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Agbontaen KO, Somasundram K, Baker M. Critical COVID-19 in a 24-week pregnant woman with 32 days of invasive mechanical ventilation before delivery of fetus: a case of successful collaborative multidisciplinary care. BMJ Case Rep 2021; 14:14/9/e243516. [PMID: 34497055 PMCID: PMC8438726 DOI: 10.1136/bcr-2021-243516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We describe the successful treatment of a 24-week pregnant, 44-year-old woman with COVID-19. Management of this complex case required multidisciplinary collaboration and included prolonged invasive mechanical ventilation and prone positioning. Caesarean section delivery was delayed for 32 days, with no monitored fetal compromise, while stabilising the mother. To our knowledge, this is the longest reported duration of invasive ventilation while pregnant in a patient with COVID-19. COVID-19 has been shown to cause increased disease severity in pregnant women, and certain pregnancy-related physiological adaptations that occur could help explain this association. While COVID-19 has been shown to cause no increased adverse neonatal outcomes, clinicians should be aware that data show increased preterm birth in symptomatic pregnant women, thereby increasing the chance of prematurity-related complications. Further research on COVID-19 in pregnancy is crucial to facilitate better management, and full inclusion of pregnant women in therapeutic clinical trials will help achieve this.
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Affiliation(s)
| | - Khevan Somasundram
- Intensive Care Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Matthew Baker
- Intensive Care Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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2
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Jaeger N, McDonough RT, Rosen AL, Hernandez-Leyva A, Wilson NG, Lint MA, Russler-Germain EV, Chai JN, Bacharier LB, Hsieh CS, Kau AL. Airway Microbiota-Host Interactions Regulate Secretory Leukocyte Protease Inhibitor Levels and Influence Allergic Airway Inflammation. Cell Rep 2021; 33:108331. [PMID: 33147448 PMCID: PMC7685510 DOI: 10.1016/j.celrep.2020.108331] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 08/22/2020] [Accepted: 10/08/2020] [Indexed: 01/04/2023] Open
Abstract
Homeostatic mucosal immune responses are fine-tuned by naturally evolved interactions with native microbes, and integrating these relationships into experimental models can provide new insights into human diseases. Here, we leverage a murine-adapted airway microbe, Bordetella pseudohinzii (Bph), to investigate how chronic colonization impacts mucosal immunity and the development of allergic airway inflammation (AAI). Colonization with Bph induces the differentiation of interleukin-17A (IL-17A)-secreting T-helper cells that aid in controlling bacterial abundance. Bph colonization protects from AAI and is associated with increased production of secretory leukocyte protease inhibitor (SLPI), an antimicrobial peptide with anti-inflammatory properties. These findings are additionally supported by clinical data showing that higher levels of upper respiratory SLPI correlate both with greater asthma control and the presence of Haemophilus, a bacterial genus associated with AAI. We propose that SLPI could be used as a biomarker of beneficial host-commensal relationships in the airway. Asthma is known to be modified by airway microbes. Jaeger et al. use a murine-adapted bacterium to show that airway colonization evokes a Th17 response associated with increased SLPI, an antimicrobial peptide, and protection from lung inflammation. In people, SLPI was correlated with airway microbiota composition.
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Affiliation(s)
- Natalia Jaeger
- Division of Allergy and Immunology, Department of Medicine and Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ryan T McDonough
- Division of Allergy and Immunology, Department of Medicine and Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Anne L Rosen
- Division of Allergy and Immunology, Department of Medicine and Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ariel Hernandez-Leyva
- Division of Allergy and Immunology, Department of Medicine and Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Naomi G Wilson
- Division of Allergy and Immunology, Department of Medicine and Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michael A Lint
- Division of Allergy and Immunology, Department of Medicine and Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Emilie V Russler-Germain
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jiani N Chai
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Leonard B Bacharier
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Chyi-Song Hsieh
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Andrew L Kau
- Division of Allergy and Immunology, Department of Medicine and Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Basharat U, Aiche MM, Kim MM, Sohal M, Chang EH. Are rhinoviruses implicated in the pathogenesis of sinusitis and chronic rhinosinusitis exacerbations? A comprehensive review. Int Forum Allergy Rhinol 2019; 9:1159-1188. [DOI: 10.1002/alr.22403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/16/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Usmaan Basharat
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Arizona College of Medicine Tucson AZ
| | - Mazen M. Aiche
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Arizona College of Medicine Tucson AZ
| | - Marianne M. Kim
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Arizona College of Medicine Tucson AZ
| | - Maheep Sohal
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Arizona College of Medicine Tucson AZ
| | - Eugene H. Chang
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Arizona College of Medicine Tucson AZ
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Mazel-Sanchez B, Yildiz S, Schmolke M. Ménage à trois: Virus, Host, and Microbiota in Experimental Infection Models. Trends Microbiol 2019; 27:440-452. [PMID: 30638775 DOI: 10.1016/j.tim.2018.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/29/2018] [Accepted: 12/13/2018] [Indexed: 12/22/2022]
Abstract
Infections of mammals with pathogenic viruses occur mostly in the polymicrobial environment of mucosal surfaces or the skin. In recent years our understanding of immune modulation by the commensal microbiota has increased dramatically. The microbiota is today accepted as the prime educator and maintainer of innate and adaptive immune functions. It became further apparent that some viral pathogens profit from the presence of commensal bacteria and their metabolites, especially in the intestinal tract. We further learned that the composition and abundance of the microbiota can change as a consequence of acute and chronic viral infections. Here we discuss recent developments in our understanding of the triangular relationship of virus, host, and microbiota under experimental infection settings.
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Affiliation(s)
- Beryl Mazel-Sanchez
- Department of Microbiology and Molecular Medicine, University of Geneva, Switzerland
| | - Soner Yildiz
- Department of Microbiology and Molecular Medicine, University of Geneva, Switzerland
| | - Mirco Schmolke
- Department of Microbiology and Molecular Medicine, University of Geneva, Switzerland.
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Bacterial and Viral Etiology of Acute Respiratory Illness among Children from two Different Geographical Localities of Odisha, 2015-2016. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2018. [DOI: 10.22207/jpam.12.2.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Barenkamp SJ, Chonmaitree T, Hakansson AP, Heikkinen T, King S, Nokso-Koivisto J, Novotny LA, Patel JA, Pettigrew M, Swords WE. Panel 4: Report of the Microbiology Panel. Otolaryngol Head Neck Surg 2017; 156:S51-S62. [PMID: 28372529 DOI: 10.1177/0194599816639028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective To perform a comprehensive review of the literature from July 2011 until June 2015 on the virology and bacteriology of otitis media in children. Data Sources PubMed database of the National Library of Medicine. Review Methods Two subpanels comprising experts in the virology and bacteriology of otitis media were created. Each panel reviewed the relevant literature in the fields of virology and bacteriology and generated draft reviews. These initial reviews were distributed to all panel members prior to meeting together at the Post-symposium Research Conference of the 18th International Symposium on Recent Advances in Otitis Media, National Harbor, Maryland, in June 2015. A final draft was created, circulated, and approved by all panel members. Conclusions Excellent progress has been made in the past 4 years in advancing our understanding of the microbiology of otitis media. Numerous advances were made in basic laboratory studies, in animal models of otitis media, in better understanding the epidemiology of disease, and in clinical practice. Implications for Practice (1) Many viruses cause acute otitis media without bacterial coinfection, and such cases do not require antibiotic treatment. (2) When respiratory syncytial virus, metapneumovirus, and influenza virus peak in the community, practitioners can expect to see an increase in clinical otitis media cases. (3) Biomarkers that predict which children with upper respiratory tract infections will develop otitis media may be available in the future. (4) Compounds that target newly identified bacterial virulence determinants may be available as future treatment options for children with otitis media.
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Affiliation(s)
- Stephen J Barenkamp
- 1 Department of Pediatrics, St Louis University School of Medicine, St Louis, Missouri, USA
| | - Tasnee Chonmaitree
- 2 Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Terho Heikkinen
- 4 Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Samantha King
- 5 The Research Institute at Nationwide Children's Hospital and Ohio State University, Columbus, Ohio, USA
| | - Johanna Nokso-Koivisto
- 6 Department of Otorhinolaryngology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura A Novotny
- 5 The Research Institute at Nationwide Children's Hospital and Ohio State University, Columbus, Ohio, USA
| | - Janak A Patel
- 2 Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, USA
| | - Melinda Pettigrew
- 7 Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - W Edward Swords
- 8 Department of Microbiology and Immunology, Wake Forest University, Winston-Salem, North Carolina, USA
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Okuma Y, Okamoto Y, Yonekura S, Iinuma T, Sakurai T, Hamasaki S, Ohki Y, Yamamoto H, Sakurai D. Persistent nasal symptoms and mediator release after continuous pollen exposure in an environmental challenge chamber. Ann Allergy Asthma Immunol 2016; 117:150-7. [PMID: 27263086 DOI: 10.1016/j.anai.2016.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/15/2016] [Accepted: 05/17/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Immediate- and late-phase reactions are associated with nasal symptoms of patients with allergic rhinitis. OBJECTIVE To examine the symptoms and mediators released after continuous allergen exposure in an environmental challenge chamber (ECC). METHODS Fifteen patients with Japanese cedar pollinosis were enrolled in this study and continuously exposed to cedar pollen at a concentration of 8,000 grains/m(3) for 3 hours in an ECC. Nasal function tests were performed, and nasal secretions were collected before pollen exposure (0 hour), immediately after exiting the ECC (3 hours), and 6 hours after exiting the ECC (9 hours). Symptom scores were recorded every 30 minutes in the ECC and every 3 hours after exiting the ECC. The frequency of sneezing and nose blowing also was monitored. RESULTS The severity of symptoms in the ECC peaked approximately 2 hours after the beginning of pollen exposure and continued more than 6 hours after leaving the ECC. Concentrations of histamine, tryptase, interleukins 5, 3, 33, and 31, and substance P increased over time, whereas that of nasal fractional exhaled nitric oxide decreased. CONCLUSION Various mediators are released during continuous allergen exposure, which subsequently induce persistent nasal symptoms. Effective treatment is required to control the intense inflammation observed after allergen exposure.
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Affiliation(s)
- Yusuke Okuma
- Department of Otolaryngology, Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshitaka Okamoto
- Department of Otolaryngology, Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Syuji Yonekura
- Department of Otolaryngology, Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomohisa Iinuma
- Department of Otolaryngology, Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Toshioki Sakurai
- Department of Head and Neck Surgery, Chiba Cancer Center, Chiba, Japan
| | - Sawako Hamasaki
- Department of Otolaryngology, Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ohki
- Department of Otolaryngology, Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | - Daiju Sakurai
- Department of Otolaryngology, Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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8
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Eccles R, Winther B, Johnston SL, Robinson P, Trampisch M, Koelsch S. Efficacy and safety of iota-carrageenan nasal spray versus placebo in early treatment of the common cold in adults: the ICICC trial. Respir Res 2015; 16:121. [PMID: 26438038 PMCID: PMC4595062 DOI: 10.1186/s12931-015-0281-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/18/2015] [Indexed: 12/03/2022] Open
Abstract
Abstract Iota-carrageenan (I-C) is active against respiratory viruses in vitro and was effective as nasal spray in three previous clinical trials. The current trial served to further investigate I-C in patients with early common cold symptoms. Methods This randomized, placebo-controlled, double-blind phase IV trial was conducted in 200 adult patients with self-diagnosed colds of <48 h’ duration that were confirmed by baseline cold symptom scores. Patients were to self-administer 0.12 % I-C or placebo spray (NaCl 0.5 %) four times daily for four to ten days and record symptom information for ten days. Common respiratory viruses were quantified by RT-PCR during pretreatment and on Day 3 or 4. The primary endpoint was the mean total symptom score (TSS) of eight cold symptoms on Days 2–4 (TSS2–4). Results Patients in both treatment groups had similar baseline TSSs (mean TSS: 6.75 for I-C and 6.79 for placebo). Viruses were detected in baseline samples from 53 of 98 I-C patients (54.1 %) and 54 of 97 placebo patients (55.7 %). Mean ± SE for TSS2–4 was 5.78 ± 0.25 for I-C patients and 6.39 ± 0.25 for placebo (p = 0.0895). Exploratory analyses after unblinding (TSS2–4 excluding a patient with aberrantly high symptom scores [TSS2–4, ex 1pt]; mean of TSS over Days 1–4 [TSS1–4]; change in TSS1–4 relative to baseline [TSS1–4, rel]) demonstrated treatment differences in favor of I-C (p = 0.0364, p = 0.0495 and p = 0.0421, respectively). For patients with quantifiable rhinovirus/enterovirus at baseline, there was a trend towards greater reduction of virus load at Day 3 or 4 (p = 0.0958; I-C: 90.2 % reduction in viral load; placebo: 72.0 %). Treatments were well tolerated with no differences in adverse event rates. Conclusions The primary endpoint did not demonstrate a statistically significant difference between I-C and placebo but showed a trend towards I-C benefit. Exploratory analyses indicated significant reduction of cold symptoms in the I-C group relative to placebo during the first four days when symptoms were most severe, and also substantiated I-C’s activity against rhinovirus/enterovirus. Trial registration NCT01944631 (clinicaltrials.gov)
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Affiliation(s)
- R Eccles
- Common Cold Centre, Cardiff School of Biosciences, Cardiff University, Cardiff, UK
| | - B Winther
- Respiratory Disease Study Center, University of Virginia, Charlottesville, VA, USA
| | - S L Johnston
- Airway Disease Infection Section & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, National Heart and Lung Institute, Imperial College, London, UK
| | - P Robinson
- Boehringer Ingelheim Pharmaceuticals Inc., Therapeutic Area Virology, Ridgefield, CT, USA
| | - M Trampisch
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biometrics & Data Management, Ingelheim/Rhein, 55216, Germany
| | - S Koelsch
- Boehringer Ingelheim Pharma GmbH & Co. KG, CHC Development, Medicine & Regulatory Affairs, Ingelheim/Rhein, 55216, Germany.
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9
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Jacobs J. Editorial: allergy and immunology. Int Forum Allergy Rhinol 2014; 3:689-90. [PMID: 24078290 DOI: 10.1002/alr.21225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Vissers M, de Groot R, Ferwerda G. Severe viral respiratory infections: are bugs bugging? Mucosal Immunol 2014; 7:227-38. [PMID: 24220300 DOI: 10.1038/mi.2013.93] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 10/09/2013] [Indexed: 02/07/2023]
Abstract
Viral respiratory tract infections (RTI) pose a high burden on the youngest members of our society. Several risk factors are known for severe viral respiratory disease. However, a large proportion of the severe RTI cannot be explained by these risk factors. A growing body of evidence shows that the composition of the microbiota has a major influence on the training of both the mucosal and the systemic immune response and can thus potentially determine susceptibility for severe viral infections. In this review, we discuss the current evidence regarding the influence of bacterial colonization on the severity of viral respiratory infections.
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Affiliation(s)
- M Vissers
- 1] Department of Pediatrics, Laboratory of Pediatric Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands [2] Nijmegen Institute for Infection, Inflammation and Immunity, Radboud university medical center, Nijmegen, The Netherlands
| | - R de Groot
- 1] Department of Pediatrics, Laboratory of Pediatric Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands [2] Nijmegen Institute for Infection, Inflammation and Immunity, Radboud university medical center, Nijmegen, The Netherlands
| | - G Ferwerda
- 1] Department of Pediatrics, Laboratory of Pediatric Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands [2] Nijmegen Institute for Infection, Inflammation and Immunity, Radboud university medical center, Nijmegen, The Netherlands
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Allen EK, Koeppel AF, Hendley JO, Turner SD, Winther B, Sale MM. Characterization of the nasopharyngeal microbiota in health and during rhinovirus challenge. MICROBIOME 2014; 2:22. [PMID: 25028608 PMCID: PMC4098959 DOI: 10.1186/2049-2618-2-22] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 05/28/2014] [Indexed: 05/05/2023]
Abstract
BACKGROUND The bacterial communities of the nasopharynx play an important role in upper respiratory tract infections (URTIs). Our study represents the first survey of the nasopharynx during a known, controlled viral challenge. We aimed to gain a better understanding of the composition and dynamics of the nasopharyngeal microbiome during viral infection. METHODS Rhinovirus illnesses were induced by self-inoculation using the finger to nose or eye natural transmission route in ten otherwise healthy young adults. Nasal lavage fluid samples (NLF) samples were collected at specific time points before, during, and following experimental rhinovirus inoculation. Bacterial DNA from each sample (N = 97 from 10 subjects) was subjected to 16S rRNA sequencing by amplifying the V1-V2 hypervariable region followed by sequencing using the 454-FLX platform. RESULTS This survey of the nasopharyngeal microbiota revealed a highly complex microbial ecosystem. Taxonomic composition varied widely between subjects and between time points of the same subject. We also observed significantly higher diversity in not infected individuals compared to infected individuals. Two genera - Neisseria and Propionibacterium - differed significantly between infected and not infected individuals. Certain phyla, including Firmicutes, Actinobacteria, and Proteobacteria, were detected in all samples. CONCLUSIONS Our results reveal the complex and diverse nature of the nasopharyngeal microbiota in both healthy and viral-challenged adults. Although some phyla were common to all samples, differences in levels of diversity and selected phyla were detected between infected and uninfected participants. Deeper, species-level metagenomic sequencing in a larger sample is warranted.
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Affiliation(s)
- E Kaitlynn Allen
- Center for Public Health Genomics, University of Virginia, PO Box 800717, Charlottesville, USA
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, USA
| | - Alex F Koeppel
- Bioinformatics Core Facility, University of Virginia, Charlottesville, USA
| | - J Owen Hendley
- Department of Pediatrics, University of Virginia, Charlottesville, USA
| | - Stephen D Turner
- Bioinformatics Core Facility, University of Virginia, Charlottesville, USA
| | - Birgit Winther
- Department of Otolaryngology, University of Virginia, Charlottesville, USA
| | - Michèle M Sale
- Center for Public Health Genomics, University of Virginia, PO Box 800717, Charlottesville, USA
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, USA
- Department of Medicine, University of Virginia, Charlottesville, USA
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12
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Obasi CN, Barrett B, Brown R, Vrtis R, Barlow S, Muller D, Gern J. Detection of viral and bacterial pathogens in acute respiratory infections. J Infect 2013; 68:125-30. [PMID: 24211414 PMCID: PMC3947238 DOI: 10.1016/j.jinf.2013.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/28/2013] [Accepted: 10/31/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The role of bacteria in acute respiratory illnesses (ARI) of adults and interactions with viral infections is incompletely understood. This study tested the hypothesis that bacterial co-infection during ARI adds to airway inflammation and illness severity. METHODS Two groups of 97 specimens each were randomly selected from multiplex-PCR identified virus-positive and virus-negative nasal specimens obtained from adults with new onset ARI, and 40 control specimens were collected from healthy adults. All specimens were analyzed for Haemophilus influenzae(HI), Moraxella catarrhalis(MC) and Streptococcus pneumoniae(SP) by quantitative-PCR. General linear models tested for relationships between respiratory pathogens, biomarkers (nasal wash neutrophils and CXCL8), and ARI-severity. RESULTS Nasal specimens from adults with ARIs were more likely to contain bacteria (37% overall; HI = 28%, MC = 14%, SP = 7%) compared to specimens from healthy adults (5% overall; HI = 0%, MC = 2.5%, SP = 2.5%; p < 0.001). Among ARI specimens, bacteria were more likely to be detected among virus-negative specimens compared to virus-positive specimens (46% vs. 27%; p = 0.0046). The presence of bacteria was significantly associated with increased CXCL8 and neutrophils, but not increased symptoms. CONCLUSION Pathogenic bacteria were more often detected in virus-negative ARI, and also associated with increased inflammatory biomarkers. These findings suggest the possibility that bacteria may augment virus-induced ARI and contribute to airway inflammation.
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Affiliation(s)
- Chidi N Obasi
- Department of Family Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, 1100 Delaplaine Ct., Madison, WI 53715, USA.
| | - Bruce Barrett
- Department of Family Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, 1100 Delaplaine Ct., Madison, WI 53715, USA
| | - Roger Brown
- Schools of Nursing, Medicine and Public Health, Research Design & Statistics Unit, University of Wisconsin-Madison, USA
| | - Rose Vrtis
- School of Medicine, Departments of Pediatrics and Medicine, University of Wisconsin-Madison, USA
| | - Shari Barlow
- Department of Family Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, 1100 Delaplaine Ct., Madison, WI 53715, USA
| | - Daniel Muller
- Department of Medicine - Rheumatology, University of Wisconsin-Madison, School of Medicine and Public Health, USA
| | - James Gern
- School of Medicine, Departments of Pediatrics and Medicine, University of Wisconsin-Madison, USA
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