiness were significantly associated with poorer mood and tended to be related to poorer performance. Caffeine significantly reduced these relationships. Nocturnal sleep measures were not related to subjective estimates of daytime sleepiness.
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Affiliation(s)
- L C Johnson
- Naval Health Research Center, San Diego, CA 92138-9174
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22
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Abstract
In a double-blind parallel group design, 80 young adult males were divided into eight treatment groups. Subjects received 15 or 30 mg flurazepam, 0.25 or 0.50 mg triazolam, or placebo at bedtime, and 250 mg caffeine or placebo in the morning for 2 treatment days. Two objective (Multiple Sleep Latency Test and lapses) and two subjective (Stanford Sleepiness Scale and Visual Analog Scale) measures of sleepiness, five performance tests, and two mood measures (Profile of Mood Scale and Visual Analog Mood Scale) were administered repeatedly on both days. Significant treatment effects were found for sleepiness but not for performance or mood. Early morning caffeine significantly antagonized next day hypnotic-induced drowsiness and enhanced alertness in the subjects who received bed-time placebo. Flurazepam, 30 mg, subjects were more sleepy than all other groups. Although not significantly different, the flurazepam, 30 mg, group demonstrated a trend toward poorer performance and a more negative mood than all other groups. Caffeine most improved performance of this group. In all groups, sleepiness was greatest and performance and mood poorest in early morning trials and caffeine was most effective at this time.
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Affiliation(s)
- L C Johnson
- Naval Health Research Center, San Diego, CA 92138-9174
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