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Mitra S, Bhagwan J, William A, Siddiqui O, Saxena S. Paeniclostridium sordellii causing liver abscess: A rare case report in India. Indian J Med Microbiol 2024; 49:100595. [PMID: 38641008 DOI: 10.1016/j.ijmmb.2024.100595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 04/21/2024]
Abstract
Paeniclostridium sordellii, an anaerobic bacterium, causes hepatic infections in alcoholics and post-surgery (liver transplantation). While liver and brain abscesses are rare, drainage procedures and targeted antibiotic therapy assisted by early microbiological diagnosis have reduced mortality rates. We report a rare case of pyogenic liver abscess caused by Paeniclostridium sordellii in India, the early diagnosis of which has led to life saving outcome for the patient. Hence, the microbiological diagnosis and comprehensive medical-surgical treatment are vital for preventing mortality in Paeniclostridium sordellii infections.
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Affiliation(s)
- Srestha Mitra
- Department of Microbiology, Maulana Azad Medical College, Delhi, India.
| | - Jai Bhagwan
- Department of Microbiology, Maulana Azad Medical College, Delhi, India.
| | - Ashish William
- Department of Microbiology, Maulana Azad Medical College, Delhi, India.
| | - Oves Siddiqui
- Department of Microbiology, Maulana Azad Medical College, Delhi, India.
| | - Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India.
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2
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Zhou R, He L, Zhang J, Zhang X, Li Y, Zhan X, Tao L. Molecular basis of TMPRSS2 recognition by Paeniclostridium sordellii hemorrhagic toxin. Nat Commun 2024; 15:1976. [PMID: 38438396 PMCID: PMC10912200 DOI: 10.1038/s41467-024-46394-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 02/26/2024] [Indexed: 03/06/2024] Open
Abstract
Hemorrhagic toxin (TcsH) is a major virulence factor produced by Paeniclostridium sordellii, which is a non-negligible threat to women undergoing childbirth or abortions. Recently, Transmembrane Serine Protease 2 (TMPRSS2) was identified as a host receptor of TcsH. Here, we show the cryo-EM structures of the TcsH-TMPRSS2 complex and uncover that TcsH binds to the serine protease domain (SPD) of TMPRSS2 through the CROP unit-VI. This receptor binding mode is unique among LCTs. Five top surface loops of TMPRSS2SPD, which also determine the protease substrate specificity, constitute the structural determinants recognized by TcsH. The binding of TcsH inhibits the proteolytic activity of TMPRSS2, whereas its implication in disease manifestations remains unclear. We further show that mutations selectively disrupting TMPRSS2-binding reduce TcsH toxicity in the intestinal epithelium of the female mice. These findings together shed light on the distinct molecular basis of TcsH-TMPRSS2 interactions, which expands our knowledge of host recognition mechanisms employed by LCTs and provides novel targets for developing therapeutics against P. sordellii infections.
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Affiliation(s)
- Ruoyu Zhou
- College of Life Sciences, Fudan University, Shanghai, 200433, China
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, 310024, China
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, 310024, China
- Westlake Institute for Advanced Study, Hangzhou, 310024, China
| | - Liuqing He
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, 310024, China
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, 310024, China
- Westlake Institute for Advanced Study, Hangzhou, 310024, China
- Research Center for Industries of the Future, Westlake University, Hangzhou, 310024, China
| | - Jiahao Zhang
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, 310024, China
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, 310024, China
- Westlake Institute for Advanced Study, Hangzhou, 310024, China
| | - Xiaofeng Zhang
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, 310024, China
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, 310024, China
- Westlake Institute for Advanced Study, Hangzhou, 310024, China
| | - Yanyan Li
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, 310024, China
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, 310024, China
- Westlake Institute for Advanced Study, Hangzhou, 310024, China
| | - Xiechao Zhan
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, 310024, China.
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, 310024, China.
- Westlake Institute for Advanced Study, Hangzhou, 310024, China.
| | - Liang Tao
- College of Life Sciences, Fudan University, Shanghai, 200433, China.
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, 310024, China.
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, 310024, China.
- Westlake Institute for Advanced Study, Hangzhou, 310024, China.
- Research Center for Industries of the Future, Westlake University, Hangzhou, 310024, China.
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3
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Bachmann I, Behrmann O, Klingenberg-Ernst M, Rupnik M, Hufert FT, Dame G, Weidmann M. Rapid Isothermal Detection of Pathogenic Clostridioides difficile Using Recombinase Polymerase Amplification. Anal Chem 2024; 96:3267-3275. [PMID: 38358754 DOI: 10.1021/acs.analchem.3c02985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Nosocomial-associated diarrhea due to Clostridioides difficile infection (CDI) is diagnosed after sample precultivation by the detection of the toxins in enzyme immunoassays or via toxin gene nucleic acid amplification. Rapid and direct diagnosis is important for targeted treatment to prevent severe cases and recurrence. We developed two singleplex and a one-pot duplex fluorescent 15 min isothermal recombinase polymerase amplification (RPA) assays targeting the toxin genes A and B (tcdA and tcdB). Furthermore, we adapted the singleplex RPA to a 3D-printed microreactor device. Analytical sensitivity was determined using a DNA standard and DNA extracts of 20 C. difficile strains with different toxinotypes. Nineteen clostridial and gastrointestinal bacteria strains were used to determine analytical specificity. Adaptation of singleplex assays to duplex assays in a 50 μL volume required optimized primer and probe concentrations. A volume reduction by one-fourth (12.4 μL) was established for the 3D-printed microreactor. Mixing of RPA was confirmed as essential for optimal analytical sensitivity. Detection limits (LOD) ranging from 119 to 1411 DNA molecules detected were similar in the duplex tube format and in the singleplex 3D-printed microreactor format. The duplex RPA allows the simultaneous detection of both toxins important for the timely and reliable diagnosis of CDI. The 3D-printed reaction chamber can be developed into a microfluidic lab-on-a-chip system use at the point of care.
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Affiliation(s)
- Iris Bachmann
- Institute of Microbiology and Virology, Brandenburg Medical School Theodor Fontane, Universitätsplatz 1, 01968 Senftenberg, Germany
| | - Ole Behrmann
- Institute of Microbiology and Virology, Brandenburg Medical School Theodor Fontane, Universitätsplatz 1, 01968 Senftenberg, Germany
| | | | - Maja Rupnik
- Center for Medical Microbiology, Department for Microbiological Research, National Laboratory for Health, Environment and Food, Prvomajska ulica 1, 2000 Maribor, Slovenia
- Faculty of Medicine, Maribor, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia
| | - Frank T Hufert
- Institute of Microbiology and Virology, Brandenburg Medical School Theodor Fontane, Universitätsplatz 1, 01968 Senftenberg, Germany
- Department of Virology, University Medical Center, Kreuzbergring 57, 37075 Göttingen, Germany
- Brandenburg University of Technology Cottbus - Senftenberg, Universitätsplatz 1, 01968 Senftenberg, Germany
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476 Potsdam, Germany
| | - Gregory Dame
- Institute of Microbiology and Virology, Brandenburg Medical School Theodor Fontane, Universitätsplatz 1, 01968 Senftenberg, Germany
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476 Potsdam, Germany
| | - Manfred Weidmann
- Institute of Microbiology and Virology, Brandenburg Medical School Theodor Fontane, Universitätsplatz 1, 01968 Senftenberg, Germany
- Department of Virology, University Medical Center, Kreuzbergring 57, 37075 Göttingen, Germany
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Zhou Y, Zhan X, Luo J, Li D, Zhou R, Zhang J, Pan Z, Zhang Y, Jia T, Zhang X, Li Y, Tao L. Structural dynamics of the CROPs domain control stability and toxicity of Paeniclostridium sordellii lethal toxin. Nat Commun 2023; 14:8426. [PMID: 38114525 PMCID: PMC10730571 DOI: 10.1038/s41467-023-44169-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
Paeniclostridium sordellii lethal toxin (TcsL) is a potent exotoxin that causes lethal toxic shock syndrome associated with fulminant bacterial infections. TcsL belongs to the large clostridial toxin (LCT) family. Here, we report that TcsL with varied lengths of combined repetitive oligopeptides (CROPs) deleted show increased autoproteolysis as well as higher cytotoxicity. We next present cryo-EM structures of full-length TcsL, at neutral (pH 7.4) and acidic (pH 5.0) conditions. The TcsL at neutral pH exhibits in the open conformation, which resembles reported TcdB structures. Low pH induces the conformational change of partial TcsL to the closed form. Two intracellular interfaces are observed in the closed conformation, which possibly locks the cysteine protease domain and hinders the binding of the host receptor. Our findings provide insights into the structure and function of TcsL and reveal mechanisms for CROPs-mediated modulation of autoproteolysis and cytotoxicity, which could be common across the LCT family.
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Affiliation(s)
- Yao Zhou
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, 310024, China
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, 310024, China
- Westlake Institute for Advanced Study, Hangzhou, Zhejiang, 310024, China
- Research Center for Industries of the Future, Westlake University, Hangzhou, Zhejiang, 310024, China
| | - Xiechao Zhan
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, 310024, China.
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, 310024, China.
- Westlake Institute for Advanced Study, Hangzhou, Zhejiang, 310024, China.
| | - Jianhua Luo
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, 310024, China
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, 310024, China
- Westlake Institute for Advanced Study, Hangzhou, Zhejiang, 310024, China
- Research Center for Industries of the Future, Westlake University, Hangzhou, Zhejiang, 310024, China
| | - Diyin Li
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, 310024, China
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, 310024, China
- Westlake Institute for Advanced Study, Hangzhou, Zhejiang, 310024, China
- Research Center for Industries of the Future, Westlake University, Hangzhou, Zhejiang, 310024, China
| | - Ruoyu Zhou
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, 310024, China
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, 310024, China
- Westlake Institute for Advanced Study, Hangzhou, Zhejiang, 310024, China
| | - Jiahao Zhang
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, 310024, China
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, 310024, China
- Westlake Institute for Advanced Study, Hangzhou, Zhejiang, 310024, China
| | - Zhenrui Pan
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, 310024, China
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, 310024, China
- Westlake Institute for Advanced Study, Hangzhou, Zhejiang, 310024, China
| | - Yuanyuan Zhang
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, 310024, China
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, 310024, China
- Westlake Institute for Advanced Study, Hangzhou, Zhejiang, 310024, China
| | - Tianhui Jia
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, 310024, China
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, 310024, China
- Westlake Institute for Advanced Study, Hangzhou, Zhejiang, 310024, China
- Research Center for Industries of the Future, Westlake University, Hangzhou, Zhejiang, 310024, China
| | - Xiaofeng Zhang
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, 310024, China
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, 310024, China
- Westlake Institute for Advanced Study, Hangzhou, Zhejiang, 310024, China
| | - Yanyan Li
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, 310024, China
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, 310024, China
- Westlake Institute for Advanced Study, Hangzhou, Zhejiang, 310024, China
| | - Liang Tao
- Center for Infectious Disease Research, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, 310024, China.
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang, 310024, China.
- Westlake Institute for Advanced Study, Hangzhou, Zhejiang, 310024, China.
- Research Center for Industries of the Future, Westlake University, Hangzhou, Zhejiang, 310024, China.
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5
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Pence S, Joshi R, Shweikeh F, Mouchli M, Shrestha K. Clostridium sordellii: A Cause of Toxic Shock Syndrome After a Breach in the GI Tract. Cureus 2023; 15:e44604. [PMID: 37795073 PMCID: PMC10546950 DOI: 10.7759/cureus.44604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/06/2023] Open
Abstract
Clostridium sordellii is a highly virulent microorganism that causes serious infections, most commonly of the uterus and perineum. It has a high associated mortality rate due to the various toxins that it produces. A review of the literature suggests that knowledge surrounding its proper management is limited. This report describes a case of Clostridium sordellii causing toxic shock syndrome posttranslocation through the GI tract. A 69-year-old man with a past medical history of renal cell carcinoma and small bowl obstruction complicating transverse colostomy presented to the emergency room with back pain and rigors. Vital signs showed that he was in hemodynamic shock, and imaging revealed a left renal mass invading the adjacent splenic flexure of the colon. There was also a significant leukemoid reaction. After receiving a series of antibiotics, blood cultures revealed Clostridium sordellii as the pathogen of interest. As the first report of its kind, we identify a unique presentation of this organism, serving as a primary example of a different setting that clinicians should be aware of while at the same time highlighting a successful course of therapy for this often deadly organism.
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Affiliation(s)
- Sydney Pence
- Internal Medicine, Ohio University Heritage College of Osteopathic Medicine, Warrensville Heights, USA
| | - Rajshri Joshi
- Internal Medicine, Cleveland Clinic Akron General, Akron, USA
| | - Faris Shweikeh
- Internal Medicine, Cleveland Clinic Akron General, Akron, USA
| | - Mohamad Mouchli
- Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
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6
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Milano VR, Cabanilla MG. Under the Skin: A Case Series of Clostridium sordellii Necrotizing Soft Tissue Infections in Patients Who Inject Drugs. Cureus 2023; 15:e43870. [PMID: 37736428 PMCID: PMC10511237 DOI: 10.7759/cureus.43870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Clostridium sordellii has been well-associated as a cause of obstetric infections but is a less commonly recognized organism of necrotizing skin and soft tissue infections (NSTI). C. sordelli infections are rare with only 14 cases reported in the literature to date. These infections are often associated with profound septic shock and the mortality rate remains high. We report four patients who presented with C. sordellii NSTI over a period of two years at an academic medical center. Notably, injection drug use was the main risk factor for infection in these patients. Appropriate management of C. sordellii NSTI necessitates a combination of antibiotics and emergent surgical intervention. However, despite these efforts, the mortality rate remains high, with three of the four patients dying. Clinicians should consider NSTI in the differential diagnosis when evaluating skin and soft tissue infections in people who inject drugs. Furthermore, it is imperative to educate patients who engage in injection drug use on the potential risks associated with NSTI and inform them of warning signs that warrant immediate medical attention. The devastating consequences of C. sordellii-associated NSTI in this vulnerable population can be mitigated by enhancing awareness and facilitating early intervention.
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Affiliation(s)
- Victoria R Milano
- Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, USA
| | - M Gabriela Cabanilla
- Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, USA
- Internal Medicine Division of Infectious Diseases, University of New Mexico Health Sciences Center, Albuquerque, USA
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7
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Winders TM, Holman DB, Schmidt KN, Luecke SM, Smith DJ, Neville BW, Dahlen CR, Swanson KC, Amat S. Feeding hempseed cake alters the bovine gut, respiratory and reproductive microbiota. Sci Rep 2023; 13:8121. [PMID: 37208436 DOI: 10.1038/s41598-023-35241-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/15/2023] [Indexed: 05/21/2023] Open
Abstract
A growing number of studies have investigated the feasibility of utilizing hemp by-products as livestock feedstuffs; however, their impact on livestock microbiomes remains unexplored. Here, we evaluated the effects of feeding hempseed cake on the gastrointestinal, respiratory, and reproductive microbiota in beef heifers. Angus-crossbred heifers (19-months old, initial body weight = 494 ± 10 kg [SE]) were fed a corn-based finishing diet containing 20% hempseed cake as a substitute for 20% corn dried distillers' grains with solubles (DM basis; Control; n = 16/group) for 111 days until slaughter. Ruminal fluid and deep nasopharyngeal swabs (days 0, 7, 42, 70 and 98), and vaginal and uterine swabs (at slaughter) were collected, and the microbiota assessed using 16S rRNA gene sequencing. Diet affected the community structure of the ruminal (d 7-98; 0.06 ≤ R2 ≤ 0.12; P < 0.05), nasopharyngeal (d 98; R2 = 0.18; P < 0.001), and vaginal (R2 = 0.06; P < 0.01) microbiota. Heifers fed hempseed cake had increased microbial diversity in the rumen, reduced microbial richness in the vagina, and greater microbial diversity and richness in the uterus. In addition to the distinct microbial communities in the rumen, nasopharynx, vagina and uterus, we identified 28 core taxa that were shared (≥ 60% of all samples) across these sampling locations. Feeding hempseed cake appeared to alter the bovine gut, respiratory and reproductive microbiota. Our results suggest that future research aiming to evaluate the use of hemp by-products in livestock diet should consider their impact on animal microbiome and microbiome mediated animal health and reproductive efficiency. Our findings also highlight the need for research evaluating the impact of hemp-associated food and personal care products on the human microbiome.
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Affiliation(s)
- Thomas M Winders
- Department of Animal Sciences, North Dakota State University, Fargo, ND, 58108-6050, USA
| | - Devin B Holman
- Lacombe Research and Development Centre, Agriculture and Agri-Food Canada, 6000 C & E Trail, Lacombe, AB, T4L 1W1, Canada
| | - Kaycie N Schmidt
- Department of Microbiological Sciences, North Dakota State University, Fargo, ND, 58108-6050, USA
| | - Sarah M Luecke
- Department of Microbiological Sciences, North Dakota State University, Fargo, ND, 58108-6050, USA
| | - David J Smith
- USDA ARS, Edward T. Schafer Agricultural Research Center, Fargo, ND, 58102, USA
| | - Bryan W Neville
- USDA-ARS, U.S. Meat Animal Research Center, Clay Center, NE, 68933, USA
| | - Carl R Dahlen
- Department of Animal Sciences, North Dakota State University, Fargo, ND, 58108-6050, USA
- Center for Nutrition and Pregnancy, North Dakota State University, Fargo, ND, 58108-6050, USA
| | - Kendall C Swanson
- Department of Animal Sciences, North Dakota State University, Fargo, ND, 58108-6050, USA
| | - Samat Amat
- Department of Microbiological Sciences, North Dakota State University, Fargo, ND, 58108-6050, USA.
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Aronoff DM, Marrazzo JM. Infections caused by Clostridium perfringens and Paeniclostridium sordellii after unsafe abortion. THE LANCET. INFECTIOUS DISEASES 2023; 23:e48-e55. [PMID: 36155670 DOI: 10.1016/s1473-3099(22)00590-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 02/01/2023]
Abstract
After the legalisation of abortion in the USA in 1973, the risk of infectious morbidity and mortality from this procedure notably decreased. With increasingly restrictive legislation targeting access to safe abortion services, reviewing infectious complications of unsafe pregnancy termination is crucial, particularly the diagnosis and management of life-threatening clostridial (and related anaerobic bacterial) infections that can complicate unsafe abortion. This Review deals with two especially devastating infections that are well-documented causes of septic abortion: the anaerobic, spore-forming pathogens Clostridium perfringens and Paeniclostridium sordellii. We seek to familiarise the reader with these bacteria, the clinical syndromes they can cause (with a focus on toxic shock syndrome), and provide a review of diagnosis and treatment options.
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Affiliation(s)
- David M Aronoff
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Jeanne M Marrazzo
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
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Odogwu NM. Role of short interpregnancy interval, birth mode, birth practices, and the postpartum vaginal microbiome in preterm birth. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 4:1082199. [PMID: 36685092 PMCID: PMC9845938 DOI: 10.3389/frph.2022.1082199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023] Open
Abstract
There have been widely documented beneficial role of vaginal Lactobacillus species as an important biomarker for vaginal health and healthy pregnancy progression. When translating this to clinical settings, pregnant women with low proportions of Lactobacillus and commensurately high proportion of rich and highly diverse abnormal microbiota are most likely to encounter negative pregnancy outcome such as preterm birth and postpartum complications. However, multiple literatures have also addressed this notion that the absence of a Lactobacillus-dominated microbiota does not appear to directly imply to a diseased condition and may not be a major determinant of negative obstetric outcome. Caesarian delivery is notably a risk factor for preterm birth and postpartum endometritis, yet recent data shows a trend in the overuse of CS across several populations. Growing evidence suggest the potential role of vaginal/uterine cleaning practice during CS procedures in influencing postpartum infections, however there is a controversy that this practice is associated with increased rates of postpartum endometritis. The preponderance of bacterial vaginosis associated bacteria vagitype at postpartum which persist for a long period of time even after lochia regression in some women may suggest why short interpregnancy interval may pose a potential risk for preterm birth, especially multigravidas. While specifically linking a community of microbes in the female reproductive tract or an exact causative infectious agent to preterm birth and postpartum pathologies remains elusive, clinical attention should also be drawn to the potential contribution of other factors such as short interpregnancy interval, birth mode, birth practices and the postpartum vaginal microbiome in preterm birth which is explicitly described in this narrative review.
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Affiliation(s)
- Nkechi Martina Odogwu
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States,School of Public Health, University of Minnesota, Minneapolis, MN, United States,Correspondence: Nkechi Martina Odogwu ,
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10
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Gonzalez-Astudillo V, Asin-Ros J, Moore J, Uzal FA, Navarro MA. Paeniclostridium sordellii-associated peripartum metritis in goats. Vet Pathol 2023; 60:69-74. [PMID: 36321809 DOI: 10.1177/03009858221133506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Paeniclostridium sordellii is involved in enteric and histotoxic infections in several animal species. In humans, P. sordellii has been linked to gynecological disease, an association not previously investigated in animals. To unveil a potential association of P. sordellii with veterinary reproductive disease, a retrospective search of the database of the California Animal Health and Food Safety Laboratory System (1990-2020) was conducted and identified 9 cases of goats with P. sordellii-associated metritis or endometritis that were confirmed by immunofluorescence antibody test and/or bacterial isolation, and often co-colonized by Escherichia coli. Six of 9 does were also copper deficient. Polymerase chain reaction (PCR) on formalin-fixed, paraffin-embedded uterine tissue identified the sordellilysin gene in all 9 cases, and the lethal toxin gene in 4. Our findings suggest goats could be predisposed to P. sordellii-associated endometritis/metritis and toxemia when co-infected with E. coli. The role of mineral deficiencies influencing vulnerability to puerperal bacterial infections in goats is possible but remains undetermined. To our knowledge, this is the first report documenting the association of P. sordellii with veterinary gynecological disease.
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Affiliation(s)
| | | | - Janet Moore
- University of California, Davis, San Bernardino, CA
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11
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Paeniclostridium sordellii hemorrhagic toxin targets TMPRSS2 to induce colonic epithelial lesions. Nat Commun 2022; 13:4331. [PMID: 35882856 PMCID: PMC9321280 DOI: 10.1038/s41467-022-31994-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/12/2022] [Indexed: 12/21/2022] Open
Abstract
Hemorrhagic toxin (TcsH) is an important exotoxin produced by Paeniclostridium sordellii, but the exact role of TcsH in the pathogenesis remains unclear, partly due to the lack of knowledge of host receptor(s). Here, we carried out two genome-wide CRISPR/Cas9 screens parallelly with TcsH and identified cell surface fucosylation and TMPRSS2 as host factors contributing to the binding and entry of TcsH. Genetic deletion of either fucosylation biosynthesis enzymes or TMPRSS2 in the cells confers resistance to TcsH intoxication. Interestingly, TMPRSS2 and fucosylated glycans can mediate the binding/entry of TcsH independently, thus serving as redundant receptors. Both TMPRSS2 and fucosylation recognize TcsH through its CROPs domain. By using Tmprss2‒/‒ mice, we show that Tmprss2 is important for TcsH-induced systematic toxicity and colonic epithelial lesions. These findings reveal the importance of TMPRSS2 and surface fucosylation in TcsH actions and further provide insights into host recognition mechanisms for large clostridial toxins. Paeniclostridium sordellii is an opportunistic pathogen that can occur and be fatal in women undergoing abortion or childbirth. The pathogenesis of a hemorrhagic toxin, TcsH, produced by this bacteria, remains unknown. Here, authors carry out genome-wide screens to identify pathologically relevant host factors of TcsH.
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12
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Varley CD, Rogers LM, Dixon BR, Bernard SC, Lacy DB, Sulpizio E, Aronoff DM, Townes JM. Persistent bacteremia and psoas abscess caused by a lethal toxin-deficient Paeniclostridiumsordellii. Anaerobe 2022; 75:102520. [PMID: 35085782 PMCID: PMC9197960 DOI: 10.1016/j.anaerobe.2022.102520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 11/18/2022]
Abstract
We present a case of persistent bacteremia and psoas abscess from Paeniclostridium sordellii without severe symptoms or the classically associated toxic shock syndrome. Further laboratory evaluation demonstrated that the Paeniclostridium sordellii isolate lacked the lethal toxin gene and there was no cytotoxicity to exposed Vero cells.
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Affiliation(s)
- Cara D Varley
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, 97239, USA; School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, 97239, USA.
| | - Lisa M Rogers
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Beverly Rea Dixon
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Sarah C Bernard
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, 37232, USA
| | - D Borden Lacy
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, 37232, USA; The Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, 37232, USA
| | - Emilio Sulpizio
- Department of Medicine, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David M Aronoff
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, 37232, USA
| | - John M Townes
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, 97239, USA
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13
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Clostridial Diseases of Horses: A Review. Vaccines (Basel) 2022; 10:vaccines10020318. [PMID: 35214776 PMCID: PMC8876495 DOI: 10.3390/vaccines10020318] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/17/2022] Open
Abstract
The clostridial diseases of horses can be divided into three major groups: enteric/enterotoxic, histotoxic, and neurotoxic. The main enteric/enterotoxic diseases include those produced by Clostridium perfringens type C and Clostridioides difficile, both of which are characterized by enterocolitis. The main histotoxic diseases are gas gangrene, Tyzzer disease, and infectious necrotic hepatitis. Gas gangrene is produced by one or more of the following microorganisms: C. perfringens type A, Clostridium septicum, Paeniclostridium sordellii, and Clostridium novyi type A, and it is characterized by necrotizing cellulitis and/or myositis. Tyzzer disease is produced by Clostridium piliforme and is mainly characterized by multifocal necrotizing hepatitis. Infectious necrotic hepatitis is produced by Clostridium novyi type B and is characterized by focal necrotizing hepatitis. The main neurotoxic clostridial diseases are tetanus and botulism, which are produced by Clostridium tetani and Clostridium botulinum, respectively. Tetanus is characterized by spastic paralysis and botulism by flaccid paralysis. Neither disease present with specific gross or microscopic lesions. The pathogenesis of clostridial diseases involves the production of toxins. Confirming a diagnosis of some of the clostridial diseases of horses is sometimes difficult, mainly because some agents can be present in tissues of normal animals. This paper reviews the main clostridial diseases of horses.
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14
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Carlson AK, Craig LE. Pathology in Practice. J Am Vet Med Assoc 2022; 260:730-732. [PMID: 35143409 DOI: 10.2460/javma.20.09.0546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Prevalence and Antimicrobial Resistance of Paeniclostridium sordellii in Hospital Settings. Antibiotics (Basel) 2021; 11:antibiotics11010038. [PMID: 35052916 PMCID: PMC8772839 DOI: 10.3390/antibiotics11010038] [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] [Received: 12/13/2021] [Revised: 12/27/2021] [Accepted: 12/27/2021] [Indexed: 12/01/2022] Open
Abstract
(1) Background: The purpose of this study was to determine the prevalence of clostridia strains in a hospital environment in Algeria and to evaluate their antimicrobial susceptibility to antibiotics and biocides. (2) Methods: Five hundred surface samples were collected from surfaces in the intensive care unit and surgical wards in the University Hospital of Tlemcen, Algeria. Bacterial identification was carried out using MALDI-TOF-MS, and then the minimum inhibitory concentrations (MICs) of various antimicrobial agents were determined by the E-test method. P. sordellii toxins were searched by enzymatic and PCR assays. Seven products intended for daily disinfection in the hospitals were tested against Clostridium spp. spore collections. (3) Results: Among 100 isolates, 90 P. sordellii were identified, and all strains were devoid of lethal and hemorrhagic toxin genes. Beta-lactam, linezolid, vancomycin, tigecycline, rifampicin, and chloramphenicol all proved effective against isolated strains. Among all strains tested, the spores of P. sordellii exhibited remarkable resistance to the tested biocides compared to other Clostridium species. The (chlorine-based 0.6%, 30 min), (glutaraldehyde solution 2.5%, 30 min), and (hydrogen peroxide/peracetic acid 3%, 15 min) products achieved the required reduction in spores. (4) Conclusions: Our hospital’s current cleaning and disinfection methods need to be optimized to effectively remove spores from caregivers’ hands, equipment, and surfaces.
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16
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Uzal FA, Arroyo LG, Navarro MA, Gomez DE, Asín J, Henderson E. Bacterial and viral enterocolitis in horses: a review. J Vet Diagn Invest 2021; 34:354-375. [PMID: 34763560 DOI: 10.1177/10406387211057469] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Enteritis, colitis, and enterocolitis are considered some of the most common causes of disease and death in horses. Determining the etiology of these conditions is challenging, among other reasons because different causes produce similar clinical signs and lesions, and also because some agents of colitis can be present in the intestine of normal animals. We review here the main bacterial and viral causes of enterocolitis of horses, including Salmonella spp., Clostridium perfringens type A NetF-positive, C. perfringens type C, Clostridioides difficile, Clostridium piliforme, Paeniclostridium sordellii, other clostridia, Rhodococcus equi, Neorickettsia risticii, Lawsonia intracellularis, equine rotavirus, and equine coronavirus. Diarrhea and colic are the hallmark clinical signs of colitis and enterocolitis, and the majority of these conditions are characterized by necrotizing changes in the mucosa of the small intestine, colon, cecum, or in a combination of these organs. The presumptive diagnosis is based on clinical, gross, and microscopic findings, and confirmed by detection of some of the agents and/or their toxins in the intestinal content or feces.
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Affiliation(s)
- Francisco A Uzal
- California Animal Health and Food Safety Laboratory, University of California-Davis, San Bernardino Laboratory, USA
| | - Luis G Arroyo
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Mauricio A Navarro
- California Animal Health and Food Safety Laboratory, University of California-Davis, San Bernardino Laboratory, USA.,Instituto de Patología Animal, Facultad de Ciencias Veterinarias, Universidad Austral de Chile, Valdivia, Chile
| | - Diego E Gomez
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Javier Asín
- California Animal Health and Food Safety Laboratory, University of California-Davis, San Bernardino Laboratory, USA
| | - Eileen Henderson
- California Animal Health and Food Safety Laboratory, University of California-Davis, San Bernardino Laboratory, USA
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17
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French JM, McIndoo ER, Schlund CM, Field KP, Wolfe AR, Stevens DL, Aldape MJ, Hobdey SE. Characterization of Paeniclostridium sordellii Metalloproteinase-1 in vitro and in an experimental model of infection. Anaerobe 2021; 77:102468. [PMID: 34688909 DOI: 10.1016/j.anaerobe.2021.102468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/12/2021] [Accepted: 10/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Paeniclostridium sordellii is a pathogen that causes rapidly fatal infections characterized by severe edema, extreme leukemoid reaction and lack of an innate immune response. We recently identified a metalloproteinase of P. sordellii-1 (Mcs1) that cleaves human vascular cell adhesion molecule 1, an adhesion molecule important to hematopoietic precursor retention and leukocyte diapedesis. In the current study, we further characterize Mcs1 activity and investigate its role in pathogenesis. METHODS Mcs1 peptide cleavage sequence and activity conditions were identified using a semi-quantitative fluorescence-based reporter assay. Additional host targets for Mcs1 protease activity were tested and confirmed by gel electrophoreses and western blots. Finally, Mcs1 knock out (ΔMcs1) and complemented (cMcs1) strains were developed for assessment in our animal model of myonecrosis. RESULTS Data show that Mcs1 prefers aliphatic amino acid residues, I or L, especially when adjacent to negatively charged or noncharged-polar residues. In vitro, Mcs1 cleaved or partially cleaved human cell adhesion molecules, E-selectin and intracellular adhesion molecule-1 (ICAM-1), and mediators of innate immune infection defense, complement protein-3 and antimicrobial peptide LL-37. In vivo, infection with the ΔMcs1 P. sordellii strain had little effect on animal survival, tissue destruction or circulating white blood cell counts compared to wild type and cMcs1 strains. CONCLUSIONS Similar to proteolytic virulence factors from other pathogens, Mcs1 is a promiscuous protease that cleaves multiple human-host factors. Despite minimal impact of Mcs1 on the murine model of P. sordellii infection, it is worth considering its role in humans and other animal models.
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Affiliation(s)
- John M French
- Veterans Affairs Medical Center, Boise, ID, 83702, USA; Idaho Veterans Research and Education Foundation, Boise, ID, 83702, USA
| | - Eric R McIndoo
- Veterans Affairs Medical Center, Boise, ID, 83702, USA; Idaho Veterans Research and Education Foundation, Boise, ID, 83702, USA
| | - Caden M Schlund
- Veterans Affairs Medical Center, Boise, ID, 83702, USA; Idaho Veterans Research and Education Foundation, Boise, ID, 83702, USA
| | - Kevin P Field
- Veterans Affairs Medical Center, Boise, ID, 83702, USA; Idaho Veterans Research and Education Foundation, Boise, ID, 83702, USA
| | - Alison R Wolfe
- Veterans Affairs Medical Center, Boise, ID, 83702, USA; Idaho Veterans Research and Education Foundation, Boise, ID, 83702, USA
| | - Dennis L Stevens
- Veterans Affairs Medical Center, Boise, ID, 83702, USA; Idaho Veterans Research and Education Foundation, Boise, ID, 83702, USA; University of Washington School of Medicine, Seattle, WA, 98195, USA
| | | | - Sarah E Hobdey
- Veterans Affairs Medical Center, Boise, ID, 83702, USA; Idaho Veterans Research and Education Foundation, Boise, ID, 83702, USA; Boise State University, Boise, ID, 83725, USA.
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18
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Li M, Li N. Clostridium perfringens bloodstream infection secondary to acute pancreatitis: A case report. World J Clin Cases 2021; 9:4357-4364. [PMID: 34141801 PMCID: PMC8173429 DOI: 10.12998/wjcc.v9.i17.4357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/06/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Clostridium perfringens (C. perfringens) is an opportunistic pathogen. It can cause infections after birth, after an abortion, and in patients with diabetes, malignancy, liver cirrhosis, or an immunosuppressive state. Here, we report a patient with C. perfringens infection secondary to acute pancreatitis, with no underlying diabetes, malignancy, or liver cirrhosis.
CASE SUMMARY A 62-year-old Han Chinese woman presented to the Tianjin Hospital of ITCWM Nankai Hospital on January 8, 2020 because of epigastric abdominal pain. Laboratory examination showed that urine amylase was 10403 U/L (reference: 47-458), and blood amylase was 1006 U/L (reference: < 100). Abdominal computed tomography showed pancreatic edema and peripancreatic exudation. She was diagnosed with mild acute pancreatitis and treated accordingly. She was readmitted the next day for similar symptoms. Two hours later, she went to the lavatory and urinated, and the urine color was like soy sauce. Oxygen saturation decreased to 77%, and she developed consciousness disturbance. She was admitted to the intensive care unit. After 8 h in the hospital, she had a high fever of 40 ℃, blood was drawn for culture, and 3 g of cefoperazone/sulbactam was administered. After 12 h, she had a cardiac arrest and died shortly. Blood culture confirmed a C. perfringens infection.
CONCLUSION C. perfringens infection may be secondary to acute pancreatitis. Rapid recognition and aggressive early management are critical for the survival of patients with C. perfringens infection.
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Affiliation(s)
- Ming Li
- Department of Hepatopancreatobiliary Surgery, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin 300000, China
| | - Ning Li
- Department of Hepatopancreatobiliary Surgery, Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin 300000, China
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19
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Abstract
Large clostridial toxins (LCTs) are a family of bacterial exotoxins that infiltrate and destroy target cells. Members of the LCT family include Clostridioides difficile toxins TcdA and TcdB, Paeniclostridium sordellii toxins TcsL and TcsH, Clostridium novyi toxin TcnA, and Clostridium perfringens toxin TpeL. Since the 19th century, LCT-secreting bacteria have been isolated from the blood, organs, and wounds of diseased individuals, and LCTs have been implicated as the primary virulence factors in a variety of infections, including C. difficile infection and some cases of wound-associated gas gangrene. Clostridia express and secrete LCTs in response to various physiological signals. LCTs invade host cells by binding specific cell surface receptors, ultimately leading to internalization into acidified vesicles. Acidic pH promotes conformational changes within LCTs, which culminates in translocation of the N-terminal glycosyltransferase and cysteine protease domain across the endosomal membrane and into the cytosol, leading first to cytopathic effects and later to cytotoxic effects. The focus of this review is on the role of LCTs in infection and disease, the mechanism of LCT intoxication, with emphasis on recent structural work and toxin subtyping analysis, and the genomic discovery and characterization of LCT homologues. We provide a comprehensive review of these topics and offer our perspective on emerging questions and future research directions for this enigmatic family of toxins.
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20
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Chaudhry R, Bahadur T, Sagar T, Agrawal SK, Arif N, Choudhary SK, Verma N. Infective Endocarditis Caused by C. sordellii: The First Case Report from India. J Lab Physicians 2021; 13:74-76. [PMID: 34054241 PMCID: PMC8154338 DOI: 10.1055/s-0041-1723750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Clostridium sordellii
is a gram-positive anaerobic bacteria most commonly isolated from skin and soft tissue infection, penetrating injurious and intravenous drug abusers. The exotoxins produced by the bacteria are associated with toxic shock syndrome. We report here a first case of infective endocarditis due to
C. sordellii
from a female patient with ventricular septal defect from India.
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Affiliation(s)
- Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Tej Bahadur
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Tanu Sagar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sonu Kumari Agrawal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nazneen Arif
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv K Choudhary
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nishant Verma
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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21
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Blair D, Piccicacco N. Management and Treatment of Necrotizing Fasciitis. AACN Adv Crit Care 2021; 31:118-125. [PMID: 32525996 DOI: 10.4037/aacnacc2020467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- David Blair
- David Blair is an Emergency Medicine Pharmacy Resident, Department of Pharmacy Services, Tampa General Hospital, 1 Tampa General Circle, Tampa, FL 33606
| | - Nicholas Piccicacco
- Nicholas Piccicacco is Infectious Diseases Pharmacotherapy Specialist, Department of Pharmacy Services, Tampa General Hospital, Tampa, Florida
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22
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Rampelli S, Turroni S, Mallol C, Hernandez C, Galván B, Sistiaga A, Biagi E, Astolfi A, Brigidi P, Benazzi S, Lewis CM, Warinner C, Hofman CA, Schnorr SL, Candela M. Components of a Neanderthal gut microbiome recovered from fecal sediments from El Salt. Commun Biol 2021; 4:169. [PMID: 33547403 PMCID: PMC7864912 DOI: 10.1038/s42003-021-01689-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 01/05/2021] [Indexed: 12/19/2022] Open
Abstract
A comprehensive view of our evolutionary history cannot ignore the ancestral features of our gut microbiota. To provide some glimpse into the past, we searched for human gut microbiome components in ancient DNA from 14 archeological sediments spanning four stratigraphic units of El Salt Middle Paleolithic site (Spain), including layers of unit X, which has yielded well-preserved Neanderthal occupation deposits dating around 50 kya. According to our findings, bacterial genera belonging to families known to be part of the modern human gut microbiome are abundantly represented only across unit X samples, showing that well-known beneficial gut commensals, such as Blautia, Dorea, Roseburia, Ruminococcus, Faecalibacterium and Bifidobacterium already populated the intestinal microbiome of Homo since as far back as the last common ancestor between humans and Neanderthals.
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Affiliation(s)
- Simone Rampelli
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, Bologna, Italy
| | - Silvia Turroni
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, Bologna, Italy
| | - Carolina Mallol
- Department of Geography and History, University of La Laguna, Campus de Guajara, La Laguna, Tenerife, Spain.,Archaeological Micromorphology and Biomarker Research Lab, University of La Laguna, Avenida Astrofísico Francisco Sánchez 2, La Laguna, Tenerife, Spain.,ICArEHB - Interdisciplinary Center for Archaeology and the Evolution of Human Behaviour, Universidade do Algarve, Campus de Gambelas, Edificio 1, Faro, Portugal
| | - Cristo Hernandez
- Department of Geography and History, University of La Laguna, Campus de Guajara, La Laguna, Tenerife, Spain
| | - Bertila Galván
- Department of Geography and History, University of La Laguna, Campus de Guajara, La Laguna, Tenerife, Spain
| | - Ainara Sistiaga
- Earth, Atmospheric and Planetary Sciences Department, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA, USA.,GLOBE Institute, Faculty of Health and Medical Sciences, University of Copenhagen, Oester Voldgade 5-7, Copenhagen, Denmark
| | - Elena Biagi
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, Bologna, Italy
| | - Annalisa Astolfi
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Via Massarenti 11, Bologna, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Via Fossato di Mortara 70, Ferrara, Italy
| | - Patrizia Brigidi
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, Bologna, Italy
| | - Stefano Benazzi
- Department of Cultural Heritage, University of Bologna, Via degli Ariani 1, Ravenna, Italy.,Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, Leipzig, Germany
| | - Cecil M Lewis
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, 101 David L. Boren Blvd, Norman, OK, USA.,Department of Anthropology, University of Oklahoma, 455W Lindsey St, Norman, OK, USA
| | - Christina Warinner
- Department of Anthropology, University of Oklahoma, 455W Lindsey St, Norman, OK, USA.,Department of Archaeogenetics, Max Planck Institute for the Science of Human History, Kahlaische Strasse 10, Jena, Germany
| | - Courtney A Hofman
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, 101 David L. Boren Blvd, Norman, OK, USA.,Department of Anthropology, University of Oklahoma, 455W Lindsey St, Norman, OK, USA
| | - Stephanie L Schnorr
- Konrad Lorenz Institute for Evolution and Cognition Research, Martinstraße 12, Klosterneuburg, Austria. .,Department of Anthropology, University of Nevada, 4505S. Maryland Pkwy, Las Vegas, NV, USA.
| | - Marco Candela
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, Bologna, Italy.
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23
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Abstract
Necrotizing soft tissue infections occur after traumatic injuries, minor skin lesions, nonpenetrating injuries, natural childbirth, and in postsurgical and immunocompromised patients. Infections can be severe, rapidly progressive, and life threatening. Survivors often endure multiple surgeries and prolonged hospitalization and rehabilitation. Despite subtle nuances that may distinguish one entity from another, clinical approaches to diagnosis and treatment are highly similar. This review describes the clinical and laboratory features of necrotizing soft tissue infections and addresses recommended diagnostic and treatment modalities. It discusses the impact of delays in surgical debridement, antibiotic use, and resuscitation on mortality, and summarizes key pathogenic mechanisms.
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Affiliation(s)
- Dennis L Stevens
- Infectious Diseases Center of Biomedical Research Excellence, Veterans Affairs Medical Center, 500 West Fort Street (Mail Stop 151), Boise, ID 83702, USA
| | - Amy E Bryant
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, Idaho State University, 1311 East Central Drive, Meridian, ID 83642, USA.
| | - Ellie Jc Goldstein
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90074, USA; R M Alden Research Laboratory, 2021 Santa Monica Boulevard, Suite #740 East, Santa Monica, CA 90404, USA
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24
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Silva J, Henry R, Strickland M, Wang D, Matsushima K. Rapidly fatal necrotizing soft tissue infection due to Clostridium sordellii in an injection drug user. Am J Emerg Med 2020; 44:480.e1-480.e3. [PMID: 33189511 DOI: 10.1016/j.ajem.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 10/31/2020] [Accepted: 11/01/2020] [Indexed: 11/28/2022] Open
Abstract
Clostridium sordellii infections are known to be associated with high morbidity and mortality. To date, only a small number of cases with necrotizing soft tissue infection due to C. Sordellii have been reported. We report a case presented with necrotizing soft tissue infection of the right upper extremity caused by C. sordellii in a patient with known use of injected heroin. Despite broad spectrum antibiotics and surgical debridement, the patient's clinical course became rapidly fatal, within 24 h of admission. C. sordellii necrotizing soft tissue infections are particularly virulent. Even in the context of appropriate surgical debridement, these infections can be rapidly fatal. This case highlights the importance of high suspicion for C. sordellii as potential pathogen of necrotizing soft tissue infection in injection drug users.
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Affiliation(s)
- Jack Silva
- Department of Surgery, University of Southern California, Los Angeles, CA, United States of America.
| | - Reynold Henry
- Department of Surgery, University of Southern California, Los Angeles, CA, United States of America.
| | - Matthieu Strickland
- Department of Surgery, University of Southern California, Los Angeles, CA, United States of America.
| | - Dandan Wang
- Department of Pathology, University of Southern California, Los Angeles, CA, United States of America.
| | - Kazuhide Matsushima
- Department of Surgery, University of Southern California, Los Angeles, CA, United States of America.
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25
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Videvall E, Song SJ, Bensch HM, Strandh M, Engelbrecht A, Serfontein N, Hellgren O, Olivier A, Cloete S, Knight R, Cornwallis CK. Early-life gut dysbiosis linked to juvenile mortality in ostriches. MICROBIOME 2020; 8:147. [PMID: 33046114 PMCID: PMC7552511 DOI: 10.1186/s40168-020-00925-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/20/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND Imbalances in the gut microbial community (dysbiosis) of vertebrates have been associated with several gastrointestinal and autoimmune diseases. However, it is unclear which taxa are associated with gut dysbiosis, and if particular gut regions or specific time periods during ontogeny are more susceptible. We also know very little of this process in non-model organisms, despite an increasing realization of the general importance of gut microbiota for health. METHODS Here, we examine the changes that occur in the microbiome during dysbiosis in different parts of the gastrointestinal tract in a long-lived bird with high juvenile mortality, the ostrich (Struthio camelus). We evaluated the 16S rRNA gene composition of the ileum, cecum, and colon of 68 individuals that died of suspected enterocolitis during the first 3 months of life (diseased individuals), and of 50 healthy individuals that were euthanized as age-matched controls. We combined these data with longitudinal environmental and fecal sampling to identify potential sources of pathogenic bacteria and to unravel at which stage of development dysbiosis-associated bacteria emerge. RESULTS Diseased individuals had drastically lower microbial alpha diversity and differed substantially in their microbial beta diversity from control individuals in all three regions of the gastrointestinal tract. The clear relationship between low diversity and disease was consistent across all ages in the ileum, but decreased with age in the cecum and colon. Several taxa were associated with mortality (Enterobacteriaceae, Peptostreptococcaceae, Porphyromonadaceae, Clostridium), while others were associated with health (Lachnospiraceae, Ruminococcaceae, Erysipelotrichaceae, Turicibacter, Roseburia). Environmental samples showed no evidence of dysbiosis-associated bacteria being present in either the food, water, or soil substrate. Instead, the repeated fecal sampling showed that pathobionts were already present shortly after hatching and proliferated in individuals with low microbial diversity, resulting in high mortality several weeks later. CONCLUSIONS Identifying the origins of pathobionts in neonates and the factors that subsequently influence the establishment of diverse gut microbiota may be key to understanding dysbiosis and host development. Video Abstract.
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Affiliation(s)
- Elin Videvall
- Department of Biology, Lund University, Lund, Sweden.
- Center for Conservation Genomics, Smithsonian Conservation Biology Institute, Washington, DC, USA.
| | - Se Jin Song
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, USA
| | | | - Maria Strandh
- Department of Biology, Lund University, Lund, Sweden
| | - Anel Engelbrecht
- Western Cape Department of Agriculture, Directorate Animal Sciences, Elsenburg, South Africa
| | - Naomi Serfontein
- Western Cape Agricultural Research Trust, Elsenburg, South Africa
| | - Olof Hellgren
- Department of Biology, Lund University, Lund, Sweden
| | - Adriaan Olivier
- South African Ostrich Business Chamber, Oudtshoorn, South Africa
| | - Schalk Cloete
- Western Cape Department of Agriculture, Directorate Animal Sciences, Elsenburg, South Africa
- Department of Animal Sciences, Stellenbosch University, Matieland, South Africa
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, USA
- Department of Computer Science & Engineering, University of California San Diego, La Jolla, CA, USA
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
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Xu C, Zhong XQ, Li XF, Shi HJ, Liu WB. Regulation of growth, intestinal microflora composition and expression of immune-related genes by dietary supplementation of Streptococcus faecalis in blunt snout bream (Megalobrama amblycephala). FISH & SHELLFISH IMMUNOLOGY 2020; 105:195-202. [PMID: 32652298 DOI: 10.1016/j.fsi.2020.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
A 10-week feeding trial was performed to investigate the effects of Streptococcus faecalis on the growth, intestinal microflora composition and expression of immune-related genes of blunt snout bream (Megalobrama amblycephala). Fish (46.32 ± 0.09 g) were fed four experimental diets containing 0 cfu/g (SF0, control), 1 × 105 cfu/g (SF1), 1 × 106 cfu/g (SF2) and 1 × 107 cfu/g (SF3) of S. faecalis, respectively. Results showed that daily growth index (DGI), feed efficiency ratio (FER), plasma glucose level, plasma contents of total protein and albumin as well as intestinal serous layer (SL), muscular layer (ML), submucous layer (SML), villi thickness (VT) and lamina propria (LP) were all no significant difference among all the treatments, whereas their (except plasma albumin content and intestinal ML) relatively high values were found in the SF2 group. Meanwhile, the intake of the SF2 diets significantly increased plasma globulin content and intestinal digestive enzymes activities, the opposite was true for the activities of plasma aspartate aminotransferase (AST) and alanine transaminase (ALT). In addition, the analysis of the intestinal microbiota showed that fish fed the SF2 diet have the highest values of intestinal alpha diversity and intestinal abundances of Actinobacteria, Chlamydiae, Firmicutes, Planctomycetes, Verrucomicrobia, Clostridium and Synechococcus, while the opposite was true for intestinal abundances of Acinetobacter, Anoxybacillus, Flavobacterium, Planctomyces, Plesiomonas, Pseudomonas, Staphylococcus and Clostridium perfringens. At the molecular level, the expression levels of tumour necrosis factor α (TNF α), interleukin 1β (IL 1β) and heat shock proteins 7 (HSP 70) in head kidney and spleen were all decreased significantly with the increasing S. faecalis levels up to 1 × 106 cfu/g, and then they were increased with further increasing S. faecalis levels. Overall, dietary supplementation of S. faecalis at 1 × 106 cfu/g could improve the intestinal health and innate immunity of blunt snout bream.
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Affiliation(s)
- Chao Xu
- College of Marine Sciences of South China Agricultural University, Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou, 510642, China; Key Laboratory of Aquatic Nutrition and Feed Science of Jiangsu Province, College of Animal Science and Technology, Nanjing Agricultural University, No. 1 Weigang Road, Nanjing, 210095, People's Republic of China
| | - Xiao-Qun Zhong
- Key Laboratory of Aquatic Nutrition and Feed Science of Jiangsu Province, College of Animal Science and Technology, Nanjing Agricultural University, No. 1 Weigang Road, Nanjing, 210095, People's Republic of China
| | - Xiang-Fei Li
- Key Laboratory of Aquatic Nutrition and Feed Science of Jiangsu Province, College of Animal Science and Technology, Nanjing Agricultural University, No. 1 Weigang Road, Nanjing, 210095, People's Republic of China.
| | - Hua-Juan Shi
- Key Laboratory of Aquatic Nutrition and Feed Science of Jiangsu Province, College of Animal Science and Technology, Nanjing Agricultural University, No. 1 Weigang Road, Nanjing, 210095, People's Republic of China
| | - Wen-Bin Liu
- Key Laboratory of Aquatic Nutrition and Feed Science of Jiangsu Province, College of Animal Science and Technology, Nanjing Agricultural University, No. 1 Weigang Road, Nanjing, 210095, People's Republic of China
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Schick L, IJsseldijk LL, Grilo ML, Lakemeyer J, Lehnert K, Wohlsein P, Ewers C, Prenger-Berninghoff E, Baumgärtner W, Gröne A, Kik MJL, Siebert U. Pathological Findings in White-Beaked Dolphins ( Lagenorhynchus albirostris) and Atlantic White-Sided Dolphins ( Lagenorhynchus acutus) From the South-Eastern North Sea. Front Vet Sci 2020; 7:262. [PMID: 32671103 PMCID: PMC7326107 DOI: 10.3389/fvets.2020.00262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/20/2020] [Indexed: 11/13/2022] Open
Abstract
In the North Sea, white-beaked dolphins (Lagenorhynchus albirostris) occur regularly and are the second most common cetacean in the area, while their close relative, the Atlantic white-sided dolphin (Lagenorhynchus acutus), prefers the deeper waters of the northern North Sea and adjacent Atlantic Ocean. Though strandings of both species have occurred regularly in the past three decades, they have decreased in the southern North Sea during the last years. Studies describing necropsy findings in stranded Lagenorhynchus spp. are, to date, still scarce, while information gained through post-mortem examinations may reveal valuable information about underlying causes of this decline, including age structure and the reproduction status. Therefore, we retrospectively assessed and compared the necropsy results from fresh Lagenorhynchus spp. stranded along the southeastern North Sea between 1990 and 2019. A full necropsy was performed on 24 white-beaked dolphins and three Atlantic white-sided dolphins from the German and Dutch coast. Samples of selected organs were taken for histopathological, bacteriological, mycological, parasitological and virological examinations. The most common post-mortem findings were emaciation, gastritis and pneumonia. Gastritis and ulceration of the stomach was often associated with an anisakid nematode infection. Pneumonia was most likely caused by bacterial infections. Encephalitis was observed in three animals and morbillivirus antigen was detected immunohistochemically in one case. Although the animal also showed pneumonic lesions, virus antigen was only found in the brain. Parasitic infections mainly affected the gastro-intestinal tract. Lungworm infections were only detected in two cases and no associations with pathological alterations were observed. Stenurus spp. were identified in two of three cases of parasitic infections of the ears. Twelve of the 26 white-beaked dolphins stranded in Germany were found between 1993 and 1994, but there was no evidence of epizootic disease events or mass strandings during the monitored period.
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Affiliation(s)
- Luca Schick
- Institute for Terrestrial and Aquatic Wildlife Research, University of Veterinary Medicine Hannover, Foundation, Buesum, Germany
| | - Lonneke L IJsseldijk
- Division of Pathology, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Miguel L Grilo
- Institute for Terrestrial and Aquatic Wildlife Research, University of Veterinary Medicine Hannover, Foundation, Buesum, Germany.,CIISA - Centre for Interdisciplinary Research in Animal Health, University of Lisbon, Lisbon, Portugal
| | - Jan Lakemeyer
- Institute for Terrestrial and Aquatic Wildlife Research, University of Veterinary Medicine Hannover, Foundation, Buesum, Germany
| | - Kristina Lehnert
- Institute for Terrestrial and Aquatic Wildlife Research, University of Veterinary Medicine Hannover, Foundation, Buesum, Germany
| | - Peter Wohlsein
- Department of Pathology, University of Veterinary Medicine Hannover, Foundation, Hanover, Germany
| | - Christa Ewers
- Institute of Hygiene and Infectious Diseases of Animals, Justus-Liebig-Universität Giessen, Giessen, Germany
| | - Ellen Prenger-Berninghoff
- Institute of Hygiene and Infectious Diseases of Animals, Justus-Liebig-Universität Giessen, Giessen, Germany
| | - Wolfgang Baumgärtner
- Department of Pathology, University of Veterinary Medicine Hannover, Foundation, Hanover, Germany
| | - Andrea Gröne
- Division of Pathology, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Marja J L Kik
- Division of Pathology, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Ursula Siebert
- Institute for Terrestrial and Aquatic Wildlife Research, University of Veterinary Medicine Hannover, Foundation, Buesum, Germany
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28
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Capewell P, Rupp A, Fuentes M, McDonald M, Weir W. Fatal Clostridium sordellii-mediated hemorrhagic and necrotizing gastroenteropathy in a dog: case report. BMC Vet Res 2020; 16:152. [PMID: 32448314 PMCID: PMC7245850 DOI: 10.1186/s12917-020-02362-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Canine hemorrhagic gastroenteritis (also canine gastrointestinal hemorrhagic syndrome) is commonly associated with Clostridium perfringens, although in some cases the etiology remains unclear. This report describes a fatal acute hemorrhagic and necrotizing gastroenteropathy in a dog associated with Clostridium sordellii, a bacterial species never before identified as the etiological agent of hemorrhagic and necrotizing gastroenteropathy in dogs. CASE PRESENTATION A fully vaccinated, eight-year-old, female neutered Labrador presented with a history of vomiting without diarrhea. Clinical examination revealed pink mucous membranes, adequate hydration, normothermia, and normocardia. The dog was discovered deceased the following day. Post-mortem examination showed moderate amounts of dark red, non-clotted fluid within the stomach that extended into the jejunum. Discoloration was noted in the gastric mucosa, liver, lungs, and kidneys, with small petechial hemorrhages present in the endocardium over the right heart base and thymic remnants. Histological analysis demonstrated that the gastric fundic mucosa, the pyloric region, small intestine, and large intestine exhibited superficial coagulative necrosis and were lined with a layer of short Gram-positive rods. Anaerobic culture of the gastric content revealed C. sordellii as the dominant bacterial species and neither Salmonella spp., Campylobacter spp., C. perfringens, nor C. difficile were isolated. Unexpectedly, whole genome sequencing of the C. sordellii isolate showed that it lacked the main plasmid-encoded virulence factors typical of the species, indicating that the genetic determinants of pathogenicity of this strain must be chromosomally encoded. Further phylogenetic analysis revealed it to be genetically similar to C. sordellii isolates associated with gastroenteric disease in livestock, indicating that the infection may have been acquired from the environment. CONCLUSIONS This case demonstrates that C. sordellii can associate with a canine hemorrhagic and necrotizing gastroenteropathy in the absence of C. perfringens and illustrates the benefits of using bacterial whole genome sequencing to support pathological investigations in veterinary diagnostics. These data also update the molecular phylogeny of C. sordellii, indicating a possible pathogenic clade in the environment that is distinct from currently identified clades.
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Affiliation(s)
- Paul Capewell
- College of Medical, Veterinary and Life Sciences, Institute of Biodiversity Animal Health and Comparative Medicine, University of Glasgow, Urquhart Building, 464 Bearsden Road, Glasgow, G61 1QH, UK.
| | - Angie Rupp
- College of Medical, Veterinary and Life Sciences, Institute of Biodiversity Animal Health and Comparative Medicine, University of Glasgow, Urquhart Building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Manuel Fuentes
- College of Medical, Veterinary and Life Sciences, Institute of Biodiversity Animal Health and Comparative Medicine, University of Glasgow, Urquhart Building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Michael McDonald
- College of Medical, Veterinary and Life Sciences, Institute of Biodiversity Animal Health and Comparative Medicine, University of Glasgow, Urquhart Building, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - William Weir
- College of Medical, Veterinary and Life Sciences, Institute of Biodiversity Animal Health and Comparative Medicine, University of Glasgow, Urquhart Building, 464 Bearsden Road, Glasgow, G61 1QH, UK
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29
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Tian S, Liu Y, Wu H, Liu H, Zeng J, Choi MY, Chen H, Gerhard R, Dong M. Genome-Wide CRISPR Screen Identifies Semaphorin 6A and 6B as Receptors for Paeniclostridium sordellii Toxin TcsL. Cell Host Microbe 2020; 27:782-792.e7. [PMID: 32302524 DOI: 10.1016/j.chom.2020.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/04/2020] [Accepted: 03/11/2020] [Indexed: 01/21/2023]
Abstract
The exotoxin TcsL is a major virulence factor in Paeniclostridium (Clostridium) sordellii and responsible for the high lethality rate associated with P. sordellii infection. Here, we present a genome-wide CRISPR-Cas9-mediated screen using a human lung carcinoma cell line and identify semaphorin (SEMA) 6A and 6B as receptors for TcsL. Disrupting SEMA6A/6B expression in several distinct human cell lines and primary human endothelial cells results in reduced TcsL sensitivity, while SEMA6A/6B over-expression increases their sensitivity. TcsL recognizes the extracellular domain (ECD) of SEMA6A/6B via a region homologous to the receptor-binding site in Clostridioides difficile toxin B (TcdB), which binds the human receptor Frizzled. Exchanging the receptor-binding interfaces between TcsL and TcdB switches their receptor-binding specificity. Finally, administration of SEMA6A-ECD proteins protects human cells from TcsL toxicity and reduces TcsL-induced damage to lung tissues and the lethality rate in mice. These findings establish SEMA6A and 6B as pathophysiologically relevant receptors for TcsL.
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Affiliation(s)
- Songhai Tian
- Department of Urology, Boston Children's Hospital, Boston, MA 02115, USA; Department of Surgery and Department of Microbiology, Harvard Medical School, Boston, MA 02115, USA
| | - Yang Liu
- Department of Urology, Boston Children's Hospital, Boston, MA 02115, USA; Department of Surgery and Department of Microbiology, Harvard Medical School, Boston, MA 02115, USA; Department of Nephrology, The First Hospital of Jilin University, Changchun 130012, China
| | - Hao Wu
- The Vascular Biology Program, Department of Surgery, Boston Children's Hospital and Harvard Medical School, MA 02115, USA
| | - Hao Liu
- Department of Urology, Boston Children's Hospital, Boston, MA 02115, USA; Department of Surgery and Department of Microbiology, Harvard Medical School, Boston, MA 02115, USA
| | - Ji Zeng
- Department of Urology, Boston Children's Hospital, Boston, MA 02115, USA; Department of Surgery and Department of Microbiology, Harvard Medical School, Boston, MA 02115, USA
| | - Mei Yuk Choi
- Division of Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Hong Chen
- The Vascular Biology Program, Department of Surgery, Boston Children's Hospital and Harvard Medical School, MA 02115, USA
| | - Ralf Gerhard
- Institute of Toxicology, Hannover Medical School, Hannover, 30625, Germany
| | - Min Dong
- Department of Urology, Boston Children's Hospital, Boston, MA 02115, USA; Department of Surgery and Department of Microbiology, Harvard Medical School, Boston, MA 02115, USA.
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30
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Prospective Evaluation of the mariPOC Test for Detection of Clostridioides difficile Glutamate Dehydrogenase and Toxins A/B. J Clin Microbiol 2020; 58:JCM.01872-19. [PMID: 31941691 DOI: 10.1128/jcm.01872-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/18/2019] [Indexed: 11/20/2022] Open
Abstract
The objective of this study was to evaluate a novel automated random-access test, mariPOC CDI (ArcDia Ltd., Finland), for the detection of Clostridioides difficile glutamate dehydrogenase (GDH) and toxins A and B directly from fecal specimens. The mariPOC test was compared with both the GenomEra C. difficile PCR assay (Abacus Diagnostica Oy, Finland) and the TechLab C. diff Quik Chek Complete (Alere Inc.; now Abbot) membrane enzyme immunoassay (MEIA). Culture and the Xpert C. difficile assay (Cepheid Inc., USA) were used to resolve discrepant results. In total, 337 specimens were tested with the mariPOC CDI test and GenomEra PCR. Of these specimens, 157 were also tested with the TechLab MEIA. The sensitivity of the mariPOC test for GDH was slightly lower (95.2%) than that obtained with the TechLab assay (100.0%), but no toxin-positive cases were missed. The sensitivity of the mariPOC test for the detection of toxigenic C. difficile by analyzing toxin expression was better (81.6%) than that of the TechLab assay (71.1%). The analytical specificities for the mariPOC and the TechLab tests were 98.3% and 100.0% for GDH and 100.0% and 99.2% for toxin A/B, respectively. The analytical specificity of the GenomEra method was 100.0%. The mariPOC and TechLab GDH tests and GenomEra PCR had high negative predictive values of 99.3%, 98.3%, and 99.7%, respectively, in excluding infection with toxigenic C. difficile The mariPOC toxin A/B test and GenomEra PCR had an identical analytical positive predictive value of 100%, providing highly reliable information about toxin expression and the presence of toxin genes, respectively.
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31
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Junior CAO, Silva ROS, Lobato FCF, Navarro MA, Uzal FA. Gas gangrene in mammals: a review. J Vet Diagn Invest 2020; 32:175-183. [PMID: 32081096 DOI: 10.1177/1040638720905830] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Gas gangrene is a necrotizing infection of subcutaneous tissue and muscle that affects mainly ruminants and horses, but also other domestic and wild mammals. Clostridium chauvoei, C. septicum, C. novyi type A, C. perfringens type A, and C. sordellii are the etiologic agents of this disease, acting singly or in combination. Although a presumptive diagnosis of gas gangrene can be established based on clinical history, clinical signs, and gross and microscopic changes, identification of the clostridia involved is required for confirmatory diagnosis. Gross and microscopic lesions are, however, highly suggestive of the disease. Although the disease has a worldwide distribution and can cause significant economic losses, the literature is limited mostly to case reports. Thus, we have reviewed the current knowledge of gas gangrene in mammals.
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Affiliation(s)
- Carlos A Oliveira Junior
- Veterinary School, Federal University of Minas Gerais, Brazil (Oliveira Junior, Silva, Lobato).,California Animal Health and Food Safety Laboratory, University of California, Davis, CA (Navarro, Uzal)
| | - Rodrigo O S Silva
- Veterinary School, Federal University of Minas Gerais, Brazil (Oliveira Junior, Silva, Lobato).,California Animal Health and Food Safety Laboratory, University of California, Davis, CA (Navarro, Uzal)
| | - Francisco C F Lobato
- Veterinary School, Federal University of Minas Gerais, Brazil (Oliveira Junior, Silva, Lobato).,California Animal Health and Food Safety Laboratory, University of California, Davis, CA (Navarro, Uzal)
| | - Mauricio A Navarro
- Veterinary School, Federal University of Minas Gerais, Brazil (Oliveira Junior, Silva, Lobato).,California Animal Health and Food Safety Laboratory, University of California, Davis, CA (Navarro, Uzal)
| | - Francisco A Uzal
- Veterinary School, Federal University of Minas Gerais, Brazil (Oliveira Junior, Silva, Lobato).,California Animal Health and Food Safety Laboratory, University of California, Davis, CA (Navarro, Uzal)
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32
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Bravo-Ojeda J, Gomez-Quintero C, Pescador-Vargas L, Suarez-Tirado J. Bacteriemia por Clostridium sordellii en paciente con neoplasia gastrointestinal. Reporte de caso y revisión de literatura. INFECTIO 2020. [DOI: 10.22354/in.v24i2.846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
La bacteriemia por Clostridium sordellii es infrecuente y usualmente se origina a partir de infecciones de etiología generalmente ginecológica y puerperal, con unamortalidad de aproximadamente el 70%. Existen pocas herramientas para el diagnóstico rápido y oportuno, siendo así la experiencia de tratamiento para este germen muy limitada en otros escenarios, lo que probablemente sea la causa de su alta mortalidad. Presentamos una paciente con antecedente de masa abdominal expansiva de larga data, con diagnóstico por histopatología e inmunohistoquimica compatibles con tumor del estroma gastrointestinal (GIST por sus siglas en inglés) y estudios de extensión que confirman compromiso metastásico hepático, en quien se documenta bacteriemia por Clostridium sordellii.
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33
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The C. difficile toxin B membrane translocation machinery is an evolutionarily conserved protein delivery apparatus. Nat Commun 2020; 11:432. [PMID: 31974369 PMCID: PMC6978384 DOI: 10.1038/s41467-020-14306-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/19/2019] [Indexed: 12/13/2022] Open
Abstract
Large Clostridial Toxins (LCTs) are a family of six homologous protein toxins that are implicated in severe disease. LCTs infiltrate host cells using a translocation domain (LCT-T) that contains both cell-surface receptor binding sites and a membrane translocation apparatus. Despite much effort, LCT translocation remains poorly understood. Here we report the identification of 1104 LCT-T homologs, with 769 proteins from bacteria outside of clostridia. Sequences are widely distributed in pathogenic and host-associated species, in a variety of contexts and architectures. Consistent with these homologs being functional toxins, we show that a distant LCT-T homolog from Serratia marcescens acts as a pH-dependent translocase to deliver its effector into host cells. Based on evolutionary footprinting of LCT-T homologs, we further define an evolutionarily conserved translocase region that we show is an autonomous translocase capable of delivering heterologous cargo into host cells. Our work uncovers a broad class of translocating toxins and provides insights into LCT translocation. Large Clostridial toxins infiltrate host cells using a translocation domain (LCT-T). Here, using a genomics-driven approach and functional assays, the authors uncover the presence of distant LCT-T homologs in bacteria outside clostridia and provide evidence for a toxic effector function in the gammaproteobacterium Serratia marcescens.
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Fatal Postpartum Infection. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Sárvári KP, Schoblocher D. The antibiotic susceptibility pattern of gas gangrene-forming Clostridium spp. clinical isolates from South-Eastern Hungary. Infect Dis (Lond) 2019; 52:196-201. [DOI: 10.1080/23744235.2019.1696472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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36
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Srikhanta YN, Hutton ML, Awad MM, Drinkwater N, Singleton J, Day SL, Cunningham BA, McGowan S, Lyras D. Cephamycins inhibit pathogen sporulation and effectively treat recurrent Clostridioides difficile infection. Nat Microbiol 2019; 4:2237-2245. [DOI: 10.1038/s41564-019-0519-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 06/20/2019] [Indexed: 02/06/2023]
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37
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Lueders I, Ludwig C, Kasberg J, Baums CG, Klimke K, Dorner MB, Ströse D, Schmidt V. Unusual Outbreak of Fatal Clostridiosis in a Group of Captive Brown Pelicans ( Pelecanus occidentalis). J Avian Med Surg 2019; 31:359-363. [PMID: 29327957 DOI: 10.1647/2016-237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fatal clostridial infections and clostridial toxicoses are common in birds. Most fatalities are associated with toxin production and progress rapidly, often within 24 hours of infection. We describe an unusual and protracted course of disease in 6 captive brown pelicans ( Pelecanus occidentalis), which was believed to result from toxicosis by toxovar A produced by a mixed infection with Clostridium sordellii and Clostridium perfringens. Although the first death in the group occurred 3 days after signs of illness were documented, the remaining birds died over a 38-day period despite aggressive antibiotic and supportive therapy. Although the birds presented with classic signs of botulism, Clostridium botulinum was not identified in any tissues or environmental samples. Postmortem findings in all pelicans included extensive subacute myonecrosis, enteritis, and nonsuppurative hepatitis. Alpha-toxins and sordellilysin genes from C perfringens and C sordelli isolates, respectively, were detected via polymerase chain reaction. The source of the pathogenic bacteria was sediment within a water basin inside the affected birds' enclosure.
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Ferreira MRA, Motta JF, Azevedo ML, Dos Santos LM, Júnior CM, Rodrigues RR, Donassolo RA, Reis ADSB, Barbosa JD, Salvarani FM, Moreira ÂN, Conceição FR. Inactivated recombinant Escherichia coli as a candidate vaccine against Clostridium perfringens alpha toxin in sheep. Anaerobe 2019; 59:163-166. [PMID: 31299397 DOI: 10.1016/j.anaerobe.2019.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/20/2019] [Accepted: 07/04/2019] [Indexed: 10/26/2022]
Abstract
Clostridium perfringens type A is the causative agent of gas gangrene and gastroenteric ("yellow lamb disease") disease in ruminants, with C. perfringens alpha toxin (CPA) being the main virulence factor in the pathogenesis of these illnesses. In the present study, we have developed recombinant Escherichia coli bacteria expressing rCPA and used it to vaccinate rabbits and sheep. Doses of up to 200 μg of rCPA used for inoculation, induced 13.82 IU.mL-1 of neutralizing antitoxin in rabbits, which is three times higher than that recommended by the USDA (4 IU.mL-1). In sheep, recombinant bacteria induced antitoxin titers of 4 IU.mL-1, 56 days after the first dose. rCPA which was expressed, mainly, in inclusion bodies, was not found to influence the immunogenicity of the vaccine. The recombinant Escherichia coli bacterin, produced simply and safely, is capable of affording protection against diseases caused by C. perfringens CPA. The current findings represent a novel production method for CPA vaccines potentially applicable to veterinary medicine.
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Affiliation(s)
- Marcos Roberto A Ferreira
- Centro de Desenvolvimento Tecnológico, Biotecnologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, CEP 96160-000, Brazil.
| | - Jaqueline F Motta
- Centro de Desenvolvimento Tecnológico, Biotecnologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, CEP 96160-000, Brazil
| | - Morgana L Azevedo
- Centro de Desenvolvimento Tecnológico, Biotecnologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, CEP 96160-000, Brazil
| | - Lucas M Dos Santos
- Centro de Desenvolvimento Tecnológico, Biotecnologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, CEP 96160-000, Brazil
| | - Clóvis Moreira Júnior
- Centro de Desenvolvimento Tecnológico, Biotecnologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, CEP 96160-000, Brazil
| | - Rafael R Rodrigues
- Centro de Desenvolvimento Tecnológico, Biotecnologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, CEP 96160-000, Brazil
| | - Rafael A Donassolo
- Centro de Desenvolvimento Tecnológico, Biotecnologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, CEP 96160-000, Brazil
| | | | - José D Barbosa
- Instituto de Medicina Veterinária, Universidade Federal do Pará, Castanhal, Pará, CEP 68740-970, Brazil
| | - Felipe M Salvarani
- Instituto de Medicina Veterinária, Universidade Federal do Pará, Castanhal, Pará, CEP 68740-970, Brazil
| | - Ângela N Moreira
- Centro de Desenvolvimento Tecnológico, Biotecnologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, CEP 96160-000, Brazil
| | - Fabricio R Conceição
- Centro de Desenvolvimento Tecnológico, Biotecnologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, CEP 96160-000, Brazil
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Abstract
ABSTRACT
The clostridia cause a spectrum of diseases in humans and animals ranging from life-threatening tetanus and botulism, uterine infections, histotoxic infections and enteric diseases, including antibiotic-associated diarrhea, and food poisoning. The symptoms of all these diseases are the result of potent protein toxins produced by these organisms. These toxins are diverse, ranging from a multitude of pore-forming toxins to phospholipases, metalloproteases, ADP-ribosyltransferases and large glycosyltransferases. The location of the toxin genes is the unifying theme of this review because with one or two exceptions they are all located on plasmids or on bacteriophage that replicate using a plasmid-like intermediate. Some of these plasmids are distantly related whilst others share little or no similarity. Many of these toxin plasmids have been shown to be conjugative. The mobile nature of these toxin genes gives a ready explanation of how clostridial toxin genes have been so widely disseminated both within the clostridial genera as well as in the wider bacterial community.
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Faure K, Dessein R, Vanderstichele S, Subtil D. Endométrites du post-partum. RPC infections génitales hautes CNGOF et SPILF. ACTA ACUST UNITED AC 2019; 47:442-450. [DOI: 10.1016/j.gofs.2019.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Bajpai V, Govindaswamy A, Agrawal SK, Malhotra R, Mathur P. Clostridium sordelli as a cause of gas gangrene in a trauma patient. J Lab Physicians 2019; 11:94-96. [PMID: 30983811 PMCID: PMC6437822 DOI: 10.4103/jlp.jlp_108_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Gas gangrene is a necrotic infection of the skin and soft tissue that is associated with high mortality and often necessitating amputation to control the infection. Clostridial myonecrosis is most often cause of gas gangrene and usually present in settings of trauma, surgery, malignancy, and other underlying immunocompromised conditions. The most common causative organism of clostridial myonecrosis is Clostridium perfringens followed by Clostridium septicum. Here, we are reporting an unusual case report of posttraumatic gas gangrene caused by Clostridium sordelli.
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Affiliation(s)
- Vijeta Bajpai
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Aishwarya Govindaswamy
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sonu Kumari Agrawal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Purva Mathur
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Clostridium perfringens is an anaerobic Gram-positive bacterium. We present the case of a 75-year-old female presented to the emergency department with progressively worsening acute on chronic left hip pain. It was not until the third day of hospitalization when the initial blood cultures finalized as Clostridium perfringens, antibiotics were changed to piperacillin-tazobactam and clindamycin. Despite the latest measurements, the patient continued getting hypotensive and progressed to multiorgan failure resulting in death by the end of the third day. The recognition of risk factors in addition to gram-positive rod cultures in the setting of septic shock reinforces the importance of appropriate and early empiric antibiotics management and infectious disease consultation to avoid fatal complications.
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Affiliation(s)
- Raynieri Fernandez
- Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, USA
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43
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Vidor CJ, Bulach D, Awad M, Lyras D. Paeniclostridium sordellii and Clostridioides difficile encode similar and clinically relevant tetracycline resistance loci in diverse genomic locations. BMC Microbiol 2019; 19:53. [PMID: 30832583 PMCID: PMC6399922 DOI: 10.1186/s12866-019-1427-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the current rise of antibiotic resistance in bacteria, it is important to monitor the efficacy of antimicrobials in clinical use. Paeniclostridium sordellii (previously Clostridium sordellii) is a bacterial pathogen that causes human uterine infection after spontaneous or medically induced abortion, for which mortality rates approach 100%. Prophylactic antibiotics have been recommended for individuals undergoing medically-induced abortion, one of which is doxycycline, a member of the tetracycline antibiotic family. However, tetracycline resistance had not been well characterized in P. sordellii. This study therefore aimed to determine the levels of tetracycline resistance in P. sordellii isolates, and to identify associated loci and their genomic locations. RESULTS Using a MIC assay, five of 24 P. sordellii isolates were found to be resistant to tetracycline, minocycline, and importantly, doxycycline. Analysis of genome sequence data from 46 isolates found that phenotypically resistant isolates encoded a variant of the Clostridium perfringens tetracycline resistance determinant Tet P. Bioinformatic analysis and comparison of the regions surrounding these determinants found variation in the genomic location of Tet P among P. sordellii isolates. The core genome comparison of the 46 isolates revealed genetic diversity and the absence of dominant genetic types among the isolates. There was no strong association between geographic location of isolation, animal host or Tet P carriage with isolate genetic type. Furthermore, the analysis of the Tet P genotype revealed that Tet P is encoded chromosomally, or on one of two, novel, small plasmids, all consistent with multiple acquisition and recombination events. BLAST analysis of Clostridioides difficile draft genome sequences also identified a Tet P locus, the genomic location of which demonstrated an evolutionary relationship with the P. sordellii locus. CONCLUSIONS The Tet P determinant is found in variable genomic locations within diverse human and animal isolates of P. sordellii and C. difficile, which suggests that it can undergo horizontal transfer, and may disseminate tetracycline resistance between clostridial species. Doxycycline is a suggested prophylactic treatment for P. sordellii infections, however, a small sub-set of the isolates tested are resistant to this antibiotic. Doxycycline may therefore not be an appropriate prophylactic treatment for P. sordellii infections.
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Affiliation(s)
- Callum J Vidor
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, Victoria, Australia
| | - Dieter Bulach
- Melbourne Bioinformatics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Milena Awad
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, Victoria, Australia
| | - Dena Lyras
- Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton, Victoria, Australia.
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Mattson JN, Hardy-Fairbanks AJ. Clostridium sordelli Toxic Shock After Endometrial Ablation: Review of Gynecologic Cases. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2018.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jordan N. Mattson
- Department of Obstetrics and Gynecology, Division of General Obstetrics/Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Abbey J. Hardy-Fairbanks
- Department of Obstetrics and Gynecology, Division of General Obstetrics/Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA
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Abstract
Patients commonly present with unintended pregnancy in the primary care setting, and 1 in 4 women has an abortion in her lifetime. Early abortion services can be safely provided in the primary care setting. Abortion options provided in primary care settings include both medication abortion and early uterine aspiration abortion. Medication abortion, provided up to 10 weeks' gestational age, includes mifepristone (a progestin antagonist) and misoprostol (a prostaglandin). Uterine aspiration can be provided via manual or electronic vacuum in the first trimester.
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Affiliation(s)
- Jennifer R Amico
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, MEB 262, New Brunswick, NJ 08901, USA.
| | - Terri L Cheng
- Department of Family Medicine and Public Health, University of California San Diego, 200 West Arbor Drive #8201A, San Diego, CA 92103, USA
| | - Emily M Godfrey
- Family Medicine, University of Washington, 4311 11th Avenue Northeast, Suite 210, Box 354982, Seattle, WA 98105, USA; Obstetrics and Gynecology, University of Washington, 4311 11th Avenue Northeast, Suite 210, Box 354982, Seattle, WA 98105, USA
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46
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Bhattacharjee D, Sorg JA. Conservation of the "Outside-in" Germination Pathway in Paraclostridium bifermentans. Front Microbiol 2018; 9:2487. [PMID: 30386321 PMCID: PMC6199464 DOI: 10.3389/fmicb.2018.02487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/28/2018] [Indexed: 12/17/2022] Open
Abstract
Clostridium difficile spore germination is initiated in response to certain bile acids and amino acids (e.g., glycine). Though the amino acid-recognizing germinant receptor is unknown, the bile acid germinant receptor is the germination-specific, subtilisin-like pseudoprotease, CspC. In C. difficile the CspB, CspA, and CspC proteins are involved in spore germination. Of these, only CspB is predicted to have catalytic activity because the residues important for catalysis are mutated in the cspA and cspC sequence. The CspB, CspA, and CspC proteins are likely localized to the outer layers of the spore (e.g., the cortex or the coat layers) and not the inner membrane where the Ger-type germinant receptors are located. In C. difficile, germination proceeds in an “outside-in” direction, instead of the “‘inside-out” direction observed during the germination of Bacillus subtilis spores. During C. difficile spore germination, cortex fragments are released prior to the release of 2,4-dipicolinic acid (DPA) from the spore core. This is opposite to what occurs during B. subtilis spore germination. To understand if the mechanism C. difficile spore germination is unique or if spores from other organisms germinate in a similar fashion, we analyzed the germination of Paraclostridium bifermentans spores. We find that P. bifermentans spores release cortex fragments prior to DPA during germination and the DPA release from the P. bifermentans spore core can be blocked by high concentrations of osmolytes. Moreover, we find that P. bifermentans spores do not respond to steroid-like compounds (unlike the related C. difficile and P. sordellii organisms), indicating that the mere presence of the Csp proteins does permit germination in response to steroid compounds. Our findings indicate that the “outside in” mechanism of spore germination observed in C. difficile can be found in other bacteria suggesting that this mechanism is a novel pathway for endospore germination.
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Affiliation(s)
- Disha Bhattacharjee
- Department of Biology, Texas A&M University, College Station, TX, United States
| | - Joseph A Sorg
- Department of Biology, Texas A&M University, College Station, TX, United States
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47
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Abstract
This article covers the diagnosis and treatment of skin and soft tissue infections commonly encountered in the emergency department: impetigo, cutaneous abscesses, purulent cellulitis, nonpurulent cellulitis, and necrotizing skin and soft tissue infections. Most purulent infections in the United States are caused by methicillin-resistant Staphylococcus aureus. For abscesses, we emphasize the importance of incision and drainage. Nonpurulent infections are usually caused by streptococcal species and initial empiric antibiotics need not cover methicillin-resistant Staphylococcus aureus. For uncommon but potentially lethal necrotizing skin and soft tissue infections, the challenge is rapid diagnosis in the emergency department and prompt surgical exploration and debridement.
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48
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Survival from Clostridium toxic shock syndrome: Case report and review of the literature. Int J Surg Case Rep 2018; 50:64-67. [PMID: 30081323 PMCID: PMC6083381 DOI: 10.1016/j.ijscr.2018.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 11/30/2022] Open
Abstract
This case is a rare presentation of C. sordellii toxic shock syndrome resulting from a Caesarian section. This is the only obstetric case of C. sordellii to have survived. Extreme levels of a leukocytosis and hypotension without fevers raises suspiscion for this severe infection. Broad spectrum antibiotics, including coverage for anaerobic organisms, and surgical intervention is the standard of care. At the moment, no early detection or antitoxins are commercially available.
Introduction Clostridial toxic shock is a rare syndrome traditionally described in case studies and reviews as a uniformly fatal condition associated with post-partum and post-abortion. Clostridium sordellii was first mentioned in scientific literature as a human pathogen in 1922 when Argentinian microbiologist Alfredo Sordellii identified the organism in gangrenous wounds. Over the past century, there has been infrequent discussion and little awareness surrounding this serious condition. Information about patients who survived C. sordellii toxic shock is essentially nonexistent. Presentation of case A 31-year old post-partum female who underwent caesarian section 17 days prior, presented with abdominal pain and septic features. She underwent six operations/procedures over the next 17 days and was hospitalized for 25 days before discharge to her home with a successful outcome. Discussion This case provides insight on the process of identifying and managing complications associated with clostridial toxic shock syndrome. Out of now, 16 reported cases of C sordellii gynecologic infections in the world literature, our patient is the second patient to survive infection by this organism. More research is needed to provide clinicians with evidence-based approaches for managing these unique cases. Conclusion We present a case report of a rare toxic shock syndrome in a post-partum female caused by Clostridium sordellii. Her survival is notable among 16 patients with whom this infection now has a documented 87.5% mortality rate. Aggressive surgical measures and optimized intensive care management may have contributed to this patient’s survival.
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Popoff MR. Clostridium difficile and Clostridium sordellii toxins, proinflammatory versus anti-inflammatory response. Toxicon 2018; 149:54-64. [DOI: 10.1016/j.toxicon.2017.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 12/17/2022]
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Gray SFM, Dieudonne BE. Clostridium sordelli causing malignant edema in a trauma patient: a case report and review of literature. Pan Afr Med J 2018; 30:118. [PMID: 30364449 PMCID: PMC6195232 DOI: 10.11604/pamj.2018.30.118.14156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/25/2018] [Indexed: 11/27/2022] Open
Abstract
Clostridium sordelli infection is a rare but potentially lethal infection associated with abortions, injury, contaminated wounds, and illicit drug use. It causes a recognizable syndrome with marked leukocytosis. Rapid diagnosis and aggressive sepsis management is required for optimal outcome. We report a case in a trauma patient with delayed presentation after sustaining facial trauma with soil contamination. The critical care management is summarized and a review of the literature.
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