1
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Gurnari C, Pascale MR, Vitale A, Diral E, Tomelleri A, Galossi E, Falconi G, Bruno A, Crisafulli F, Frassi M, Cattaneo C, Bertoli D, Bernardi M, Condorelli A, Morsia E, Poloni A, Crisà E, Caravelli D, Triggianese P, Brussino L, Battipaglia G, Bindoli S, Sfriso P, Caroni F, Dragani M, Mallegni F, Pilo F, Firinu D, Curti A, Papayannidis C, Olivieri A, Kordasti S, Albano F, Pane F, Musto P, Bocchia M, Lugli E, Breccia M, Frigeni M, Dagna L, Greco R, Franceschini F, Campochiaro C, Cantarini L, Voso MT. Diagnostic capabilities, clinical features, and longitudinal UBA1 clonal dynamics of a nationwide VEXAS cohort. Am J Hematol 2024; 99:254-262. [PMID: 38108611 DOI: 10.1002/ajh.27169] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023]
Abstract
VEXAS is a prototypic hemato-inflammatory disease combining rheumatologic and hematologic disorders in a molecularly defined nosological entity. In this nationwide study, we aimed at screenshotting the current diagnostic capabilities and clinical-genomic features of VEXAS, and tracked UBA1 longitudinal clonal dynamics upon different therapeutics, including allogeneic hematopoietic cell transplant. We leveraged a collaboration between the Italian Society of Experimental Hematology and of Rheumatology and disseminated a national survey to collect clinical and molecular patient information. Overall, 13/29 centers performed UBA1 genomic testing locally, including Sanger sequencing (46%), next-generation sequencing (23%), droplet digital polymerase chain reaction (8%), or combination (23%). A total of 41 male patients were identified, majority (51%) with threonine substitutions at Met41 hotspot, followed by valine and leucine (27% and 8%). Median age at VEXAS diagnosis was 67 years. All patients displayed anemia (median hemoglobin 9.1 g/dL), with macrocytosis. Bone marrow vacuoles were observed in most cases (89%). The most common rheumatologic association was polychondritis (49%). A concomitant myelodysplastic neoplasm/syndrome (MDS) was diagnosed in 71% of patients (n = 28), chiefly exhibiting lower Revised International Prognostic Scoring System risk profiles. Karyotype was normal in all patients, except three MDS cases showing -Y, t(12;16)(q13;q24), and +8. The most frequently mutated gene was DNMT3A (n = 10), followed by TET2 (n = 3). At last follow-up, five patients died and two patients progressed to acute leukemia. Longitudinal UBA1 clonal dynamics demonstrated mutational clearance following transplant. We collected a nationwide interdisciplinary VEXAS patient cohort, characterized by heterogeneous rheumatologic manifestations and treatments used. MDS was diagnosed in 71% of cases. Patients exhibited various longitudinal UBA1 clonal dynamics.
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Affiliation(s)
- Carmelo Gurnari
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Maria Rosaria Pascale
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Vitale
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Elisa Diral
- Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele & Vita-Salute San Raffaele University, Milan, Italy
| | - Elisa Galossi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giulia Falconi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Bruno
- Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Micol Frassi
- ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Chiara Cattaneo
- ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Diego Bertoli
- ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Massimo Bernardi
- Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Erika Morsia
- Hematology Department, University of Ancona, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Antonella Poloni
- Hematology Department, University of Ancona, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Elena Crisà
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | | | - Paola Triggianese
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Luisa Brussino
- Department of Medical Sciences Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - Giorgia Battipaglia
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Sara Bindoli
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Paolo Sfriso
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Federico Caroni
- Hematology, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Flavia Mallegni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Federica Pilo
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Curti
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cristina Papayannidis
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Attilio Olivieri
- Hematology Department, University of Ancona, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Sharham Kordasti
- Hematology Department, University of Ancona, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
- Haematology, Guy's Hospital & Comprehensive Cancer Centre, King's College, London, UK
| | - Francesco Albano
- Department of Precision and Regenerative Medicine and Ionian Area, "Aldo Moro" University, Bari, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Pellegrino Musto
- Department of Precision and Regenerative Medicine and Ionian Area, "Aldo Moro" University, Bari, Italy
| | - Monica Bocchia
- Hematology, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Elisabetta Lugli
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Breccia
- Department of Translational and Precision Medicine, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Marco Frigeni
- Azienda SocioSanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele & Vita-Salute San Raffaele University, Milan, Italy
| | - Raffaella Greco
- Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele & Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Cantarini
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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2
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Santinelli E, Pascale MR, Xie Z, Badar T, Stahl MF, Bewersdorf JP, Gurnari C, Zeidan AM. Targeting apoptosis dysregulation in myeloid malignancies - The promise of a therapeutic revolution. Blood Rev 2023; 62:101130. [PMID: 37679263 DOI: 10.1016/j.blre.2023.101130] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
In recent years, the therapeutic landscape of myeloid malignancies has been completely revolutionized by the introduction of several new drugs, targeting molecular alterations or pathways crucial for leukemia cells survival. Particularly, many agents targeting apoptosis have been investigated in both pre-clinical and clinical studies. For instance, venetoclax, a pro-apoptotic agent active on BCL-2 signaling, has been successfully used in the treatment of acute myeloid leukemia (AML). The impressive results achieved in this context have made the apoptotic pathway an attractive target also in other myeloid neoplasms, translating the experience of AML. Therefore, several drugs are now under investigation either as single or in combination strategies, due to their synergistic efficacy and capacity to overcome resistance. In this paper, we will review the mechanisms of apoptosis and the specific drugs currently used and under investigation for the treatment of myeloid neoplasia, identifying critical research necessities for the upcoming years.
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Affiliation(s)
- Enrico Santinelli
- Department of Biomedicine and Prevention, PhD in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, 00133 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Maria Rosaria Pascale
- Department of Biomedicine and Prevention, PhD in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Zhuoer Xie
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Talha Badar
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Maximilian F Stahl
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Jan P Bewersdorf
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carmelo Gurnari
- Department of Biomedicine and Prevention, PhD in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, 00133 Rome, Italy; Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Amer M Zeidan
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine and Yale Cancer Center, New Haven, CT, USA.
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3
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Attardi E, Savi A, Borsellino B, Piciocchi A, Cipriani M, Ottone T, Fabiani E, Divona M, Travaglini S, Pascale MR, Awada H, Durmaz A, Visconte V, Della Porta MG, Venditti A, Maciejewski JP, Gurnari C, Voso MT. Applicability of 2022 classifications of acute myeloid leukemia in the real-world setting. Blood Adv 2023; 7:5122-5131. [PMID: 37327116 PMCID: PMC10477447 DOI: 10.1182/bloodadvances.2023010173] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/18/2023] Open
Abstract
The increasing knowledge of molecular genetics of acute myeloid leukemia (AML) necessitated the update of previous diagnostic and prognostic schemes, which resulted in the development of the World Health Organization (WHO), the International Consensus Classification (ICC), and the new European LeukemiaNet (ELN) recommendations in 2022. We aimed to provide a real-world application of the new models, unravel differences and similarities, and test their implementation in clinical AML diagnosis. A total of 1001 patients diagnosed with AML were reclassified based on the new schemes. The overall diagnostic changes between the WHO 2016 and the WHO 2022 and ICC classifications were 22.8% and 23.7%, respectively, with a 13.1% difference in patients' distribution between ICC and WHO 2022. The 2022 ICC "not otherwise specified" and WHO "defined by differentiation" AML category sizes shrank when compared with that in WHO 2016 (24.1% and 26.8% respectively, vs 38.7%), particularly because of an expansion of the myelodysplasia (MDS)-related group. Of 397 patients with a MDS-related AML according to the ICC, 55.9% were defined by the presence of a MDS-related karyotype. The overall restratification between ELN 2017 and ELN 2022 was 12.9%. The 2022 AML classifications led to a significant improvement of diagnostic schemes. In the real-world setting, conventional cytogenetics, usually rapidly available and less expensive than molecular characterization, stratified 56% of secondary AML, still maintaining a powerful diagnostic role. Considering the similarities between WHO and ICC diagnostic schemes, a tentative scheme to generate a unified model is desirable.
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Affiliation(s)
- Enrico Attardi
- Department of Biomedicine and Prevention, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Arianna Savi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Beatrice Borsellino
- Department of Biomedicine and Prevention, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Alfonso Piciocchi
- Italian Group for Adult Hematologic Diseases (GIMEMA) Foundation, Rome, Italy
| | - Marta Cipriani
- Italian Group for Adult Hematologic Diseases (GIMEMA) Foundation, Rome, Italy
- Department of Statistical Sciences, University of Rome La Sapienza, Rome, Italy
| | - Tiziana Ottone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Neuro-Oncohematology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Santa Lucia, Rome, Italy
| | - Emiliano Fabiani
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Mariadomenica Divona
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Serena Travaglini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Maria Rosaria Pascale
- Department of Biomedicine and Prevention, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Hussein Awada
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - Arda Durmaz
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - Valeria Visconte
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - Matteo Giovanni Della Porta
- IRCCS Humanitas Clinical & Research Center and Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Adriano Venditti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Jaroslaw P. Maciejewski
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - Carmelo Gurnari
- Department of Biomedicine and Prevention, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Neuro-Oncohematology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Santa Lucia, Rome, Italy
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4
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Marino F, Mazzotta M, Pascale MR, Derelitto C, Girolamini L, Cristino S. First water safety plan approach applied to a Dental Clinic complex: identification of new risk factors associated with Legionella and P. aeruginosa contamination, using a novel sampling, maintenance and management program. J Oral Microbiol 2023; 15:2223477. [PMID: 37346998 PMCID: PMC10281406 DOI: 10.1080/20002297.2023.2223477] [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: 03/21/2023] [Revised: 05/18/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023] Open
Abstract
Dental unit waterlines (DUWLs) represent a complex environment able to promote microbial contamination, due to functional, mechanical and practical risk factors. According to a water safety plan approach, the main goal is to preserve the health of dentists, dental staff and patients. The aim of this study is to develop a DUWLs water safety plan that is able to support correct and effective maintenance and disinfection procedures. Three different water systems serve 60 dental chairs: (i) water that comes directly from municipal water (Type A), (ii) water supplied by municipal water and water bottles (Type B) and (iii) water supplied only via water bottles (Type C). For each type, Legionella and Pseudomonas aeruginosa contamination was studied, by applying a new sampling scheme, based on separate sampling from water bottles, cup filler and handpieces. Type B DUWL is the only type of DUWL contaminated by L. pneumophila (ST 59) and L. anisa (mean contamination: 608.33 ± 253.33 cfu/L) detected in cup filler and handpieces, as well as the high presence of P. aeruginosa (44.42 ± 13.25 cfu/100 mL). Two subsequent shock treatments and resampling procedures were performed by increasing disinfectant dosage and contact time and removing some DUWL components linked to biofilm growth in DUWLs. A significant reduction of contamination was obtained for both microorganisms (Legionella spp.: -100%, p < 0.001 and P. aeruginosa: -99.86%, p = 0.006). The sampling strategy proposed allows us to identify the source of contamination and better focus on the maintenance and disinfection procedures. DUWLs represent an environment that requires a multidisciplinary approach, combining the knowledge of all DUWL components to correct procedures that are able to preserve the health of personnel and patients, as well as guaranteeing DUWLs' safe functionality.
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Affiliation(s)
- Federica Marino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- Department of Civil, Chemical, Environmental and Materials Engineering, University of Bologna, Bologna, Italy
| | - Carlo Derelitto
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
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Girolamini L, Pascale MR, Salaris S, Mazzotta M, Orsini M, Grottola A, Zini N, Cristino S. Corrigendum: Legionella bononiensis sp. nov., isolated from a hotel water distribution system in northern Italy. Int J Syst Evol Microbiol 2023; 73. [PMID: 36749701 DOI: 10.1099/ijsem.0.005710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Luna Girolamini
- Department of Biological, Geological and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna (BO), Italy.,European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Maria Rosaria Pascale
- Department of Biological, Geological and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna (BO), Italy
| | - Silvano Salaris
- Department of Biological, Geological and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna (BO), Italy
| | - Marta Mazzotta
- Department of Biological, Geological and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna (BO), Italy
| | - Massimiliano Orsini
- Laboratory of Microbial Ecology and Genomics of Microorganisms, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Antonella Grottola
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland.,Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Unit of Molecular Virology and Microbiology, Modena University Hospital, Modena, Italy
| | - Nicoletta Zini
- CNR-National Research Council of Italy, Institute of Molecular Genetics "Luigi Luca Cavalli-Sforza",, Unit of Bologna, via di Barbiano 1/10, 40136, Bologna, Italy.,IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, Bologna, Italy
| | - Sandra Cristino
- Department of Biological, Geological and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna (BO), Italy.,European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
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6
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Pasqualone G, Buzzatti E, Palmieri R, Savi A, Pascale MR, Borsellino B, Guarnera L, Buccisano F, Voso MT, Maurillo L, Sconocchia G, Venditti A, Del Principe MI. Case report: A Saprochaete clavata (Magnusiomyces clavatus) severe infection effectively treated with granulocyte transfusion in a young patient with myeloid sarcoma. Front Oncol 2022; 12:970188. [PMID: 36185191 PMCID: PMC9521543 DOI: 10.3389/fonc.2022.970188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Myeloid sarcoma is a hematologic malignancy consisting of extramedullary tissue involvement by myeloid blasts, usually considered as acute myeloid leukemia and treated accordingly. The disease itself, together with chemotherapy and disease-associated factors, may have an impact in increasing the risk of developing severe and frequently life-threatening infections. Herein, we describe the case of a patient with a right breast skin lesion, histologically diagnosed myeloid sarcoma, who developed a severe disseminated fungal infection by Saprochaete clavata (Magnusiomyces clavatus), during the first consolidation course of chemotherapy. Despite maximum antifungal therapy, the infection progressed and the fungus continued to be isolated until granulocyte transfusion therapy was initiated. Our experience suggests that patients with profound and long-lasting neutropenia could benefit from granulocyte transfusions as additional therapy in severe fungal infections resistant to broad-spectrum antimicrobial therapy.
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Affiliation(s)
- Gianmario Pasqualone
- Hematology, Department of Biomedicine and Prevention, Università degli studi di Roma Tor Vergata, Rome, Italy
| | - Elisa Buzzatti
- Hematology, Department of Biomedicine and Prevention, Università degli studi di Roma Tor Vergata, Rome, Italy
| | - Raffaele Palmieri
- Hematology, Department of Biomedicine and Prevention, Università degli studi di Roma Tor Vergata, Rome, Italy
| | - Arianna Savi
- Hematology, Department of Biomedicine and Prevention, Università degli studi di Roma Tor Vergata, Rome, Italy
| | - Maria Rosaria Pascale
- Hematology, Department of Biomedicine and Prevention, Università degli studi di Roma Tor Vergata, Rome, Italy
| | - Beatrice Borsellino
- Hematology, Department of Biomedicine and Prevention, Università degli studi di Roma Tor Vergata, Rome, Italy
| | - Luca Guarnera
- Hematology, Department of Biomedicine and Prevention, Università degli studi di Roma Tor Vergata, Rome, Italy
| | - Francesco Buccisano
- Hematology, Department of Biomedicine and Prevention, Università degli studi di Roma Tor Vergata, Rome, Italy
| | - Maria Teresa Voso
- Hematology, Department of Biomedicine and Prevention, Università degli studi di Roma Tor Vergata, Rome, Italy
| | - Luca Maurillo
- Hematology, Department of Biomedicine and Prevention, Università degli studi di Roma Tor Vergata, Rome, Italy
| | - Giuseppe Sconocchia
- Institute of Translational Pharmacology, Department of Biomedical Sciences, National Research Council (CNR), Rome, Italy
- *Correspondence: Giuseppe Sconocchia,
| | - Adriano Venditti
- Hematology, Department of Biomedicine and Prevention, Università degli studi di Roma Tor Vergata, Rome, Italy
| | - Maria Ilaria Del Principe
- Hematology, Department of Biomedicine and Prevention, Università degli studi di Roma Tor Vergata, Rome, Italy
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7
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Girolamini L, Pascale MR, Salaris S, Mazzotta M, Orsini M, Grottola A, Zini N, Cristino S. Legionella bononiensis sp. nov., isolated from a hotel water distribution system in northern Italy. Int J Syst Evol Microbiol 2022; 72. [PMID: 36173731 DOI: 10.1099/ijsem.0.005512] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Legionella-like isolates, strains 27fs60, 30fs61 and 30cs62T, were isolated from a hotel water distribution system in the Emilia-Romagna region, Italy. Isolates were Gram- and Ziehl Neelsen-stain-negative, rod-shaped, with transitory flagella presence and able to grow at 32-37 °C (with an optimum at 32 °C) on buffered charcoal-yeast extract agar with l-cysteine, glycine-vancomycin-polymyxin B-cycloheximide agar and Wadowsky-Yee medium agar. The strains showed positive reactions for oxidase, hippurate and gelatinase and a weakly positive reaction for catalase. Based on the EUCAST cut-off, strain 30cs62T was resistant to ciprofloxacin (5 mg l-1). The mip and rpoB gene sequences of the three strains showed close matches to those of Legionella quateirensis ATCC 49507T with similarity values of 98.2 and 94.5 %, respectively. Whole genome sequencing of the three strains was performed, resulting in G+C contents of 39.0, 39.1 and 39.0 mol%, respectively. The identity percentage measured by average nucleotide identity between the three strains and their respective closest strains were: 91.32 % L. quateirensis NCTC 12376T, 91.45 % L. quateirensis ATCC 49507T and 91.45 % L. quateirensis ATCC 49507T, respectively. The digital DNA-DNA hybridization analysis demonstrated how the isolates were separated from the most related phylogenetic Legionella species (L. quateirensis ATCC 49507T, ≤40.10 % DNA-DNA relatedness). The concatenated phylogenetic tree based on 16S rRNA, mip, rpoB and rnpB genes, shows a close relationship with L. quateirensis ATCC 49507T. The results obtained confirm the status of an independent species. The name proposed for this species is Legionella bononiensis sp. nov. with 30cs62T (=ATCC TSD-262T=DSM 112526T) as the type strain.
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Affiliation(s)
- Luna Girolamini
- Department of Biological, Geological and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna (BO), Italy.,European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Maria Rosaria Pascale
- Department of Biological, Geological and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna (BO), Italy
| | - Silvano Salaris
- Department of Biological, Geological and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna (BO), Italy
| | - Marta Mazzotta
- Department of Biological, Geological and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna (BO), Italy
| | - Massimiliano Orsini
- Laboratory of Microbial Ecology and Genomics of Microorganisms, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Antonella Grottola
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland.,Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Unit of Molecular Virology and Microbiology, Modena University Hospital, Modena, Italy
| | - Nicoletta Zini
- CNR-National Research Council of Italy, Institute of Molecular Genetics "Luigi Luca Cavalli-Sforza", Unit of Bologna, via di Barbiano 1/10, 40136, Bologna, Italy.,IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, Bologna, Italy
| | - Sandra Cristino
- Department of Biological, Geological and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna (BO), Italy.,European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
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8
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Girolamini L, Pascale MR, Mazzotta M, Spiteri S, Marino F, Salaris S, Grottola A, Orsini M, Cristino S. Combining Traditional and Molecular Techniques Supports the Discovery of a Novel Legionella Species During Environmental Surveillance in a Healthcare Facility. Front Microbiol 2022; 13:900936. [PMID: 35770167 PMCID: PMC9234573 DOI: 10.3389/fmicb.2022.900936] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/21/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022] Open
Abstract
Legionella surveillance plays a significant role not only to prevent the risk of infection but also to study the ecology of isolates, their characteristics, and how their prevalence changes in the environment. The difficulty in Legionella isolation, identification, and typing results in a low notification rate; therefore, human infection is still underestimated. In addition, during Legionella surveillance, the special attention given to Legionella pneumophila leads to an underestimation of the prevalence and risk of infection for other species. This study describes the workflow performed during environmental Legionella surveillance that resulted in the isolation of two strains, named 8cVS16 and 9fVS26, associated with the genus Legionella. Traditional and novel approaches such as standard culture technique, MALDI-TOF MS, gene sequencing, and whole-genome sequencing (WGS) analysis were combined to demonstrate that isolates belong to a novel species. The strain characteristics, the differences between macrophage infectivity potential (mip), RNA polymerase β subunit (rpoB), and reference gene sequences, the average nucleotide identity (ANI) of 90.4%, and the DNA–DNA digital hybridization (dDDH) analysis of 43% demonstrate that these isolates belong to a new Legionella species. The finding suggests that, during the culture technique, special attention should be paid to the characteristics of the isolates that are less associated with the Legionella genus in order to investigate the differences found using more sensitive methods. The characterization of the two newly discovered isolates based on morphological, biochemical, and microscopic characteristics is currently underway and will be described in another future study.
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Affiliation(s)
- Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- Department of Civil, Chemical, Environmental, and Materials Engineering, University of Bologna, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Simona Spiteri
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Federica Marino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Silvano Salaris
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Antonella Grottola
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
- Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Molecular Microbiology and Virology Unit, University Hospital-Policlinico Modena, Modena, Italy
| | - Massimiliano Orsini
- Laboratory of Microbial Ecology and Genomics of Microorganisms, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
- *Correspondence: Sandra Cristino
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9
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Scaturro M, Girolamini L, Pascale MR, Mazzotta M, Marino F, Errico G, Monaco M, Girolamo A, Rota MC, Ricci ML, Cristino S. Case Report: First Report of Fatal Legionella pneumophila and Klebsiella pneumoniae Coinfection in a Kidney Transplant Recipient. Front Med (Lausanne) 2022; 9:912649. [PMID: 35770012 PMCID: PMC9234666 DOI: 10.3389/fmed.2022.912649] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/04/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
A very rare case of pulmonary Klebsiella pneumoniae-Legionella pneumophila coinfection in a double kidney transplanted man affected by the chronic renal disease is described. Cases of Legionnaires' disease with an incubation period of 14 days have rarely been documented. Despite the long period of hospitalization, typing of clinical and environmental L. pneumophila strains demonstrated that the patient's home water distribution system was the source of infection, highlighting that Legionella house contamination can be a hidden risk, especially for immune-compromised people.
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Affiliation(s)
- Maria Scaturro
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Luna Girolamini
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Federica Marino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Giulia Errico
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Monica Monaco
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Antonietta Girolamo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Cristina Rota
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Luisa Ricci
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Sandra Cristino
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- *Correspondence: Sandra Cristino
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10
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Buzzatti E, Paterno G, Palmieri R, Esposito F, Pascale MR, Mallegni F, Guarnera L, Pasqualone G, Irno Consalvo MA, Fraboni D, Moretti F, Savi A, Borsellino B, Maurillo L, Buccisano F, Sconocchia G, Venditti A, Del Principe MI. Occult central nervous system involvement guides therapeutic choices in blastic plasmacytoid dendritic cell neoplasms. Leuk Lymphoma 2022; 63:1754-1757. [DOI: 10.1080/10428194.2022.2042687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Elisa Buzzatti
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Giovangiacinto Paterno
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Raffaele Palmieri
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Fabiana Esposito
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Maria Rosaria Pascale
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Flavia Mallegni
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Luca Guarnera
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Gianmario Pasqualone
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Maria Antonietta Irno Consalvo
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Daniela Fraboni
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Federico Moretti
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Arianna Savi
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | | | - Francesco Buccisano
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Giuseppe Sconocchia
- Laboratory of Tumor Immunology and Immunotherapy, Institute of Translation Pharmacology, Department of Medicine, National Research Council of Italy (CNR), Rome, Italy
| | - Adriano Venditti
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Maria Ilaria Del Principe
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- Fondazione Policlinico Tor Vergata, Rome, Italy
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11
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Pascale MR, Bisognin F, Mazzotta M, Girolamini L, Marino F, Dal Monte P, Cordovana M, Scaturro M, Ricci ML, Cristino S. Use of Fourier-Transform Infrared Spectroscopy With IR Biotyper® System for Legionella pneumophila Serogroups Identification. Front Microbiol 2022; 13:866426. [PMID: 35558114 PMCID: PMC9090449 DOI: 10.3389/fmicb.2022.866426] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/11/2022] [Indexed: 01/09/2023] Open
Abstract
Legionella spp. are Gram-negative bacteria that inhabit freshwater environments representing a serious risk for human health. Legionella pneumophila (Lp) is the species most frequently responsible for a severe pneumonia known as Legionnaires' disease. Lp consists of 15 serogroups (Sgs), usually identified by monoclonal or polyclonal antibodies. With regard to Lp serogrouping, it is well known that phenotyping methods do not have a sufficiently high discriminating power, while genotypic methods although very effective, are expensive and laborious. Recently, mass spectrometry and infrared spectroscopy have proved to be rapid and successful approaches for the microbial identification and typing. Different biomolecules (e.g., lipopolysaccharides) adsorb infrared radiation originating from a specific microbial fingerprint. The development of a classification system based on the intra-species identification features allows a rapid and reliable typing of strains for diagnostic and epidemiological purposes. The aim of the study was the evaluation of Fourier Transform Infrared Spectroscopy using the IR Biotyper® system (Bruker Daltonik, Germany) for the identification of Lp at the serogroup (Sg) level for diagnostic purposes as well as in outbreak events. A large dataset of Lp isolates (n = 133) and ATCC reference strains representing the 15 Lp serogroups were included. The discriminatory power of the instrument's classifier, was tested by Principal Component Analysis (PCA) and Linear Discriminant Analysis (LDA). All isolates were classified as follows: 12/133 (9.0%) as Lp Sg1 and 115/133 (86.5%) as Lp Sg 2-15 (including both ATCC and environmental Lp serogroup). Moreover, a mis-classification for 2/133 (1.5%) isolates of Lp Sg 2-15 that returned as Lp Sg1 was observed, and 4/133 (3.0%) isolates were not classified. An accuracy of 95.49% and an error rate of 4.51% were calculated. IR Biotyper® is able provide a quick and cost-effective reliable Lp classification with advantages compared with agglutination tests that show ambiguous and unspecific results. Further studies including a larger number of isolates could be useful to implement the classifier obtaining a robust and reliable tool for the routine Lp serogrouping. IR Biotyper® could be a powerful and easy-to-use tool to identify Lp Sgs, especially during cluster/outbreak investigations, to trace the source of the infection and promptly adopt preventive and control strategies.
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Affiliation(s)
- Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Francesco Bisognin
- Microbiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, IRCCS S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Federica Marino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Paola Dal Monte
- Microbiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, IRCCS S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Maria Scaturro
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Luisa Ricci
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
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12
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Girolamini L, Salaris S, Pascale MR, Mazzotta M, Cristino S. Dynamics of Legionella Community Interactions in Response to Temperature and Disinfection Treatment: 7 Years of Investigation. Microb Ecol 2022; 83:353-362. [PMID: 34091718 PMCID: PMC8891097 DOI: 10.1007/s00248-021-01778-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/17/2021] [Indexed: 05/12/2023]
Abstract
In man-made water distribution systems, Legionella community interactions remain unknown, due to their ability to change from sessile to planktonic states or live in viable but non-culturable forms, in response to anthropic and environmental stress. During 7 years of hospital Legionella surveillance, in 191 hot water positive samples, the interactions among the Legionella species, temperature, and disinfection treatment were evaluated. Legionella was isolated following ISO 11731:2017, and identification was performed by mip gene sequencing and sequence-based typing (SBT) for L. anisa or L. rubrilucens and L. pneumophila, respectively. The species with the higher frequency of isolation was L. pneumophila serogroup 1 (78.53%; 4865.36 ± 25,479.11 cfu/L), followed by L. anisa (54.45%; 558.79 ± 2637.41 cfu/L) and L. rubrilucens (21.99%; 307.73 ± 1574.95 cfu/L), which were sometimes present together. Spearman's rho correlation test was conducted among the species with respect to temperature and disinfectant (H2O2/Ag+). The results showed a generally positive interaction among these species sharing the same environment, except for competition between L. anisa and L. rubrilucens. High temperature (48.83 ± 2.59 °C) and disinfection treatment (11.58 ± 4.99 mg/L) affected the presence of these species. An exception was observed with L. anisa, which showed disinfection treatment resistance. For the purposes of environmental surveillance, it is fundamental to better understand the interactions and dynamic of the Legionella community in man-made water systems in order to choose the proper physical or chemical treatments. The simultaneous presence of different Legionella species could result in an increased resistance to high temperature and disinfectant treatment, leading to changes in contamination level and species diversity.
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Affiliation(s)
- Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, BO Italy
| | - Silvano Salaris
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, BO Italy
| | - Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, BO Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, BO Italy
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, BO Italy
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13
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Pascale MR, Salaris S, Mazzotta M, Girolamini L, Fregni Serpini G, Manni L, Grottola A, Cristino S. New Insight regarding Legionella Non- Pneumophila Species Identification: Comparison between the Traditional mip Gene Classification Scheme and a Newly Proposed Scheme Targeting the rpoB Gene. Microbiol Spectr 2021; 9:e0116121. [PMID: 34908503 PMCID: PMC8672888 DOI: 10.1128/spectrum.01161-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/05/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
The identification of Legionella non-pneumophila species (non-Lp) in clinical and environmental samples is based on the mip gene, although several studies suggest its limitations and the need to expand the classification scheme to include other genes. In this study, the development of a new classification scheme targeting the rpoB gene is proposed to obtain a more reliable identification of 135 Legionella environmental isolates. All isolates were sequenced for the mip and rpoB genes, and the results were compared to study the discriminatory power of the proposed rpoB scheme. Complete concordance between the mip and rpoB results based on genomic percent identity was found for 121/135 (89.6%) isolates; in contrast, discordance was found for 14/135 (10.4%) isolates. Additionally, due to the lack of reference values for the rpoB gene, inter- and intraspecies variation intervals were calculated based on a pairwise identity matrix that was built using the entire rpoB gene (∼4,107 bp) and a partial region (329 bp) to better evaluate the genomic identity obtained. The interspecies variation interval found here (4.9% to 26.7%) was then proposed as a useful sequence-based classification scheme for the identification of unknown non-Lp isolates. The results suggest that using both the mip and rpoB genes makes it possible to correctly discriminate between several species, allowing possible new species to be identified, as confirmed by preliminary whole-genome sequencing analyses performed on our isolates. Therefore, starting from a valid and reliable identification approach, the simultaneous use of mip and rpoB associated with other genes, as it occurs with the sequence-based typing (SBT) scheme developed for Legionella pneumophila, could support the development of multilocus sequence typing to improve the knowledge and discovery of Legionella species subtypes. IMPORTANCELegionella spp. are a widely spread bacteria that cause a fatal form of pneumonia. While traditional laboratory techniques have provided valuable systems for Legionella pneumophila identification, the amplification of the mip gene has been recognized as the only useful tool for Legionella non-pneumophila species identification both in clinical and environmental samples. Several studies focused on the mip gene classification scheme showed its limitations and the need to improve the classification scheme, including other genes. Our study provides significant advantages on Legionella identification, providing a reproducible new rpoB gene classification scheme that seems to be more accurate than mip gene sequencing, bringing out greater genetic variation on Legionella species. In addition, the combined use of both the mip and rpoB genes allowed us to identify presumed new Legionella species, improving epidemiological investigations and acquiring new understanding on Legionella fields.
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Affiliation(s)
- Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Silvano Salaris
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Giulia Fregni Serpini
- Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Molecular Microbiology and Virology Unit, University Hospital-Policlinico Modena, Modena, Italy
| | - Laura Manni
- Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Molecular Microbiology and Virology Unit, University Hospital-Policlinico Modena, Modena, Italy
| | - Antonella Grottola
- Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Molecular Microbiology and Virology Unit, University Hospital-Policlinico Modena, Modena, Italy
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
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14
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Mazzotta M, Salaris S, Pascale MR, Girolamini L, Cristino S. Occurrence of Legionella spp. in Man-Made Water Sources: Isolates Distribution and Phylogenetic Characterization in the Emilia-Romagna Region. Pathogens 2021; 10:552. [PMID: 34063633 PMCID: PMC8147600 DOI: 10.3390/pathogens10050552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/13/2021] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 11/16/2022] Open
Abstract
Legionella species distribution in the Emilia-Romagna region, involving hospital (H) and community (C) environments, was conducted. Legionella culture, agglutination test, and mip-gene sequencing were applied on 240 isolates. The analysis showed a higher prevalence of non-Legionellapneumophila (n-Lp) species (84.1%) compared with L. pneumophila (Lp) (15.9%), with a higher frequency of n-Lp with respect to Lp species in both environments (77.6% and 96.4%, in H and C, respectively). The Shannon index showed a significant difference in Legionella distribution (p = 0.00017), with a significant abundance of Lp in the H compared with C environment (p = 0.00028). The continuous disinfection treatment in H could contribute to adaptive survival of the Lp species. Phylogenetic analysis revealed a conservative clade distribution between H and C: L. feeleii clade with three subclades in C and the Lp clade with five subclades in H and two in C, respectively. Our findings suggest the importance of Legionella surveillance both in H and C, with a focus on n-Lp species less connected to human disease. The Legionella prevalence and diversity found here indicate that geographical and temporal isolate evolution should be considered during surveillance, particularly in the light of global warming and changes in population risk factors.
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Affiliation(s)
| | | | | | | | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy; (M.M.); (S.S.); (M.R.P.); (L.G.)
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15
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Pascale MR, Mazzotta M, Salaris S, Girolamini L, Grottola A, Simone ML, Cordovana M, Bisognin F, Dal Monte P, Bucci Sabattini MA, Viggiani M, Cristino S. Evaluation of MALDI-TOF Mass Spectrometry in Diagnostic and Environmental Surveillance of Legionella Species: A Comparison With Culture and Mip-Gene Sequencing Technique. Front Microbiol 2021; 11:589369. [PMID: 33384668 PMCID: PMC7771186 DOI: 10.3389/fmicb.2020.589369] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/19/2020] [Indexed: 12/19/2022] Open
Abstract
Legionella spp. are widespread bacteria in aquatic environments with a growing impact on human health. Between the 61 species, Legionella pneumophila is the most prevalent in human diseases; on the contrary, Legionella non-pneumophila species are less detected in clinical diagnosis or during environmental surveillance due to their slow growth in culture and the absence of specific and rapid diagnostic/analytical tools. Reliable and rapid isolate identification is essential to estimate the source of infection, to undertake containment measures, and to determine clinical treatment. Matrix-assisted laser desorption ionization–time-of-flight mass spectrometry (MALDI–TOF MS), since its introduction into the routine diagnostics of laboratories, represents a widely accepted method for the identification of different bacteria species, described in a few studies on the Legionella clinical and environmental surveillance. The focus of this study was the improvement of MALDI–TOF MS on Legionella non-pneumophila species collected during Legionella nosocomial and community surveillance. Comparative analysis with cultural and mip-gene sequencing results was performed. Moreover, a phylogenetic analysis was carried out to estimate the correlations amongst isolates. MALDI–TOF MS achieved correct species-level identification for 45.0% of the isolates belonging to the Legionella anisa, Legionella rubrilucens, Legionella feeleii, and Legionella jordanis species, displaying a high concordance with the mip-gene sequencing results. In contrast, less reliable identification was found for the remaining 55.0% of the isolates, corresponding to the samples belonging to species not yet included in the database. The phylogenetic analysis showed relevant differences inside the species, regruped in three main clades; among the Legionella anisa clade, a subclade with a divergence of 3.3% from the main clade was observed. Moreover, one isolate, identified as Legionella quinlivanii, displayed a divergence of 3.8% from the corresponding reference strain. However, these findings require supplementary investigation. The results encourage the implementation of MALDI–TOF MS in routine diagnostics and environmental Legionella surveillance, as it displays a reliable and faster identification at the species level, as well as the potential to identify species that are not yet included in the database. Moreover, phylogenetic analysis is a relevant approach to correlate the isolates and to track their spread, especially in unconventional reservoirs, where Legionella prevention is still underestimated.
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Affiliation(s)
- Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Silvano Salaris
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Antonella Grottola
- Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Unit of Microbiology and Virology, Modena University Hospital, Modena, Italy
| | - Maria Luisa Simone
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Miriam Cordovana
- Microbiology Unit-Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesco Bisognin
- Microbiology Unit-Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Paola Dal Monte
- Microbiology Unit-Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | | | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
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Mazzotta M, Girolamini L, Pascale MR, Lizzadro J, Salaris S, Dormi A, Cristino S. The Role of Sensor-Activated Faucets in Surgical Handwashing Environment as a Reservoir of Legionella. Pathogens 2020; 9:pathogens9060446. [PMID: 32516992 PMCID: PMC7350366 DOI: 10.3390/pathogens9060446] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/21/2020] [Accepted: 06/03/2020] [Indexed: 12/18/2022] Open
Abstract
Surgical handwashing is a mandatory practice to protect both surgeons and patients in order to control Healthcare-Associated Infections (HAIs). The study is focused on Legionella and Pseudomonas aeruginosa contamination in Surgical Handwashing Outlets (SHWOs) provided by sensor-activated faucets with Thermostatic Mixer Valves (TMVs), as correlated to temperature, technologies, and disinfection used. Samples were analyzed by standard culture techniques, comparing hot- and cold-water samples. Legionella isolates were typed by an agglutination test and by mip sequencing. Legionella contamination showed the same distribution between hot and cold samples concerning positive samples and mean concentration: 44.5% and 1.94 Log10 cfu/L vs. 42.6% and 1.81 Log10 cfu/L, respectively. Regarding the distribution of isolates (Legionella pneumophila vs. Legionella non-pneumophila species), significant differences were found between hot- and cold-positive samples. The contamination found in relation to ranges of temperature showed the main positive samples (47.1%) between 45.1-49.6 °C, corresponding to high Legionella concentrations (2.17 Log10 cfu/L). In contrast, an increase of temperature (>49.6 °C) led to a decrease in positive samples (23.2%) and mean concentration (1.64 Log10 cfu/L). A low level of Pseudomonas aeruginosa was found. For SHWOs located in critical areas, lack of consideration of technologies used and uncorrected disinfection protocols may lead to the development of a high-risk environment for both patients and surgeons.
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Affiliation(s)
- Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy; (M.M.); (L.G.); (M.R.P.); (J.L.); (S.S.)
| | - Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy; (M.M.); (L.G.); (M.R.P.); (J.L.); (S.S.)
| | - Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy; (M.M.); (L.G.); (M.R.P.); (J.L.); (S.S.)
| | - Jessica Lizzadro
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy; (M.M.); (L.G.); (M.R.P.); (J.L.); (S.S.)
| | - Silvano Salaris
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy; (M.M.); (L.G.); (M.R.P.); (J.L.); (S.S.)
| | - Ada Dormi
- Department of Medical and Surgical Science, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy;
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy; (M.M.); (L.G.); (M.R.P.); (J.L.); (S.S.)
- Correspondence: ; Tel.: +39-051-209-4811; Fax: +39-051-209-4829
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17
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Zezza F, Kerner J, Pascale MR, Giannini R, Martelli EA. Rapid determination of amino acids by high-performance liquid chromatography: release of amino acids by perfused rat liver. J Chromatogr A 1992; 593:99-101. [PMID: 1639918 DOI: 10.1016/0021-9673(92)80273-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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
Perfused rat liver can be considered as one of the most suitable ex vivo models for studies of liver metabolism. To assess the possible effect of L-carnitine and some of its acyl esters on proteolysis in the rat liver, the amino acid derivatization and high-performance liquid chromatographic separation of Tapuhi et al. [Anal. Biochem., 115 (1981) 123] was modified.
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Affiliation(s)
- F Zezza
- Department of Biochemistry, Research and Development, Sigma-tau SpA, Rome, Italy
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